Lung Sounds

Question 1

What do flat percussion tones indicate?

Answer 1

large pleural effusion

Question 2

What do dull percussion tones indicate?

Answer 2

Lobar pneumonia

Question 3

What doe resonant percussion tones indicate?

Answer 3

simple chronic bronchitis

Question 4

What do hyperresonant percussion tones indicate?

Answer 4

COPD or pneumothorax

Question 5

What do tympanic percussion tones indicate?

Answer 5

Large pneumothorax

Question 6

Where are the R middle lobe and lingual heard?

Answer 6

at the anterior inferior chest + lateral inferior chest

Question 7

What are crackles?

Answer 7

intermittent, non-musical and short successive or overlapping clicks; fine (like velcro) or coarse (like tearing fabric stitching)

Question 8

What are fine crackles (rales)?

Answer 8

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

Question 9

The fine crackles (rales) of HF are usually best heard where?

Answer 9

in the posterior inferior lung fields

Question 10

Clearing of crackles, wheezes or rhonci after coughing or position change suggests what?

Answer 10

inspissated (thickened) secretions seen in bronchitis or atelectasis

Question 11

Rales that persist unchanged from breath to breath suggest what?

Answer 11

abnormal lung tissue (parenchyma)

Question 12

What are coarse crackles (rhonchi)?

Answer 12

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

Question 13

What are wheezes?

Answer 13

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

Question 14

What can cause extrinsic wheezes?

Answer 14

pressure foreign body, mucus plug, or tumor

Question 15

What can cause intrinsic wheezes?

Answer 15

contracted or inflamed muscular walls of small to medium bronchioles from asthma, COPD, and bronchitis

Question 16

Why is a lack of wheezing an ominous sign?

Answer 16

as the airways become more narrowed wheezes become less audible meaning the pt cannot inhale enough to open airways and create wheezing

Question 17

What is stridor?

Answer 17

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

Question 18

What are the causes of stridor?

Answer 18

anaphylaxis, epiglottitis, foreign body, tracheal stenosis from intubation, airway edema after device removal

Question 19

What is mediastinal crunch?

Answer 19

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

Question 20

Mediastinal crunch has been reported in cases of what?

Answer 20

tracheobronchial injury, blunt trauma, pulmonary dz, use of recreational drugs, childbirth, and rapid ascent from scuba diving

Question 21

What are pleural friction rubs?

Answer 21

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)

Question 22

What triples the likelihood of pneumonia?

Answer 22

in pts with fever and cough, the presence of bronchial breath sounds and egophony

Question 23

What are the lung sounds associated with LHF?

Answer 23

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

Question 24

What are the lung sounds for bronchitis?

Answer 24

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

Question 25

What are the lungs sounds associated with lobar pneumonia?

Answer 25

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

Question 26

What lung sounds are associated with partial lobar obstruction?

Answer 26

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

Question 27

What are the lung sounds associated with pleural effusion?

Answer 27

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

Question 28

What are the lung sounds associated with pneumothorax?

Answer 28

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

Question 29

What are the lung sounds associated with COPD?

Answer 29

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

Question 30

What are the lung sounds associated with asthma?

Answer 30

Resonant to diffusely hyperresonant percussion; midline trachea; breath sounds often obscured by wheezes and possibly crackles; decreased tactile fremitus and voice sounds