Heart and lung sounds

Question 1

Crackles

Answer 1

Coarse crackles or crepitations are associated with bronchiectasis or resolving pneumonia,

fine crackles can be heard with either pulmonary oedema or interstitial fibrosis.

Question 2

Stridor

Answer 2

Stridor is a loud, high-pitched, musical sound produced by upper respiratory tract obstruction.[4] It is different from wheezing by the following reasons. It is louder over the neck than chest wall. Secondly; stridor is mainly inspiratory.[1]

Question 3

Pleural rub

Answer 3

A discontinuous grating sound or creak in phase with breathing that occurs in the presence of pleural inflammation. Friction rubs are heard better when the stethoscope is applied firmly to the chest wall. Pleural rubs must be distinguished from similar sounds produced by movement of the scapula, ribs and thoracic musculature under the stethoscope. The latter disappear on repositioning of the stethoscope, changing pressure of application to the chest wall or by repositioning of the patient.

Question 4

Finger clubbing has a number of causes including

Answer 4

infective endocarditis and cyanotic congenital heart disease

Question 5

Collapsing pulse – associated

Answer 5

with aortic regurgitation

Question 6

Auscultate the four valves

Answer 6

1. Palpate the carotid pulse to determine the first heart sound.
2. Auscultate ‘upwards’ through the valve areas using the diaphragm of the stethoscope:

Mitral valve – 5th intercostal space – midclavicular line (apex beat)

Tricuspid valve – 4th or 5th intercostal space – lower left sternal edge

Pulmonary valve – 2nd intercostal space – left sternal edge

Aortic valve – 2nd intercostal space – right sternal edge

In other words Nipple , left side sternum, upper left sternum, upper right sternum

Question 7

Repeat auscultation across the four valves with

Answer 7

the bell of the stethoscope.

4. Auscultate the carotid arteries with the patient holding their breath to check for radiation of an aortic stenosis murmur (this is known as an accentuation manoeuvre).
5. Sit the patient forwards and auscultate over the aortic area during expiration to listen for the murmur of aortic regurgitation (this is known as an accentuation manoeuvre).
6. Roll the patient onto their left side and listen over the mitral area with the bell during expiration for mitral murmurs (regurgitation/stenosis).