lung sounds

Question 1

Where is the thyroid cartilage?

Answer 1

C4 and C5

Question 2

Where is the cricoid cartilage?

Answer 2

C6

Question 3

Where is the tracheal bifuricates?

Answer 3

T4-T5

Question 4

What are the normal breath sounds?

Answer 4

Vesicular breath sounds

Tracheal/bronchial sounds

Question 5

What are the vesicular breath sounds?

Answer 5

Sounds heard during auscultation in the peripheral lung field of a healthy person

Soft, muffled

Inspiratory component predominates

Question 6

Where are the tracheal breathe sounds heard?

Answer 6

Sounds heard over the sternum/trachea

Tubular in quality

Louder, higher-pitched than vesicular sounds

Expiratory phase = inspiratory phase or is slightly longer

Question 7

What are the abnormal sounds?

Answer 7

Crackles

Wheezes (polyphonic, monophonic)

Pleural rub

Rhonci

Question 8

What should be note when listening to abnormal breath sounds?

Answer 8

Pitch 
location
intensity 
timing 
Continuous or discontinuous

Wheezing (continuos)
crackles (discontinuous)

Question 9

What are crackles?

Answer 9

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)

Question 10

What are characteristics of crackles?

Answer 10

Discontinuous
Involves small airways
Common during inspiration
AKA rales***

Question 11

When are crackles usually heard and why?

Answer 11

usually heard during inspiraton

An increase in alveolar volume-air moves through liquid in alveolar and it snap crackle and pops

Question 12

What can crackles be divided into?

Answer 12

Fine
Medium
Coarse

Question 13

What are the differentials for crackles?

Answer 13

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

Question 14

When is it secretions in a patient with crackles?

Answer 14

wake them first thing in the morning, have them cough

if disappear then secretions

Question 15

What are the most likely people to get asbestos with crackles?

Answer 15

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

Question 16

What are wheezes caused by?

Answer 16

airflow through narrowed airways.

Very musical in nature
Indicates airflow obstruction

Smooth airway muscle constriction,
Mucosal edema,
Secretions/mucus

Question 17

When are wheezes more pronounced?

Answer 17

during expiration

Wheezing may no longer be heard if airway narrowing is severe!!!

Question 18

What are the different types of wheezes?

Answer 18

Polyphonic

Monophonic

Question 19

What are the characteristics of Polyphonic wheezes? In what disease is it seen?

Answer 19

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

Question 20

What are the characteristics of a monophonic wheeze?

Answer 20

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,

Question 21

What are the diseases caused by wheezes?

Answer 21

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

Question 22

What causes plueral rubs? when can plueral rubs be heard?

Answer 22

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

Question 23

What are the specialized lung sounds?

Answer 23

Egophony
Whispering pectoriloquy
Bronchophony

Question 24

What are egophony and how is it heard?

Answer 24

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

Question 25

What isa whispering pectoriloquy? how is it heard?

Answer 25

Have patient whisper “1-2-3”

Normal lung: Not audible

Abnormal lung: Whispering becomes audible on auscultation

Question 26

What is a bronchophony and how is it heard?

Answer 26

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