20 Questions
What is the primary purpose of auscultation in a cardiovascular and pulmonary physical therapy evaluation?
To identify abnormal heart sounds and diagnose cardiovascular conditions
Which of the following heart sounds occurs during ventricular systole?
S1
What is the underlying cause of an S3 heart sound?
Enlarged ventricle chamber that is weak and overly compliant
What type of heart muscle is associated with diastolic dysfunction?
Thick and overly stiff
What is the primary function of the diaphragm on a stethoscope?
To detect high frequency sounds
Which of the following is NOT a component of a complete cardiovascular and pulmonary physical therapy evaluation?
Pharmacological interventions
What is the primary difference between an S3 and an S4 heart sound?
S3 occurs after S2, while S4 occurs before S1
During heart auscultation, what is the correct position of the patient?
Supine and breathing normally
What is the location of the mitral valve sound during heart auscultation?
Left, 5th intercostal space, midclavicular
What is the objective of the 7250.8 evaluation?
To demonstrate a complete and safe cardiovascular and pulmonary physical therapy evaluation
What is the term for the vibration from turbulent flow that creates a blowing, whooshing, or rasping sound heard during a heartbeat?
Murmur
What is the abbreviation used to remember the locations of heart auscultation?
APTM
Which type of normal lung sound is characterized by a soft, low-pitched inspiration sound that is greater than expiration sound?
Vesicular
In which location are bronchovesicular lung sounds typically auscultated?
Manubrium, right and left main bronchus
What is the characteristic of bronchial lung sounds?
Harsh, high-pitched expiration sound
What is the common cause of decreased or absent bronchial lung sounds in peripheral lung fields?
Elderly, obese, emphysema, or pleural dysfunction
What is the characteristic of fine crackles?
High-pitched, similar to fire popping or Velcro
What is the characteristic of rhonchi?
Low-pitched, continuous sound
What should the patient be positioned in during lung auscultation?
Sitting
What should be avoided during lung auscultation?
All of the above
Study Notes
Heart Auscultation
- Objective 7250.8: Demonstrate a complete and safe cardiovascular and pulmonary physical therapy evaluation in a simulated environment.
- Normal heart sounds:
- S1: AV valves closing, ventricular systole
- S2: SL valves closing, ventricular diastole
- Abnormal heart sounds:
- S3 (Ventricular gallop): occurs after S2, blood sloshing in, creating turbulence, systole dysfunction, enlarged ventricle chamber
- S4 (Atrial gallop): occurs before S1, blood hits resistance, creating turbulence, diastolic dysfunction, thick and stiff heart muscle
- Murmur: vibration from turbulent flow, blowing, whooshing, or rasping sound heard during a heartbeat, common causes are valve dysfunctions or septal defects
- Pericardial friction rub
- Stethoscope:
- Diaphragm is better for high frequency (S1, S2)
- Bell is better for low frequency (S3, S4)
- Heart auscultation procedure:
- Patient is supine, breathing normally (or seated)
- Explain the procedure
- Place the diaphragm on the skin over 4 locations (APTM)
- Repeat with the bell at all four locations
- Auscultation locations:
- Aortic: Right, 2nd intercostal space, parasternal
- Pulmonary: Left, 2nd intercostal space, parasternal
- Tricuspid: Left, 5th intercostal space, parasternal
- Mitral (apex): Left, 5th intercostal space, midclavicular
- Heart auscultation documentation:
- “Normal S1 and S2, with regular rate and rhythm. No splitting of the heart sounds heard. No murmur. No S3 or S4, no friction rub.”
Lung Auscultation
- Normal lung sounds:
- Vesicular: peripheral lung fields, soft, low-pitched, inspiration sound > expiration
- Bronchovesicular: manubrium, right and left main bronchus, inspiration sound = expiration
- Bronchial: trachea, harsh, high-pitched, expiration sound ≥ inspiration
- Abnormal lung sounds:
- Bronchial in peripheral lung fields: consolidation due to pneumonia
- Decreased or absent sounds: elderly, obese, emphysema, pleural dysfunction
- Adventitious lung sounds:
- Crackles (rales): discontinuous sounds, high-pitched (fine) or low-pitched (coarse)
- Wheezes (rhonchi): continuous sounds, high-pitched (fine) or low-pitched (coarse)
- Pleural friction rub: leather on leather sound, inflamed pleural
- Lung auscultation procedure:
- Ideally, patient is positioned in sitting
- Explain the procedure
- Instruct patient to take deep breaths
- Let the patient rest after 5-6 breaths
- Auscultate over each area shown
- Listen during the entire breathing cycle
- Lung auscultation charting:
- “Vesicular breath sounds in all peripheral lung fields; no rales, wheezes, or friction rub.”
- “High-pitched inspiratory crackles heard over bilateral lower lobes.”
Heart auscultation is a crucial part of physical therapy evaluation. This quiz covers normal and abnormal heart sounds, including S1, S2, S3, and S4, and their significance in cardiovascular health.
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