DLA3(1)- Abnormal Breath Sounds

Question 1

Normal Breath Sounds- tracheal

-describe the sound duration, intensity upon expiration, pitch upon expiration, normally heard location

Answer 1

Duration: inspiration = expiration

Expiration Intensity: very loud

Expiration Pitch: relatively high

Location: over trachea in the neck

Question 2

Normal Breath Sounds- bronchial

-describe the sound duration, intensity upon expiration, pitch upon expiration, normally heard location

Answer 2

Duration: expiration > inspiration

Expiration Intensity: loud

Expiration Pitch: relatively high

Location: over manubrium (large proximal airways)

Question 3

Normal Breath Sounds- broncho-vesicular

-describe the sound duration, intensity upon expiration, pitch upon expiration, normally heard location

Answer 3

Duration: inspiration = expiration

Expiration Intensity: intermediate

Expiration Pitch: intermediate

Location: 1st/2nd intercostal spaces anterior // between the scapula posterior

Question 4

Normal Breath Sounds- vesicular

-describe the sound duration, intensity upon expiration, pitch upon expiration, normally heard location

Answer 4

Duration: inspiration > expiration

Expiration Intensity: soft

Expiration Pitch: relatively low

Location: most of the lung / chest

Question 5

Bronchial breath sounds are abnormal if (1) is evident.

• (soft/loud)
• (low/high) pitched
• inspiration (>/=) expiration
• (Y/N) gap between phases

Answer 5

1- heard over majority of lung far away from main airways
2- loud (and tubular)
3- high pitched
4- equal phases
5- gap is present

Question 6

bronchial breath sounds are commonly exhibited in (1) of the lung and therefore prompts examiner to perform (2)

Answer 6

1- lung consolidation

2- voice transmission maneuvers: bronchophony, egophony, whispering pectoriloquey

Question 7

Crackles = (1)

• (2) type sounds, possibly due to (3) mechanism
• it occurs in (early/late) inspiration
• (5) list the types

Answer 7

1- rales
2- discontinuous, nonmusical
3- series of tiny explosions: small distal airways deflate upon expiration, pop open during inspiration
4- early (COPD), late (pulmonary fibrosis), or biphasic (pneumonia)
5- fine and coarse crackles

Question 8

Fine Crackles:

• (soft/loud)
• (low/high) pitched
• (short/long) duration // (high/low) frequency
• best heard in (4) phase
• (varies/doesn’t vary) with change in body position

*include examples

Answer 8

1/2/3- soft, high pitched, short duration / high frequency

4- mid to late inspiration
5- changes with body position

ex: pulmonary and interstitial diseases

Question 9

Crackles = (1)

• (2) type sounds, possibly due to (3) mechanism
• it occurs in (early/late) inspiration
• (5) list the types

Answer 9

1- rales
2- discontinuous, nonmusical
3- series of tiny explosions

Question 10

Wheezes

• (1) type sounds due to (2) mechanism
• it occurs in (3) phase
• localization can occur due to (4)

Answer 10

1- continuous, musical sound
2- rapid airflow b/c narrowed bronchial airways (narrowed almost to the point of closure)
3- inspiration, expiration, or biphasic
4- foreign body, mucous plug, tumor [can also be heard through the lung]

Question 11

Coarse Crackles:

• (short/long) duration // (high/low) frequency
• best heard in (2) phase
• (varies/doesn’t vary) with change in body position
• changes and or disappears with (4)

*include examples

Answer 11

1- long duration / low frequency
2- biphasic, early inspiration through expiration
3- doesn’t vary with body position
4- cough (–> transmitted to mouth)

ex: COPD, asthma, bronchietasis, pneumonia, HF

Question 12

compare Rhonchi to wheezes

Answer 12

• rhonchi are considered a variant of wheezes
• same mechanism

Rhonchi are:

• lower in pitch
• can disappear with cough –> secretions can be involved => snoring, gurgling, rumbling sounds

Question 13

Stridor

• (dis-/continuous)
• (low/high) pitched
• (short/long) duration // (high/low) frequency
• best heard in (4) phase in (5) location

*include examples

Answer 13

1/2/3- continuous, high-pitched musical sound, short duration / high frequency

4/5- inspiration over the neck

ex: underlying airway obstruction: tracheal stenosis (via intubation), airway edema (via device removal), epiglottitis, foreign body, anaphylaxis

Question 14

Pleural Friction Rub

• (dis-/continuous)
• (short/long) duration // (high/low) frequency
• best heard in (3) phase in (4) location
• (5) mechanism

*include examples

Answer 14

1/2- discontinuous non-musical, long duration / low frequency

3/4- biphasic over axilla and base of lungs

5- inflammation and roughening of visceral pleura sliding against parietal pleura

Note- difficult to distinguish from pericardial rub