week 1

Question 1

describe normal breath sounds

Answer 1

soft non-musical
heard over the entire lung fields
muffled in quality
normal to get quieter the further from the trachea
inspiration is louder than expiration
inspiration is heard longer than the expiration
no pause between inspiration and expiration

Question 2

describe decreased breath sounds

Answer 2

much lower intensity with a soft, distant quality

Question 3

what are the causes of decreased breath sounds

Answer 3

decreased in ability to generate sound
decreased transmission of the sound to the chest wall
combination of both

Question 4

describe increased/bronchial breath sounds

Answer 4

inspiration and expiration are equal pitch, equal intensity, equal duration
it is a louder, harsher and more brassy sound
definite pause between inspiration and expiration

Question 5

when do bronchial/increased breath sounds occur

Answer 5

occurs when the lung tissue around a large airway is more dense due to pathology such as consolidation or collapse and the main airway is still patent

Question 6

name some causes of increased breath sounds

Answer 6

consolidation
collapse
at the fluid line of a pleural effusion
large mass

Question 7

name some causes of decreased/absent breath sounds

Answer 7

shallow breathing/drowsiness/pain
poor position
atelectasis/collapse
collapse with complete obstruction of a large airway
hyperinflation e.g. emphysema
obesity/very muscular patients
pleural effusion
pneumothorax/haemothorax
ankylosing spondylitis

Question 8

what are crackles on auscultation due to

Answer 8

the explosive equalisation of gas pressure and sudden opening and closing of the airways

Question 9

when are coarse crackles normally heard

Answer 9

early inspiration and throughout expiration

Question 10

when are fine crackles heard

Answer 10

mid-to-late inspiration and occasionally on expiration

Question 11

what are the clinical causes of fine crackles

Answer 11

interstitial lung fibrosis
early congestive heart failure
pneumonia
can be the earliest signs or diseases such as idiopathic pulmonary fibrosis and asbestosis

Question 12

what are the clinical causes of course crackles

Answer 12

most indicative of secretions
present in COPD, pneumonia, asthma, bronchiectasis
also present in congestive cardiac failure with severe pulmonary oedema

Question 13

what airways do early inspiratory crackles indicate

Answer 13

proximal airways

Question 14

what airways do late inspiratory crackles indicate

Answer 14

peripheral airways

Question 15

what airways do early expiratory crackles indicate

Answer 15

proximal airways

Question 16

what airways do late expiratory crackles indicate

Answer 16

peripheral airways

Question 17

describe a wheeze

Answer 17

whistling musical high-pitched sound, heard on both inspiration and expiration

Question 18

what is a wheeze caused by

Answer 18

oscillations of the bronchial wall as air passes through narrowed airways

Question 19

what are the two types of wheeze

Answer 19

monophonic and polyphonic

Question 20

what is a monophonic wheeze generated by

Answer 20

one airway, single note, same position in the respiratory cycle

Question 21

what is a polyphonic wheeze generated by

Answer 21

several airways giving different notes and is more likely to be widespread

Question 22

describe a stridor

Answer 22

a high-pitched, musical sound (darth vadar)

Question 23

what produces a stridor

Answer 23

it is produced as turbulent flow passes through a narrowed segment of the upper respiratory tract

Question 24

name some clinical causes of stridor

Answer 24

epiglottitis
airway oedema after removal of artificial airway
anaphylaxis
vocal cord dysfunction
inhalation of foreign body
laryngeal tumour
thyroiditis
tracheal carcinoma

Question 25

describe a pleural rub

Answer 25

creaky leathery sound or boot crunching down snow

Question 26

name the cause of pleural rub

Answer 26

inflammation of the pleura

Question 27

name some causes of a wheeze

Answer 27

bronchospasm
airway oedema
sputum
tumour
foreign body