Auscultation

Question 1

what is auscultation?

Answer 1

• involves listening to the internal body sounds using a stethoscope

Question 2

what does auscultation help you understand? (3)

Answer 2

• nature
• severity
• location

Question 3

what two questions should you keep in mind when performing auscultation?

Answer 3

• are the breath sounds increased, normal or decreased?
• are they abnormal or adventitious breath sounds?

Question 4

what does adventitious mean?

Answer 4

• added from another source

Question 5

which way do you wear the stethoscope and why?

Answer 5

• worn facing forwards as the ear canals run anteriorly

Question 6

how do you optimise environment for auscultation? (3)

Answer 6

• quiet
• warm
• appropriate lighting

Question 7

why do you ensure the environment is optimal for auscultation?

Answer 7

• to ensure no interference e.g., shivering

Question 8

how do you perform auscultation?

Answer 8

• instruct the patient to breathe deeper than normal through the mouth
• listen to each position for at least one ventilatory cycle

Question 9

where do you start with auscultation? what do you compare?

Answer 9

• begin at the top
• compare side to side

Question 10

what are sounds of auscultation based on? (4)

Answer 10

• intensity
• pitch
• inspiratory: expiratory ratio
• location

Question 11

what is the normal lung sound? which phase do you hear the most?

Answer 11

• vesicular is usually quiet
• mostly inspiratory with a distinct pause before a quieter expiratory phase

Question 12

what is the E:I ratio for normal vesicular breathing?

Answer 12

• 3:1

Question 13

where are bronchovesicular sounds heard? (3)

Answer 13

• heard over 1st and 2nd intercostal spaces and interscapular area

Question 14

describe the inspiration and expiration of bronchovesicular sounds - what is the pitch?

Answer 14

• inspiration and expiration equal in length
• medium pitch

Question 15

what are bronchovesicular sounds produced?

Answer 15

• when air moves through large airways of the lungs

Question 16

where are bronchial sounds normally heard?

Answer 16

• normally heard over the manubrium

Question 17

what is the expiration and inspiration like in bronchial sounds? what is the pitch like?

Answer 17

• expiratory phase is greater than inspiration
• high pitch

Question 18

where are tracheal sounds heard?

Answer 18

• heard directly over the tracheal

Question 19

what is the expiration and inspiration like in tracheal sounds? what is the pitch?

Answer 19

• inspiratory phase = expiratory phase
• loud sound
• high pitch

Question 20

what are bronchial sounds that are heard elsewhere indicative of?

Answer 20

• indicative of consolidation area

Question 21

what is a consolidation area?

Answer 21

• space that usually contains air now contains fluid or solid lung tissue

Question 22

what are the 5 main abnormal breathing sounds?

Answer 22

• crackles
• wheezes
• rhonchi
• stridor
• pleural rub

Question 23

what are the 6 reasons for absent/ decreased breath sounds?

Answer 23

• ARDS
• asthma
• atelectasis
• pleural effusion
• pneumothorax

Question 24

when do breath sounds become absent in atelectasis?

Answer 24

• become absent if the bronchial obstruction persists

Question 25

what are crackles caused by?

Answer 25

- caused by excessive fluid in the airways

Question 26

when do crackles occur?

Answer 26

- occur when a small airway pops open during inspiration after collapse

Question 27

what is the pitch like in crackles?

Answer 27

- more high-pitched and discontinued

Question 28

what are crackles more common in?

Answer 28

- more common in inspiration

Question 29

what can crackles be indicative of?

Answer 29

- indicative of early coronary heart failure

Question 30

what are the two types of crackles?

Answer 30

- coarse and fine

Question 31

what is the sound of coarse crackles? what is usually louder?

Answer 31

- lower pitched and long-lasting sounds - usually early inspiratory louder

Question 32

what does coarse crackles indicate? what two conditions can this be?

Answer 32

- indicative of excessive fluid on the lung e.g., pneumonia and pulmonary oedema

Question 33

what do fine crackles sound like? what is inspiratory typically?

Answer 33

- typically late inspiratory high-pitched, soft and brief sounds

Question 34

what condition does fine crackles occur in?

Answer 34

- pulmonary fibrosis

Question 35

what are wheezes?

Answer 35

- expiratory sound caused by forced airflow through collapsed airways

Question 36

what does the collapsed airway causing wheeziness lead to?

Answer 36

- elevated velocity of air in the lungs

Question 37

what do wheezes sound like? what is it more frequent on?

Answer 37

- continuous high pitched hissing sound - more frequent on expiration

Question 38

when are wheezes produced?

Answer 38

- when air flows through airways narrowed by secretions, foreign bodies or obstructive lesions

Question 39

what conditions would you hear wheezes for? (4)

Answer 39

- asthma - pulmonary oedema - interstitial lung disease - chronic bronchitis

Question 40

what are rhonchi sounds? what are they similar to?

Answer 40

- low pitched continuous musical sounds that are similar to wheezes

Question 41

what condition can rhonchi sounds be heard in?

Answer 41

- cystic fibrosis

Question 42

what do rhonchi sounds usually imply?

Answer 42

- obstruction of a larger airway by secretions

Question 43

what is a stridor?

Answer 43

- inspiratory musical wheeze

Question 44

where is stridor commonly heard?

Answer 44

- loudest over the trachea

Question 45

what is a stridor sound indicative of?

Answer 45

- indicates obstructed trachea/ larynx - upper airway obstruction

Question 46

what is a pleural rub sound?

Answer 46

- cracking/ brushing sounds

Question 47

when are pleural rub sounds produced?

Answer 47

- produced when the pleural spaces are inflamed/ roughened and hence rub against each other

Question 48

what two conditions can pleural rub sounds be found in?

Answer 48

- pleural effusion - pneumothorax

Question 49

what are the two types of pleural rub sounds?

Answer 49

- continuous - discontinuous

Question 50

where is the pleural rub sound usually heard?

Answer 50

- localised to a particular chest wall place

Question 51

what phase can pleural rub be heard?

Answer 51

- both inspiration and expiration

Question 52

what information does auscultation gather?

Answer 52

- gathers info about the function of systems

Question 53

what does auscultation aid? (2)

Answer 53

- diagnosis - management

Question 54

what does asymmetrical lung sounds indicate?

Answer 54

- indicate unilateral pathology

Question 55

what does auscultation guide? (2)

Answer 55

- decision making on interventions - monitoring disease progression

Question 56

what should you do if there are abnormal findings?

Answer 56

- refer or escalate