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Cardiopulm 2 > Heart & Lung sounds > Flashcards

Heart & Lung sounds Flashcards

1
Q

normal S1 heart sound

A

“lub”

mitral and tricuspid valves closing at onset of ventricular systole (muscular contraction phase of cardiac cycle- begins at end of diastole)

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2
Q

normal S2 heart sound

A

“dub”

aortic & pulmonic valves closing at onset of diastole (period of relaxation & filling)

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3
Q

abnormal S3 heart sound

A

= ventricular gallop
association with early rapid passive filling of the ventricles immediately after the MV and TV open.
Most frequently associated with: heart failure, although it may occur normally in children & young adults up to age 40.
abnormal in older adults; noncompliant LV, maybe associated with CHF.

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4
Q

abnormal S4 heart sound

A

=atrial gallop
Pathological sound of vibration or ventricular wall with ventricular filling.
May be associates with HTN, stenosis, hypertensive heart disease or MI
“atrial kick” indicates elevated atrial pressure

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5
Q

murmurs

A

due to turbulent blood flow; usually heard as a “whooshing” sound
can be normal or pathological

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6
Q

3 categories of murmurs

A

1: caused by high rates of flow through normal or abnormal valves
2: caused by forward flow through a stenotic or deformed valve
3: caused by backward flow through a valve (regurgitation)

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7
Q

examine the chest

A
  • observe body type
  • overall posture
  • chest type- barrel, excavatum, scoliosis, kyphosis
  • look for symmetry
  • coloration
  • scars
  • abnormal movements
  • muscle contractions
  • comfortable? facial expression?
  • extremities- hairy?scars?
  • skin color?
  • fingers for clubbing
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8
Q

schamroth’s sign

A

indicates clubbing of fingers

putting 2 fingers together- should be a diamond shaped space= Schamroth’s window.

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9
Q

intercostal indrawing

A

can visibly see intercostal spacing between ribs bc breathing is so tough. spaces are drawn inwards on inspiration- especially with inspiratory effort.

seen in patients with severe obstructive disease

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10
Q

signs of respiratory problems

A 
"bad cat"
B= breathing that is audible
A= active accessory muscles
D=dyspnea
C=cyanosis or clubbing
A=anterior/posterior diameter >1
T=tracheal deviation from midline
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11
Q

posterior superior border of lungs

A

T3-T4

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12
Q

posterior inferior border of lungs

A

T10

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13
Q

anterior apex of lungs

A

2-3 cm above middle third clavicle

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14
Q

anterior lower border of lungs

A

medial: 6th rib
Lateral: 8th rib

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15
Q

lateral border of lungs

A

vertical lines just anterior and posterior to deltoid from axillary lines

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16
Q

oblique fissure

A

from T3 SP to anterior 6th intercostal space at midclavicular line

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17
Q

horizontal fissure

A

divides anterior portion of R lung into upper and middle lobes

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18
Q

respiratory rhythm

A

test position: seated

  • note rhythm- regular? irregular?
  • count for 30-60 seconds

normal findings:

  • expiration 2 times longer than inspiration
  • signing normal
  • adult rate=9-10/hr; can occur on inspiration or expiration
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19
Q

apnea

A

temporary cessation of breathing at the end of a normal expiration

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20
Q

blot’s breathing

A

characterized by repeated sequences of deep gasps and apnea

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21
Q

eupnea

A

normal quite breathing

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22
Q

hyperpnea

A

breathing that is regulated to meet an increase demand by the body for oxygen

23
Q

dyspnea

A

labored or difficult breathing (usually associated with lung or heart disease and resulting in SOB)

24
Q

respiratory arrest

A

failure to resume breathing following a period of apnea, or apneusis

25
Q

apneusis

A

sustained, gasping inspiration followed by short, inefficient expiration, which can continue to the point of asphyxia. often associated with lesions in the respiratory center in the brain
cessation of breathing in the inspiratory phase

26
Q

Cheyne-stokes breathing

A

periodic type of abnormal breathing often seen in terminally ill or brain-damage patients.

characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing- apnea.
Pt repeats, with each cycle usually taking 20 seconds to 2 minutes.
It is oscillation of ventilation between apnea and hypernea with a crescendo-decrescendo pattern

27
Q

breathing patterns

A

chest breather

diaphragmatic breather

28
Q

respiratory depth & symmetry of movement

A

test position: seated
-place hands at upper lobes, middle lobe, and posterior lower lobe during rest and inspiration

normal findings: symmetric, 3-5 cm expansion

positive findings:

  • less than 3 cm of movement
  • unilateral delay suggests atelectasis, pneumonia, and post op guarding
29
Q

thoracic excursion with tape measure

A

test position: standing

  • measure circumference at T5 and 3rd intercostal space
  • measure circumference at T10 and tip of xiphoid

Instruct pt to take full inspiration and hold; fully exhale and hold

Normal findings: for healthy adult males

  • upper chest 3.6 (+/- 0.6)
  • lower chest 4.9 (+/-0.6)

positive findings: >1.7 cm

30
Q

listening to breath sounds: preparation of the patient

A
  • teach importance of deep breathing through the mouth-my hyperventilate, get dizzy
  • report dizziness or fatigue during deep breathing
31
Q

breath sounds

A

generated by the vibration and turbulence of air flowing in and out of the airways and lung tissue during inhalation and exhalation

32
Q

4 normal breath sounds

A

1: tracheal
2: bronchial
3: vesicular
4: bronchovesicular

have pt do at least 1 full breath when listening to each area
L to R, hear both lobes

33
Q

tracheal breath sound

A

high pitched and loud (~wind blowing through a pipe) heard over trachea alone

34
Q

bronchial breath sound

A

heard adjacent to the sternum and over major airways; similar to tracheal sound but not as loud.
Louder on expiration than inspiration.

