Heart & Lung sounds

Question 1

normal S1 heart sound

Answer 1

“lub”

mitral and tricuspid valves closing at onset of ventricular systole (muscular contraction phase of cardiac cycle- begins at end of diastole)

Question 2

normal S2 heart sound

Answer 2

“dub”

aortic & pulmonic valves closing at onset of diastole (period of relaxation & filling)

Question 3

abnormal S3 heart sound

Answer 3

= ventricular gallop
association with early rapid passive filling of the ventricles immediately after the MV and TV open.
Most frequently associated with: heart failure, although it may occur normally in children & young adults up to age 40.
abnormal in older adults; noncompliant LV, maybe associated with CHF.

Question 4

abnormal S4 heart sound

Answer 4

=atrial gallop
Pathological sound of vibration or ventricular wall with ventricular filling.
May be associates with HTN, stenosis, hypertensive heart disease or MI
“atrial kick” indicates elevated atrial pressure

Question 5

murmurs

Answer 5

due to turbulent blood flow; usually heard as a “whooshing” sound
can be normal or pathological

Question 6

3 categories of murmurs

Answer 6

1: caused by high rates of flow through normal or abnormal valves
2: caused by forward flow through a stenotic or deformed valve
3: caused by backward flow through a valve (regurgitation)

Question 7

examine the chest

Answer 7

• observe body type
• overall posture
• chest type- barrel, excavatum, scoliosis, kyphosis
• look for symmetry
• coloration
• scars
• abnormal movements
• muscle contractions
• comfortable? facial expression?
• extremities- hairy?scars?
• skin color?
• fingers for clubbing

Question 8

schamroth’s sign

Answer 8

indicates clubbing of fingers

putting 2 fingers together- should be a diamond shaped space= Schamroth’s window.

Question 9

intercostal indrawing

Answer 9

can visibly see intercostal spacing between ribs bc breathing is so tough. spaces are drawn inwards on inspiration- especially with inspiratory effort.

seen in patients with severe obstructive disease

Question 10

signs of respiratory problems

Answer 10

"bad cat"
B= breathing that is audible
A= active accessory muscles
D=dyspnea
C=cyanosis or clubbing
A=anterior/posterior diameter >1
T=tracheal deviation from midline

Question 11

posterior superior border of lungs

Answer 11

T3-T4

Question 12

posterior inferior border of lungs

Answer 12

T10

Question 13

anterior apex of lungs

Answer 13

2-3 cm above middle third clavicle

Question 14

anterior lower border of lungs

Answer 14

medial: 6th rib
Lateral: 8th rib

Question 15

lateral border of lungs

Answer 15

vertical lines just anterior and posterior to deltoid from axillary lines

Question 16

oblique fissure

Answer 16

from T3 SP to anterior 6th intercostal space at midclavicular line

Question 17

horizontal fissure

Answer 17

divides anterior portion of R lung into upper and middle lobes

Question 18

respiratory rhythm

Answer 18

test position: seated

• note rhythm- regular? irregular?
• count for 30-60 seconds

normal findings:

• expiration 2 times longer than inspiration
• signing normal
• adult rate=9-10/hr; can occur on inspiration or expiration

Question 19

apnea

Answer 19

temporary cessation of breathing at the end of a normal expiration

Question 20

blot’s breathing

Answer 20

characterized by repeated sequences of deep gasps and apnea

Question 21

eupnea

Answer 21

normal quite breathing

Question 22

hyperpnea

Answer 22

breathing that is regulated to meet an increase demand by the body for oxygen

Question 23

dyspnea

Answer 23

labored or difficult breathing (usually associated with lung or heart disease and resulting in SOB)

Question 24

respiratory arrest

Answer 24

failure to resume breathing following a period of apnea, or apneusis

Question 25

apneusis

Answer 25

sustained, gasping inspiration followed by short, inefficient expiration, which can continue to the point of asphyxia. often associated with lesions in the respiratory center in the brain cessation of breathing in the inspiratory phase

Question 26

Cheyne-stokes breathing

Answer 26

periodic type of abnormal breathing often seen in terminally ill or brain-damage patients. characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing- apnea. Pt repeats, with each cycle usually taking 20 seconds to 2 minutes. It is oscillation of ventilation between apnea and hypernea with a crescendo-decrescendo pattern

Question 27

breathing patterns

Answer 27

chest breather | diaphragmatic breather

Question 28

respiratory depth & symmetry of movement

Answer 28

test position: seated -place hands at upper lobes, middle lobe, and posterior lower lobe during rest and inspiration normal findings: symmetric, 3-5 cm expansion positive findings: - less than 3 cm of movement - unilateral delay suggests atelectasis, pneumonia, and post op guarding

Question 29

thoracic excursion with tape measure

Answer 29

test position: standing - measure circumference at T5 and 3rd intercostal space - measure circumference at T10 and tip of xiphoid Instruct pt to take full inspiration and hold; fully exhale and hold Normal findings: for healthy adult males - upper chest 3.6 (+/- 0.6) - lower chest 4.9 (+/-0.6) positive findings: >1.7 cm

Question 30

listening to breath sounds: preparation of the patient

Answer 30

- teach importance of deep breathing through the mouth-my hyperventilate, get dizzy - report dizziness or fatigue during deep breathing

Question 31

breath sounds

Answer 31

generated by the vibration and turbulence of air flowing in and out of the airways and lung tissue during inhalation and exhalation

Question 32

4 normal breath sounds

Answer 32

1: tracheal 2: bronchial 3: vesicular 4: bronchovesicular have pt do at least 1 full breath when listening to each area L to R, hear both lobes

Question 33

tracheal breath sound

Answer 33

high pitched and loud (~wind blowing through a pipe) heard over trachea alone

Question 34

bronchial breath sound

Answer 34

heard adjacent to the sternum and over major airways; similar to tracheal sound but not as loud. Louder on expiration than inspiration. When heard in other areas, are abnormal; may be due to consolidation, compressed or airless tissue.

