Lung Sounds Flashcards
What do flat percussion tones indicate?
large pleural effusion
What do dull percussion tones indicate?
Lobar pneumonia
What doe resonant percussion tones indicate?
simple chronic bronchitis
What do hyperresonant percussion tones indicate?
COPD or pneumothorax
What do tympanic percussion tones indicate?
Large pneumothorax
Where are the R middle lobe and lingual heard?
at the anterior inferior chest + lateral inferior chest
What are crackles?
intermittent, non-musical and short successive or overlapping clicks; fine (like velcro) or coarse (like tearing fabric stitching)
What are fine crackles (rales)?
opening of alveoli or small bronchioles, traction by surrounding parenchyma pulls open the passage allowing airflow, the sudden flow creates a click, from abnormalities of the lung parenchyma (pneumonia, ILD, pulmonary fibrosis, atelectasis, HF), rarely from airway dz like bronchitis
The fine crackles (rales) of HF are usually best heard where?
in the posterior inferior lung fields
Clearing of crackles, wheezes or rhonci after coughing or position change suggests what?
inspissated (thickened) secretions seen in bronchitis or atelectasis
Rales that persist unchanged from breath to breath suggest what?
abnormal lung tissue (parenchyma)
What are coarse crackles (rhonchi)?
Boluses of gas passing through small airways as they open and close intermittently; causes include COPD, asthma, bronchiectasis, pneumonia, HF; may disappear with coughing which suggests secretions may be involved
What are wheezes?
continuous musical sounds that occur during rapid airflow when bronchial airways are narrowed almost to the point of closure; inspiratory, expiratory or biphasic; may be localized or diffuse
What can cause extrinsic wheezes?
pressure foreign body, mucus plug, or tumor
What can cause intrinsic wheezes?
contracted or inflamed muscular walls of small to medium bronchioles from asthma, COPD, and bronchitis
Why is a lack of wheezing an ominous sign?
as the airways become more narrowed wheezes become less audible meaning the pt cannot inhale enough to open airways and create wheezing
What is stridor?
Continuous, high frequency, high pitched musical sound produced during airflow through a narrowing in the URT; immediate intervention is warranted; loudest over the neck (can radiate to the chest and be mistaken for wheezing); typically on inspiration but can be biphasic
What are the causes of stridor?
anaphylaxis, epiglottitis, foreign body, tracheal stenosis from intubation, airway edema after device removal
What is mediastinal crunch?
a series of precordial crackles synchronous with the heartbeat not with respiration; best heard in the left lateral position; caused by air entry into the mediastinum causing mediastinal emphysema; produces severe central CP
Mediastinal crunch has been reported in cases of what?
tracheobronchial injury, blunt trauma, pulmonary dz, use of recreational drugs, childbirth, and rapid ascent from scuba diving
What are pleural friction rubs?
discontinuous, low frequency, coarse, grating biphasic sounds heard primarily during expiration; often best heard in the axilla and base of the lungs; from inflammation and roughening of the visceral pleura as it slides against the parietal pleura (pleurisy, pneumonia, PE)
What triples the likelihood of pneumonia?
in pts with fever and cough, the presence of bronchial breath sounds and egophony
What are the lung sounds associated with LHF?
Percussion note: resonant; trachea: midline; vesicular breath sounds (normal); adventitious sounds: late inspiratory crackles in the dependent portions of the lungs; possibly wheezes; tactile remits and transmitted voice sounds normal
What are the lung sounds for bronchitis?
resonant percussion note; midline trachea; vesicular/normal to harsh breath sounds; no adventitious breath sounds (possible scattered coarse crackles in early inspiration and expiration, possible wheezes or rhonchi; normal tactile fremitus and transmitted voice sounds
What are the lungs sounds associated with lobar pneumonia?
Percussion is dull over the airless area; trachea midline; bronchial breath sounds over the involved area; late inspiratory crackles over the involved area (adventitious sounds); increased over the involved area, with egophony, bronchophony, and whispered pectoriloquy
What lung sounds are associated with partial lobar obstruction?
dull over airless area; trachea may be shifted toward involved side; usually absent breath sounds when bronchial plug persists (exception include RUL atelectasis, where adjacent tracheal sound may be transmitted); no adventitious sounds; absent tactile fremtius when the bronchial plug persists
What are the lung sounds associated with pleural effusion?
Dull to flat percussion over the fluid with dependent shifting; trachea shifted toward unaffected side in large unilateral effusion; breath sounds decreased to absent but bronchial breath sounds may be heard near top of large effusion; no adventitious sounds except possible pleural rub; decreased to absent tactile fremitus
What are the lung sounds associated with pneumothorax?
Hyperresonant percussion or tympanic over pleural air; trachea shifted toward the unaffected side if tension pneumo; decreased to absent breath sounds; no adventitious breath sounds except a possible pleural rub; decreased to absent tactile fremitus
What are the lung sounds associated with COPD?
hyperresonant percussion; trachea midline; breath sounds decreased to absent with delayed expiration; no adventitious breath sounds (or the crackles, wheezes, and rhonchi of associated chronic bronchitis; decreased tactile fremitus and transmitted voice sounds
What are the lung sounds associated with asthma?
Resonant to diffusely hyperresonant percussion; midline trachea; breath sounds often obscured by wheezes and possibly crackles; decreased tactile fremitus and voice sounds
