Auscultations: Heart and Lung Sounds

Question 1

What is the purpose of the diaphragm and bell on a stethoscope?

Answer 1

a) Diaphragm: Identify high-pitched sounds.

b) Bell: Used to identify lower-frequency sounds such as atrial and ventricular gallops.

Question 2

What are the main steps in heart auscultation?

Answer 2

• listen over the 4 designated areas systematically, assess rate, rhythm, and for extra sounds or murmurs.

Question 3

What is the S1 heart sound and what does it signify?

Answer 3

S1 is the ‘lub’ sound, signifying the closure of the mitral and tricuspid valves and the onset of ventricular systole.

Question 4

What is the S2 heart sound and what does it signify?

Answer 4

S2 is the ‘dub’ sound, signifying the closure of the aortic and pulmonary valves and the onset of ventricular diastole.

Question 5

What causes the S1 heart sound?

Answer 5

The closure of the mitral and tricuspid valves.

Question 6

What causes the S2 heart sound?

Answer 6

The closure of the aortic and pulmonary valves.

Question 7

What is the characteristic difference between S1 and S2?

Answer 7

S1 has a lower pitch and longer duration, while S2 has a higher pitch and shorter duration.

Question 8

What is an S3 heart sound?

Answer 8

S3 - An extra heart sound heard during early diastole, associated with increased ventricular compliance (can be normal in children).

Question 9

What is an S4 heart sound?

Answer 9

S4 - An extra heart sound heard before S1, associated with atrial contraction into a stiff ventricle.

Question 10

What conditions are associated with an S4 heart sound?

Answer 10

• hypertension
• hypertrophic heart disease
• pulmonary disease
• myocardial infarction

Question 11

What is a ventricular gallop?

Answer 11

An S3 heart sound, commonly found in ventricular failure.

Question 12

What is an atrial gallop?

Answer 12

An S4 heart sound, associated with a stiff or hypertrophic ventricle.

Question 13

What is a heart murmur?

Answer 13

A longer-duration sound caused by the disruption of blood flow, such as through a stenotic or regurgitant valve.

Question 14

What causes a systolic murmur?

Answer 14

Typically due to ejection or regurgitation between S1 and S2, heard as a ‘swishing’ sound.

Question 15

What causes a diastolic murmur?

Answer 15

Caused by aortic or pulmonary regurgitation or mitral stenosis, heard immediately following S2.

Question 16

What is a mitral valve prolapse?

Answer 16

A condition where the mitral valve does not close properly, causing a clicking sound during systole.

Question 17

What are vesicular breath sounds?

Answer 17

Soft, low-pitched sounds heard during inspiration over distal airways.

Question 18

What are bronchial breath sounds?

Answer 18

Loud, tubular sounds normally heard over the trachea, with a shorter inspiratory phase.

Question 19

What are bronchovesicular breath sounds?

Answer 19

Softer than bronchial sounds, heard over the mainstem bronchi, continuous between inspiration and expiration.

Question 20

What are diminished and absent breath sounds?

Answer 20

a) Diminished breath sounds: Breath sounds that are less intense than expected, often due to conditions like hyperinflation or obesity.

b) Absent breath sounds: No audible breath sounds, often due to lobectomy, morbid obesity, or pneumothorax.

Question 21

What does it mean when bronchial breath sounds are heard outside their normal location?

Answer 21

This indicates consolidation or compression of lung tissue, facilitating sound transmission.

Question 22

What are adventitious breath sounds?

Answer 22

Abnormal sounds such as crackles, wheezes, and pleural friction rubs.

Question 23

What are crackles (rales)?

Answer 23

Discontinuous, high-pitched popping sounds, often associated with fluid or secretions in the lungs.

Question 24

What causes wet crackles?

Answer 24

Conditions like pulmonary edema or pleural effusion, where fluid is present in the lungs.

Question 25

What causes dry crackles?

Answer 25

Caused by the sudden opening of closed airways, seen in atelectasis or pulmonary fibrosis.

Question 26

What are wheezes?

Answer 26

Continuous high- or low-pitched sounds, often heard during exhalation, indicating airway obstruction.

Question 27

What are low-pitched wheezes (rhonchi)?

Answer 27

Low-pitched continuous sounds associated with mucus, common in chronic bronchitis or pneumonia.

Question 28

What is stridor?

Answer 28

A severe, high-pitched wheeze heard in the upper airway, often due to obstruction and considered an emergency.

Question 29

What is pleural friction rub?

Answer 29

A sound resembling two pieces of leather rubbing together, associated with pleural inflammation.

Question 30

What is bronchophony?

Answer 30

Increased vocal resonance with greater clarity and loudness, indicating lung consolidation.

Question 31

What is egophony?

Answer 31

A form of bronchophony where the ‘E’ sound changes to a nasal ‘A’, indicating consolidation.

Question 32

What is whispered pectoriloquy?

Answer 32

Clearer, louder recognition of whispered words, indicating lung consolidation.

Question 33

How do you auscultate the lungs?

Answer 33

Place the diaphragm on the chest wall, start at the apices, compare symmetrical points, and listen to at least one full breath cycle.

Question 34

What precautions should you take when performing lung auscultation?

Answer 34

Prevent patient dizziness, drape appropriately, and ensure deep breaths through the mouth.

Question 35

What are normal vesicular breath sounds?

Answer 35

Soft, low-pitched sounds during inspiration with a 3:1 inspiration to expiration ratio.

Question 36

What are abnormal bronchial breath sounds?

Answer 36

Heard outside of the tracheal area, indicating conditions like consolidation or compression.

Question 37

What is the significance of diminished or absent lung sounds?

Answer 37

May indicate conditions such as hyperinflation, lobectomy, or a complete airway blockage.

Question 38

How can abnormal voice sounds help in diagnosis?

Answer 38

Increased vocal resonance, as in bronchophony or egophony, indicates consolidation or atelectasis.

Question 39

What is the significance of stridor in lung auscultation?

Answer 39

It indicates a life-threatening upper airway obstruction and requires immediate intervention.

Question 40

What is the difference between wet and dry crackles?

Answer 40

Wet crackles are due to fluid in the lungs, while dry crackles result from sudden airway opening.

Question 41

What is the purpose of lung auscultation?

Answer 41

To confirm findings from the chart, rule out dysfunction, and assess ventilation after treatment.