Question 35

vesicular breath sound

Answer 35

low pitched and muffled "soft" sound compared to sound of wind blowing through the leaves of a tree. inspiration is louder, longer and higher pitched than expiration (very brief) normal in all area of lung except over trachea. sound heard over the chest at a distance of large airways. *most common sound heard in the absence of lung disease

Question 36

bronchovesicular

Answer 36

inspiration/expiration are similar lengths at the same pitch with a slight break between the two. normal when heard adjacent to sternum, at costo-sternal border or between scapulae at T3-T6

Question 37

abnormal breath sounds

Answer 37

1: find crackle 2: wheezing 3: coarse crackle

Question 38

fine crackle lung sounds

Answer 38

"discontinuous" (intermittent) "explosive" sounds - high pitched - heard in atelectasis, interstitial pulmonary fibrosis and sometimes in healthy people

Question 39

wheezing (Rhonchi)

Answer 39

continuous high, medium or low pitched whistling sounds - caused by airway narrowing (bronchospasms), secretions - heard on either inspiration or expiration or both - expiratory more common- associated with diffuse airway obstruction- ex: in CF or chronic bronchitis "musical snoring"

Question 40

coarse crackle lung sounds

Answer 40

intermittent "bubbling" sound -caused by secretions in the airway hear in pathological condition

Question 41

voice sounds

Answer 41

used in examination of the chest to determine the presence/absence of consolidation consolidation=something in the lung -pneumonia, cancer, hemothorax something dense filling air space

Question 42

types of voice sounds

Answer 42

1: egophony 2: bronchophony 3: whispered pectoriloquy 4: fremitus

Question 43

egophony

Answer 43

- listen to chest with stethoscope - ask patient to say the letter "E" normal findings: will sound like muffled long E sound In presence of pneumonia or cancer (consolidation of lung tissue) will hear a higher pitched sound like "a" -physician refers to this as "E to A changes"

Question 44

bronchophony

Answer 44

- listen with stethoscope to symmetrical areas of the patient's lung - ask pt to repeat a word (99, or 66) - In normal tissue, sound becomes less distinct (quieter) as move to periphery of lungs; muffled, indistinct sounds - in presence of pneumonia or cancer, voice remains loud or becomes louder in periphery; 99 sounds normal - may be noted as "increased breath sounds" consolidation will stay loud or get louder compare sides

Question 45

whispered pectoriloquy

Answer 45

- refers to the loudness of a whispered voice while listening to the lungs with a stethoscope - ask pt to whisper "1,2,3" repeatedly Normal: whispered sounds would be faint or not heard In presence of pneumonia or cancer, they are heard

Question 46

voice fremitus

Answer 46

vibration - vocal or tactile fremitus is the vibration produced by the voice and transmitted to the chest wall - PT evaluates fremitus by comparing the intensity of the vibrations detected by each hand during quiet breathing and speech Normal: equal & moderate vibrations are noticed during speech Abnormal: when it is increased or decreased - increased fremitus indicates a loss or decrease in ventilation in the underlying lung - decreased indicates increased air within the lung bc sound is similarly transmitted more poorly through a hyperinflated lung

Question 47

tactile fremitus

Answer 47

position: seated action: place ulnar hand over posterior thorax between spinous processes & scapula - repeat on anterior chest at supraclavicular area, lateral to sternum, below T4 patient repeats "99" and examiner notes bilateral differences Normal: moderate vibration palpable - usually stronger in upper chest between scapulae & SP and on R vs L - low pitched voice generates more fremitus than high pitched - thin chest wall allows for greater feeling of fremitus than muscular or obese chest wall

Question 48

percussion

Answer 48

position: - post thorax: seated with arms crossed - ant thorax: supine Normal: - sounds specific to anatomical locations heard only on those locations - anterior: dullness noted in R midclavicular line from T4 to liver - anterior: dullness in 3rd to 5th intercostal space (heart)

Question 49

percussion sounds

Answer 49

1: resonant: loud, low pitch 2: hyper-resonant 3: tympanic 4: dull 5: flat

Question 50

resonant percussion sound

Answer 50

``` location: normal lung tissue loud intensity low pitch hollow long duration sounds like: normal peripheral lung ```

Question 51

hyper resonant percussion sound

Answer 51

very loud intensity lowest pitch longer duration sounds like: knocking on empty barrel possible pathologies: -air trapping (asthma, emphysema, pneumothorax, pleural effusion)

Question 52

tympanic percussion sounds

Answer 52

``` location: stomach or GI tract (air bubble) loud or very loud intensity musical or high pitch medium duration sounds like: drum ``` possible pathologies: - large pneumothorax - emphysematous bleb

Question 53

dull percussion sound

Answer 53

``` location: liver medium intensity medium-high pitch thud like medium duration sounds like: knocking on a full barrel ``` possible pathologies: - solid or fluid in air space due to pleural effusion - hemothorax - emphysema - consolidation - mass

Question 54

flat percussion sound

Answer 54

``` location: thigh soft intensity high pitch short duration sounds like: duller than dull ``` possible pathologies: - massive atelectasis - large pleural effusion - pneumonectomy