Auscultations: Heart and Lung Sounds

Question 1

What is the purpose of the diaphragm and bell on a stethoscope?

Answer 1

a) Diaphragm: Identify high-pitched sounds.

b) Bell: Used to identify lower-frequency sounds such as atrial and ventricular gallops.

Question 2

What are the main steps in heart auscultation?

Answer 2

• listen over the 4 designated areas systematically
• assess rate, rhythm, and for extra sounds or murmurs

Question 3

What is the S1 heart sound and what does it signify?

Answer 3

S1 is the ‘lub’ sound, signifying the closure of the mitral and tricuspid valves and the onset of ventricular systole.

Question 4

What is the S2 heart sound and what does it signify?

Answer 4

S2 is the ‘dub’ sound, signifying the closure of the aortic and pulmonary valves and the onset of ventricular diastole.

Question 5

What causes the S1 heart sound?

Answer 5

The closure of the mitral and tricuspid valves.

Question 6

What causes the S2 heart sound?

Answer 6

The closure of the aortic and pulmonary valves.

Question 7

What is the characteristic difference between S1 and S2?

Answer 7

• S1 has a lower pitch and longer duration.
• S2 has a higher pitch and shorter duration.

Question 8

What is an S3 heart sound?

Answer 8

S3 - An extra heart sound heard during early diastole, associated with increased ventricular compliance (can be normal in children).

Question 9

What is an S4 heart sound?

Answer 9

S4 - An extra heart sound heard before S1, associated with atrial contraction into a stiff ventricle.

Question 10

What conditions are associated with an S4 heart sound?

Answer 10

• hypertension
• hypertrophic heart disease
• pulmonary disease
• myocardial infarction

Question 11

What is a ventricular gallop?

Answer 11

An S3 (lub-dub-dub / Ken-Tu-Cky)
heart sound, commonly found in ventricular failure.

Question 12

What is an atrial gallop?

Answer 12

An S4 (la-lub-dub / Ten-Ne-See)
heart sound, associated with a stiff or hypertrophic ventricle.

Question 13

What is a heart murmur?

Answer 13

• A longer-duration sound caused by the disruption of blood flow, such as through a stenotic or regurgitant valve.
• “Soft, blowing, or swishing”

Question 14

What causes a systolic murmur?

Answer 14

• Typically due to ejection or regurgitation between S1 and S2, heard as a ‘swishing’ sound.

Question 15

What causes a diastolic murmur?

Answer 15

Caused by aortic or pulmonary regurgitation or mitral stenosis, heard immediately following S2.

Question 16

What is a mitral valve prolapse?

Answer 16

A condition where the mitral valve does not close properly, causing a clicking sound during systole.

Question 17

What are vesicular breath sounds?

Answer 17

Soft, low-pitched sounds heard during inspiration over distal airways.

Question 18

What are bronchial breath sounds?

Answer 18

Loud, tubular sounds normally heard over the trachea, with a shorter inspiratory phase.

Question 19

What are bronchovesicular breath sounds?

Answer 19

• softer than bronchial sounds
• heard over the mainstem bronchi
• continuous between inspiration and expiration

Question 20

Differences between diminished and absent breath sounds?

Answer 20

a) Diminished breath sounds: Breath sounds that are less intense than expected, often due to conditions like hyperinflation or obesity.

b) Absent breath sounds: No audible breath sounds, often due to lobectomy, morbid obesity, or pneumothorax.

Question 21

What does it mean when bronchial breath sounds are heard outside their normal location?

Answer 21

This indicates consolidation or compression of lung tissue, facilitating sound transmission.

Question 22

What are adventitious breath sounds?

Answer 22

Abnormal sounds such as crackles, wheezes, and pleural friction rubs.

• Adventitious - “added sounds”

Question 23

What are crackles (rales)?

Answer 23

Discontinuous, high-pitched popping sounds, often associated with fluid or secretions in the lungs.

Question 24

What causes wet and dry crackles?

Answer 24

• Wet: Conditions like pulmonary edema or pleural effusion, where fluid is present in the lungs.
• Dry: Caused by the sudden opening of closed airways, seen in atelectasis or pulmonary fibrosis.

Question 25

What are wheezes?

Answer 25

Continuous high- or low-pitched sounds, often heard during exhalation, indicating airway obstruction.

Question 26

What are **Rhonchi** and **Stridor**?

Answer 26

* **Rhonchi**: Low-pitched continuous sounds associated with mucus, common in chronic bronchitis or pneumonia. * **Stridor:** A severe, high-pitched wheeze heard in the upper airway, often due to obstruction and considered an emergency.

Question 27

What is pleural friction rub?

Answer 27

A sound resembling two pieces of leather rubbing together, associated with pleural inflammation.

Question 28

What is bronchophony?

Answer 28

Increased vocal resonance with greater clarity and loudness, indicating lung consolidation.

Question 29

What is egophony?

Answer 29

A form of bronchophony where the '**E**' sound changes to a nasal '**A**', indicating consolidation.

Question 30

What is whispered pectoriloquy?

Answer 30

Clearer, louder recognition of whispered words, indicating lung consolidation.

Question 31

How do you auscultate the lungs?

Answer 31

* place the diaphragm on the chest wall * start at the apices * compare symmetrical points * listen to at least one full breath cycle

Question 32

What precautions should you take when performing lung auscultation?

Answer 32

Prevent patient dizziness, drape appropriately, and ensure deep breaths through the mouth.

Question 33

What are normal vesicular breath sounds?

Answer 33

* soft, low-pitched sounds during inspiration with a 3:1 inspiration to expiration ratio.

Question 34

What are abnormal bronchial breath sounds?

Answer 34

Heard outside of the tracheal area, indicating conditions like consolidation or compression.

Question 35

What is the significance of diminished or absent lung sounds?

Answer 35

**Diminished**: Sounds less then what you would expect in the area * pain * not taking deep enough breath * hyperinflation/emphysema (lesser) * obesity (further away from chest wall d/t adipose tissue and harder to breath)  **Absent**: don't hear anything  * Lobectomy, nothing to hear * morbid obesity * mucus plugging has blocked airway completely * pneumothorax with air in space 

Question 36

How can abnormal voice sounds help in diagnosis?

Answer 36

Increased vocal resonance, as in bronchophony or egophony, indicates consolidation or atelectasis.

Question 37

What is the significance of stridor in lung auscultation?

Answer 37

It indicates a life-threatening upper airway obstruction and requires immediate intervention.

Question 38

What is the difference between wet and dry crackles?

Answer 38

* **Wet** crackles are due to fluid in the lungs * **Dry** crackles result from sudden airway opening.

Question 39

What is the purpose of lung auscultation?

Answer 39

* to confirm findings from the chart * rule out dysfunction * assess ventilation after treatment