Auscultation

Question 1

What are the anatomical landmarks for auscultation?

Answer 1

Anterior
Oblique fissure starts at the 4th chondrocostal junction
Upper lobe above 4th chondrocostal junction
Middle lobe (R Lung) is between the 4th and 6th chondrocostal junction and finishes mid axillary line

Posterior
Oblique fissure starts at T3
Upper lobe above T3
Lower lobe bellow T3
Distal border of lung is T10

Question 2

Where are the sites for auscultation?

Answer 2

Anterior and posterior upper lobe R + L

Middle lobe mid axillary line for R and middle zone for L

Posterior lower lobe all the way down to T10 R + L

Question 3

What are the advantages and disadvantages of using a stethoscope for auscultation?

Answer 3

Advantages
Cheap
Lightweight
Portable

Disadvantages
Subjective - depends on skill and ‘ear’ of clinician
Low frequency sounds below human hearing range

Question 4

What area of the lungs are breath sounds harsher?

Answer 4

Upper lobes

Question 5

What are normal breaths sounds described as?

Answer 5

Vesicular

Question 6

How are vasicular breath sounds produced?

Answer 6

Turbulence in the airways

Question 7

What are crackles during auscultations?

Answer 7

Opening of previously closed bronchioles

Question 8

When are crackles mostly heard?

Answer 8

During inspiration

Question 9

What are early inspiratory crackles and late inspiratory crackles associated with?

Answer 9

Early inspiratory crackles - airflow limitation

Late inspiratory crackles - pulmonary oedema, fibrosis of the lung and bronchiectasis

Question 10

How can you differentiate between crackles and wheezing?

Answer 10

Wheezing is a continuous sound

Crackles are interrupted sounds

Question 11

What are the 2 types of crackles and what do they mean?

Answer 11

Fine crackles - fibrotic lung disease

Coarse crackles - heard more in obstructive disease

Question 12

When do you usually hear wheezing and why do they occur?

Answer 12

Expiration

Result from vibrations in collapsed airways - resistance as a result of flow limiting mechanisms

Question 13

What is monophonic and polyphonic?

Answer 13

Monophonic - Single large airway obstruction

Polyphonic - Narrowing of many smaller airways

Question 14

What are the typical lung sound on auscultation for asthma?

Answer 14

Decreased breath sounds due to diminished airflow

Expiratory wheeze = bronchospasm

Prolonged expiration phase

Crackles = if sputum present

Question 15

What are the typical lung sound on auscultation for COPD?

Answer 15

Inspiratory and expiratory wheeze = bronchospasm

Prolonged expiration forced expiration - to try and prevent airway walls collapsing during expiration

Coarse crackles - Airway closure due to mucus

Paradoxical quiet breathing sounds

Question 16

What are the typical lung sound on auscultation for bronchiectasis?

Answer 16

Abnormal dilation of the bronchi after obstruction and infection

Inspiratory and expiratory crackles = pus in lungs

Question 17

What are the typical lung sound on auscultation for pulmonary oedema?

Answer 17

Inspiratory and expiratory crackles in bases = fluid accumulation in base of lungs

Wheeze heard sometimes = obstruction of airways with fluid

Question 18

What are the typical lung sound on auscultation for interstitial lung disease?

Answer 18

End-inspiratory crackles heard in half of cases = Thickening of airways causes obstruction

Question 19

What are the typical lung sound on auscultation for cystic fibrosis?

Answer 19

Inspiratory and expiratory wheeze = obstruction due to hypertrophy and increased amount of mucous-secreting glands

Some fine crackles = secretions

Question 20

When auscultating how do you find the middle lobe from posterior of the patient?

Answer 20

Find T5, follow line horizontally to the mid axillary line

This is where the middle lobe starts

Question 21

What are the anatomical landmarks for the lower border of the lung on a normal breath?

Answer 21

T10 posteriorly

8th rib mid axillary line

6th rib mid clavicular line

S-shaped

Question 22

What are the anatomical landmarks for the lower border of the lung on a deep breath?

Answer 22

T12 posteriorly

10th rib mid axillary line

8th rib mid clavicular line

S-shaped

Question 23

What is the anatomical marks of the oblique fisser?

Answer 23

Starts at T3 posteriorly

T5 mid axillary line to meet with horizontal fissure (R lung)

Continues to angle down to meet the lower border of the lung at the 6th rib mid clavicular line

Question 24

From the anterior view, what are the 2 main lobes you can see?

Answer 24

Upper and middle lobe R

Upper lobe L

Question 25

Which is longer inspiration of expiration in healthy lungs?

Answer 25

Expiration 1:2 ratio

Question 26

Where do breath sounds become fainter? And why?

Answer 26

Apex in an upright position as inspiration progresses Due to differences in regional flow rates

Question 27

Where are expiratory breath sounds produced more than inspiratory?

Answer 27

Centrally

Question 28

When do you hear paradoxically quiet breath sounds?

Answer 28

When expiration is restricted e.g. COPD Due to loss of elastic tension in the lung

Question 29

Can crackles be cleared by coughing?

Answer 29

No

Question 30

What is bronchial breathing?

Answer 30

More hollow sounding and higher pitch than vesicular sounds Believed these are true lung sounds and vesicular sounds are filtered

Question 31

When would you hear bronchial breathing?

Answer 31

Over consolidation, collapsed lung and areas of fibrosis

Question 32

What is a pleural rub in auscultation?

Answer 32

Creaking or groaning sound

Question 33

What does a pleural rub in auscultation indicate and why?

Answer 33

Inflammation or thickening of the pleural surfaces Pleural surfaces would glide silently over one another in normal lungs

Question 34

What is a stridor in auscultation and what causes it?

Answer 34

Inspiratory musical type of noise Rapid airflow due to obstruction in the upper respiratory tract