Misc: Abnormal Lung Sounds

Question 1

Describe a vesicular breath sound and where it should normally be heard.

Answer 1

Gentle, low pitched sound that is LONGER in INSPIRATION than expiration.

Generally heard over most of the lung fields, aside from the bronchial area.

Rustling leaves

Question 2

What kind of patients have diminished vesicular breath sounds?

Answer 2

• Low volume of air: Elderly or shallow breathing.
• Obese or highly muscular patients.

Question 3

Describe a bronchial breath sound and where it should normally be heard.

Answer 3

Loud, high pitched sound that is EQUAL in inspiration and expiration, with a pause between phases.
Normally heard over the suprasternal notch.

Question 4

What kind of patients have abnormal bronchial breath sounds?

Answer 4

1. Consolidation
2. Collapse of Lobe
3. Cavity of lung

Question 5

If a patient presents with bronchial breath sounds over a lung field, what further PE tests can we do to evaluate?

Answer 5

• Tactile fremitus (Should be increased)
• Bronchophony
• Egophony (EE heard as AY)
• Whispering pectoriloquy

Question 6

Describe wheezing and what it indicates.

Answer 6

• Continuous, musical quality on EXPIRATION.
• Variable pitch.
• Suggests narrowed airways, either due to obstruction or secretions.

Wheezing = Whistle
We have asthma = airway constriction

Question 7

What is a sibilant wheeze?

Answer 7

High pitched wheezing that sounds like a whistle, typically in asthma due to a narrowing from bronchospasm.

Inspiratory wheezing from vented patient with asthma

sounds like a whale

Question 8

What is a sonorous wheeze?

Answer 8

Low pitched wheezing, AKA rhonchi, typically in chronic bronchitis due to a narrowing from secretions.

COPD Wheezing audio

Rhonchi is not a preferred term, low-pitched wheezing is better.

Question 9

When does a polyphonic wheeze occur vs monophonic?

Answer 9

Polyphonic wheeze is due to bronchospasm.

Monophonic wheeze is due to obstruction in a localized area.

Question 10

Describes crackles and the pathophysiology.

Answer 10

• Interrupted, non-musical quality sounds.
• Usually only on inspiration.
• Peripheral airway collapse on expiration due to interstial fibrosis or secretions/fluid.
• Inspiration causes the collapsed airways to reopen abruptly.

Rales = Crackles = CrePitations
Really Crumple Paper

Question 11

What does early crackles suggest? Mid? Late? and Biphasic?

Answer 11

• Early: small airway disease like bronchiolitis.
• Mid: Pulmonary edema.
• Late: Pulmonary fibrosis, edema, COPD, resolving pneumonia, lung abscess, or lung cavities from TB.
• Biphasic: bronchiectasis

Question 12

What do fine crackles suggest?

Answer 12

• Bronchiolitis
• Pulmonary edema
• Pulmonary Fibrosis

Pulmonary Edema audio

Question 13

What do coarse crackles suggest?

Answer 13

• COPD
• Resolving Pneumonia
• Lung abscess
• TB lung cavities
• Bronchiectasis

Bronchiestasis audio

Question 14

Guess this audio :)

Answer 14

Coarse crackles and wheezes in a patient with Bronchiecstasis and CF.

Question 15

Describe a pleural friction rub and its etiologies.

Answer 15

• Low pitched, grating sound on inspiration similar to walking on snow.
• Caused by consolidation, pulmonary infract, or uremia.
• Due to a inflammation of either pleura as they slide over each other.

Also described as rubbing two pieces of leather together.

Question 16

How can you differentiate pleural rub from pericardial rub?

Answer 16

Inspiratory hold maneuver. If it continues during it; it is mostly likely a pericardial rub.

Question 17

Guess this audio :)

Answer 17

Pleural Rub

Question 18

Guess this audio :)

Answer 18

Baby cooing

Question 19

Describe stridor and the primary etiologies.

Answer 19

• Loud, High pitched crowing breath sound heard during inspiration but can occur throughout the respiratory cycle as patient worsens
• Caused from upper airway narrowing or obstruction, such as croup, epiglottitis, and aspiration.

Mnemonic:
Sounds like a Screen Door
Scary
Squeaky
Stride to the ER

Question 20

What is egophony?

Answer 20

• Hearing an A sound when the patient goes EEEEEEEE
• Suggests consolidation.

Question 21

What is whispered pectoriloquy?

Answer 21

• Hearing 99 clearly when the patient is only whispering it.
• Suggests fluid or consolidation.