When heard in other areas, are abnormal; may be due to consolidation, compressed or airless tissue.

35
Q

vesicular breath sound

A

low pitched and muffled
“soft” sound compared to sound of wind blowing through the leaves of a tree.
inspiration is louder, longer and higher pitched than expiration (very brief)

normal in all area of lung except over trachea.
sound heard over the chest at a distance of large airways.

*most common sound heard in the absence of lung disease

36
Q

bronchovesicular

A

inspiration/expiration are similar lengths at the same pitch with a slight break between the two.
normal when heard adjacent to sternum, at costo-sternal border or between scapulae at T3-T6

37
Q

abnormal breath sounds

A

1: find crackle
2: wheezing
3: coarse crackle

38
Q

fine crackle lung sounds

A

“discontinuous” (intermittent) “explosive” sounds

  • high pitched
  • heard in atelectasis, interstitial pulmonary fibrosis and sometimes in healthy people
39
Q

wheezing (Rhonchi)

A

continuous high, medium or low pitched whistling sounds

  • caused by airway narrowing (bronchospasms), secretions
  • heard on either inspiration or expiration or both
  • expiratory more common- associated with diffuse airway obstruction- ex: in CF or chronic bronchitis

“musical snoring”

40
Q

coarse crackle lung sounds

A

intermittent “bubbling” sound
-caused by secretions in the airway

hear in pathological condition

41
Q

voice sounds

A

used in examination of the chest to determine the presence/absence of consolidation

consolidation=something in the lung
-pneumonia, cancer, hemothorax
something dense filling air space

42
Q

types of voice sounds

A

1: egophony
2: bronchophony
3: whispered pectoriloquy
4: fremitus

43
Q

egophony

A
  • listen to chest with stethoscope
  • ask patient to say the letter “E”

normal findings: will sound like muffled long E sound

In presence of pneumonia or cancer (consolidation of lung tissue) will hear a higher pitched sound like “a”
-physician refers to this as “E to A changes”

44
Q

bronchophony

A
  • listen with stethoscope to symmetrical areas of the patient’s lung
  • ask pt to repeat a word (99, or 66)
  • In normal tissue, sound becomes less distinct (quieter) as move to periphery of lungs; muffled, indistinct sounds
  • in presence of pneumonia or cancer, voice remains loud or becomes louder in periphery; 99 sounds normal
  • may be noted as “increased breath sounds”

consolidation will stay loud or get louder
compare sides

45
Q

whispered pectoriloquy

A
  • refers to the loudness of a whispered voice while listening to the lungs with a stethoscope
  • ask pt to whisper “1,2,3” repeatedly

Normal: whispered sounds would be faint or not heard

In presence of pneumonia or cancer, they are heard

46
Q

voice fremitus

A

vibration

  • vocal or tactile fremitus is the vibration produced by the voice and transmitted to the chest wall
  • PT evaluates fremitus by comparing the intensity of the vibrations detected by each hand during quiet breathing and speech

Normal: equal & moderate vibrations are noticed during speech

Abnormal: when it is increased or decreased

  • increased fremitus indicates a loss or decrease in ventilation in the underlying lung
  • decreased indicates increased air within the lung bc sound is similarly transmitted more poorly through a hyperinflated lung
47
Q

tactile fremitus

A

position: seated

action: place ulnar hand over posterior thorax between spinous processes & scapula
- repeat on anterior chest at supraclavicular area, lateral to sternum, below T4

patient repeats “99” and examiner notes bilateral differences

Normal: moderate vibration palpable

  • usually stronger in upper chest between scapulae & SP and on R vs L
  • low pitched voice generates more fremitus than high pitched
  • thin chest wall allows for greater feeling of fremitus than muscular or obese chest wall
48
Q

percussion

A

position:
- post thorax: seated with arms crossed
- ant thorax: supine

Normal:

  • sounds specific to anatomical locations heard only on those locations
  • anterior: dullness noted in R midclavicular line from T4 to liver
  • anterior: dullness in 3rd to 5th intercostal space (heart)
49
Q

percussion sounds

A

1: resonant: loud, low pitch
2: hyper-resonant
3: tympanic
4: dull
5: flat

50
Q

resonant percussion sound

A 
location: normal lung tissue
loud intensity
low pitch
hollow
long duration
sounds like: normal peripheral lung
51
Q

hyper resonant percussion sound

A

very loud intensity
lowest pitch
longer duration
sounds like: knocking on empty barrel

possible pathologies:
-air trapping (asthma, emphysema, pneumothorax, pleural effusion)

52
Q

tympanic percussion sounds

A 
location: stomach or GI tract (air bubble)
loud or very loud intensity
musical or high pitch
medium duration
sounds like: drum

possible pathologies:

  • large pneumothorax
  • emphysematous bleb
53
Q

dull percussion sound

A 
location: liver
medium intensity
medium-high pitch
thud like
medium duration
sounds like: knocking on a full barrel

possible pathologies:

  • solid or fluid in air space due to pleural effusion
  • hemothorax
  • emphysema
  • consolidation
  • mass
54
Q

flat percussion sound

A 
location: thigh
soft intensity
high pitch
short duration
sounds like: duller than dull

possible pathologies:

  • massive atelectasis
  • large pleural effusion
  • pneumonectomy

Cardiopulm 2 (13 decks)

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