Pulmonary - Auscultation and voice sounds

Question 1

When auscultating when do you use the bell and when would you use the diaphragm

Answer 1

Diaphragm for lungs, bell for (abnormal) heart sounds

Question 2

What other things should you consider when listening to lungs

Answer 2

Apply firmly to bare skin
Be systematic - Compare sides
Listen to both inspiration and expiration (full cycle each time you move)

Question 3

What are some errors to avoid when auscultating

Answer 3

Listening through clothing

Letting tubing rub

Auscultating in a noisy environment

Misinterpreting the rubbing sound of hair

Auscultating only where “convenient”

Question 4

What is meant by voice sounds and auscultation

Answer 4

Tests where we are looking for areas of consolidation (mucus from PNA or effusion)

Sounds waves are carried more strongly

Hyperinflation leads to weaker, softer sounds
(ex: emphysema or acute asthma)

Question 5

What are the 3 types of voice sounds

Answer 5

Bronchophany

Egophony

Whispered Pectoriloquy

Question 6

How do you do Bronchophany and what might this mean?

Answer 6

you put stethoscope on someone’s back and ask them to say “99”

Sound will be louder and clearer over areas of pathology

indicative of PNA or atelectases

Question 7

How do you do Egophony

and what might this mean?

Answer 7

Ask pt to say letter “E”

If nasal sounding “A” sound is heard indicates pathology

Usually heard over pleural effusion

Question 8

How do you do Whispered Pectoriloquy and what might this mean?

Answer 8

Ask pt to whisper “1-2-3”

Normally hear low pitched, muffled sounds

If hear clear sounds like regular speech indicates pathology

Useful for finding small areas of consolidation

Question 9

What is Mediate Percussion

Answer 9

Use to sense density of underlying structures

Normal Resonance: Drum like

Different over different structures e.g., liver vs. stomach

Increased Resonance: (Tympanic) May be due to ↑ air in lungs e.g., emphysema or pneumothorax

Decreased Resonance: (Thud) May be due to
↓ air in lungs e.g., pleural fluid,
consolidation or atelectasis

Question 10

Consolidation and atelectases can diminish respiration what type of tools to can you use to find them:

Answer 10

Auscultation

Whispered Pectoriloquy

Bronchophany and Egophany

Mediate Percussion

Question 11

Inefficient breathing, guarding and muscle weakness can also diminish respiration what type of tools can you use to find/modify them:

Answer 11

Assessing breathing style

Assessing chest wall motion

Incentive Spirometry