lung sounds Flashcards
Where is the thyroid cartilage?
C4 and C5
Where is the cricoid cartilage?
C6
Where is the tracheal bifuricates?
T4-T5
What are the normal breath sounds?
Vesicular breath sounds
Tracheal/bronchial sounds
What are the vesicular breath sounds?
Sounds heard during auscultation in the peripheral lung field of a healthy person
Soft, muffled
Inspiratory component predominates
Where are the tracheal breathe sounds heard?
Sounds heard over the sternum/trachea
Tubular in quality
Louder, higher-pitched than vesicular sounds
Expiratory phase = inspiratory phase or is slightly longer
What are the abnormal sounds?
Crackles
Wheezes (polyphonic, monophonic)
Pleural rub
Rhonci
What should be note when listening to abnormal breath sounds?
Pitch location intensity timing Continuous or discontinuous
Wheezing (continuos)
crackles (discontinuous)
What are crackles?
Crackles signify the “opening” of small airways or alveoli that have been collapsed or decreased in volume secondary to:
Fluid (e.g. CHF, pleural effusion),
Inflammatory exudate, OR
Poor aeration (e.g. atelectasis)
What are characteristics of crackles?
Discontinuous
Involves small airways
Common during inspiration
AKA rales***
When are crackles usually heard and why?
usually heard during inspiraton
An increase in alveolar volume-air moves through liquid in alveolar and it snap crackle and pops
What can crackles be divided into?
Fine
Medium
Coarse
What are the differentials for crackles?
Pulmonary fibrosis
Generally bibasilar predominance
Pulmonary edema 2/2 CHF
Generally bibasilar in upright position
Gravity dependent otherwise
Asbestosis exposure
Associated with ‘honeycombing’ on imaging
Generally bibasilar as classic ‘bibasilar plaques’ on imaging
Apices of the lung are generally spared
Pneumonia
Bronchiectasis
When is it secretions in a patient with crackles?
wake them first thing in the morning, have them cough
if disappear then secretions
What are the most likely people to get asbestos with crackles?
Shipbuilder, plumber, or someone in NYC during 911 attacks with:
Pulmonary symptoms
Bibasilar fine end-inspiratory crackles and
‘Honeycombing’ or bibasilar ‘pleural plaques’ on imaging
Ferruginous body or “dumbbell” asbestos fiber on histology
usually takes 15-10 years
What are wheezes caused by?
airflow through narrowed airways.
Very musical in nature
Indicates airflow obstruction
Smooth airway muscle constriction,
Mucosal edema,
Secretions/mucus
When are wheezes more pronounced?
during expiration
Wheezing may no longer be heard if airway narrowing is severe!!!
What are the different types of wheezes?
Polyphonic
Monophonic
What are the characteristics of Polyphonic wheezes? In what disease is it seen?
Combo of different musical pitches that start and stop at different times during the expiratory cycle
Usually characteristic of small airway obstruction
Seen in asthma, COPD
What are the characteristics of a monophonic wheeze?
Single pitch, usually heard in only one area of the chest
Results from focal narrowing of the trachea or large bronchi
When the site of narrowing is in the larynx or the extrathoracic portion of the trachea,
What are the diseases caused by wheezes?
Extrathoracic upper airway causes
Intrathoracic central airway causes
Intrathoracic lower airway causes of wheeze:
Implies airways generally < 2 mm in diameter
Asthma
COPD
Foreign body obstruction
What causes plueral rubs? when can plueral rubs be heard?
Primary inflammatory diseases of the pleura or parenchymal processes that extend out to the pleural surface
E.g. pneumonia, pulmonary embolism, and pulmonary infarction***
Heard whenever the pleura move with respiration
AKA, heard in BOTH inspiration and expiration
What are the specialized lung sounds?
Egophony
Whispering pectoriloquy
Bronchophony
What are egophony and how is it heard?
Have patient say “E” as you listen through their lung fields
Normal lung: Eeee still sounds like Eeee on auscultation
Abnormal consolidated lung: Eeee to Aaaa transition
What isa whispering pectoriloquy? how is it heard?
Have patient whisper “1-2-3”
Normal lung: Not audible
Abnormal lung: Whispering becomes audible on auscultation
What is a bronchophony and how is it heard?
A type of pectoriloquy
Normal lung: “Ninety-nine” becomes muffled/diminished in peripheral lung fields
Abnormal lung: “Ninety-nine” does NOT become muffled as you auscultate peripherally
