Clinical Utility of Chest Auscultation in Common Pulmonary Disease

Questions and Answers

What is the typical pitch range of wheezes?

≥400 Hz (correct)

200-350 Hz

100-150 Hz

150-200 Hz

What is the typical duration range of wheezes?

<50 ms

>80 ms (correct)

100-150 ms

50-80 ms

Which of the following lung sounds is typically associated with secretions in large airways?

Fine late inspiratory crackles

Rhonchi (correct)

Crackles

Wheezes

Which of the following lung sounds is typically associated with abnormal lung tissue?

Fine late inspiratory crackles Signup and view all the answers

Which of the following lung sounds is typically associated with bronchitis or atelectasis?

Wheezes that clear after coughing Signup and view all the answers

Which of the following lung sounds is typically associated with heart failure?

Crackles in the posterior inferior lung fields Signup and view all the answers

What is a key characteristic of the 'silent chest' in severe asthma?

Absence of wheezes and breath sounds Signup and view all the answers

What lung condition can be mistaken for wheezing when originating in the neck?

Stridor Signup and view all the answers

Which technique can help differentiate between true wheezes and laryngeal sounds?

Assessing transmitted voice sounds Signup and view all the answers

In what lung condition might you hear pleural rubs primarily during expiration?

Pleurisy Signup and view all the answers

What is a characteristic feature of rhonchi when assessing abnormal lung sounds?

Loud sounds over the neck Signup and view all the answers

How can you differentiate transmitted voice sounds from abnormally located bronchovesicular breath sounds?

Using three specific techniques Signup and view all the answers

Which statement about crackles (rales) is correct?

Fine crackles have a higher pitch and shorter duration than coarse crackles. Signup and view all the answers

Which of the following conditions can cause crackles?

All of the above Signup and view all the answers

Which characteristic best describes wheezes?

Continuous and sinusoidal Signup and view all the answers

According to the American Thoracic Society, how should the term 'rhonchi' be used?

It should be used to describe continuous, low-pitched wheezes. Signup and view all the answers

Which of the following is NOT a characteristic of adventitious (added) breath sounds?

They are musical and continuous throughout the respiratory cycle. Signup and view all the answers

What is the primary focus of auscultation during a pulmonary examination?

Identifying adventitious (added) breath sounds Signup and view all the answers

Study Notes

Types of Lung Sounds

Wheezes: relatively high-pitched (≥400 Hz) with hissing or shrill quality (>80 ms), arise in narrowed airways of asthma, COPD, and bronchitis
Rhonchi: relatively low-pitched (150–200 Hz) with snoring quality (>80 ms), often used to describe sounds from secretions in large airways that may change with coughing

Characteristics of Crackles

Fine late inspiratory crackles that persist from breath to breath suggest abnormal lung tissue
Crackles in dependent portions of the lungs may occur after prolonged recumbency
Clearing of crackles after coughing or position change suggests inspissated secretions, seen in bronchitis or atelectasis

Wheezes and Rhonchi

Wheezes or rhonchi may change with deep breathing or coughing
Beware of the silent chest, in which air movement is minimal, a clinical emergency
Findings predictive of COPD include combinations of symptoms and signs, especially dyspnea and wheezing, plus >70 pack-years of smoking, history of bronchitis or emphysema, and decreased breath sounds

Pleural Rubs

Coarse, grating biphasic sounds heard primarily during expiration
May be heard in pleurisy, pneumonia, and pulmonary embolism

Adventitious Sounds

Detection of adventitious sounds is an important focus of the examination, often leading to diagnosis of cardiac and pulmonary conditions
The most common adventitious sounds are crackles (or rales), wheezes, and rhonchi
Crackles can arise from abnormalities of the lung parenchyma (pneumonia, interstitial lung disease, pulmonary fibrosis, atelectasis, heart failure) or of the airways (bronchitis, bronchiectasis)

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Description

Learn about the clinical utility of chest auscultation in common pulmonary diseases with a focus on detecting adventitious sounds like crackles, wheezes, and rhonchi, which can lead to the diagnosis of cardiac and pulmonary conditions. Understand the importance of detecting these sounds during examinations.