Week 9 - Abnormal and Adventitious Lung Sounds

Question 1

Who invented the Stethocope?

Answer 1

Introduced by Rene Laennec in 1816. The original stethoscopes were wooden cylinders. From the Greek stethos (breast) and skopein (to view).

Question 2

What are the 3 adventitious sound categories as classified by the American College of Chest Physicians?

Answer 2

crackles, wheezes and rhonchi

Question 3

Describe normal breath sounds

Answer 3

Bronchial and vesicular

Question 4

What are abnormal breath sounds?

Answer 4

Absent or transmission of bronchial breath sounds to areas of atelectasis or lobar consolidation

Question 5

Vocal sounds

Answer 5

Bronchophony (vocal fremitus) - A, B, C
egophony (“eee” to “aay”)
whispered pectoriloquy - 1, 2, 3

Question 6

Define adventitious breath sounds

Answer 6

Sounds superimposed over breath sounds

Question 7

What are crackles and what causes the sound?

Answer 7

aka “Rales”.
Discontinuous lung sounds produced by the sudden opening of collapsed airways, or by the movement of air through excessive airway secretions.

Question 8

What is wheezing and what causes the sound?

Answer 8

High-pitched musical sound associated with airway wall vibrations secondary to narrowing of airways

Question 9

What are Rhonchi?

Answer 9

Low-pitched continuous sounds (low-pitched wheezes)

Question 10

What is stridor?

What pathologies is stridor associated with?

Answer 10

nspiratory wheeze that is heard over the large airways. Happens in croup and epiglottitis when there is partial obstruction of the trachea and larynx.

Question 11

What is Pleural rub and what causes it?

Answer 11

Grating sound caused by inflamed pleural surfaces rubbing

Question 12

Describe Normal Sounding Lungs:
Appearance/Vital signs
Percussion Note
Fremitus Vocal Sounds
Adventitious Sounds

Answer 12

Appearance/Vital signs: Rate 10-12/min; Trachea midline, no cyanosis or pallor.

Percussion Note: Resonant

Fremitus Vocal Sounds: Tactile fremitus equal bilaterally. Normal breath and voice sounds.

Adventitious Sounds: None

Question 13

Atelectasis:
Appearance/Vital signs
Percussion Note
Fremitus Vocal Sounds
Adventitious Sounds

Answer 13

Appearance/Vital signs: Trachea shifted and lag on expansion on the involved side. Increased respiratory rate and pulse. Possible cyanosis.

Percussion Note: Dull over the airless area.

Fremitus Vocal Sounds: Voice sounds absent or diminished over the affected area.

Adventitious Sounds: none

Question 14

Lobar Pneumonia:
Appearance/Vital signs
Percussion Note
Fremitus Vocal Sounds
Adventitious Sounds

Answer 14

Appearance/Vital signs: Increased respiratory rate and pulse. Patient looks “bad sick.”

Percussion Note: Dull over area of consolidation.

Fremitus Vocal Sounds: Tactile fremitus increased over area of consolidation. Bronchophony, egophony, and whispered pectoriloquy bronchial breath sounds all present over involved lobe.

Adventitious Sounds: Late inspiratory crackles (fine to medium), worse after deep inspiration and coughing. Heard over the affected lobe (focal crackles).

Question 15

Bronchitis:
Appearance/Vital signs
Percussion Note
Fremitus Vocal Sounds
Adventitious Sounds

Answer 15

Appearance/Vital signs: Trachea midline. Normal respiratory rate.

Percussion Note: Resonant.

Fremitus Vocal Sounds: Tactile fremitus equal bilaterally. Normal breath and voice sounds.

Adventitious Sounds: Either no adventitious sounds or early inspiratory crackles, which clear with coughing and deep respiration. Crackles are heard diffusely. May have wheeze.