Pulmonary Breath Sounds Quiz

Pulmonary Breath Sounds

• Tracheal: Normal air movement through the trachea; loud, high pitched, equal inspiratory/expiratory phases (1:1), heard directly over the trachea.
• Bronchial: Air moving through large airways; high pitched, hollow, louder expiration than inspiration (1:2), heard in upper sternum and between scapulae.
• Bronchovesicular: Air movement in mid-sized airways; moderate pitch and intensity, equal inspiratory/expiratory phases (1:1), heard in peripheral lung fields.
• Vesicular: Air moving through small airways; soft, low pitched, longer inspiration than expiration (3:1), heard in peripheral lung fields.
• Crackles/Rales: Fluid or alveolar popping, representing wetness in the airways; continuous, heard during inspiration, associated with pneumonia, heart failure, pulmonary fibrosis.
• Wheezes/Rhonchi: Airflow obstruction, usually heard during exhalation (bronchoconstriction/secretions); continuous, high pitched musical sound (wheezes), or lower pitched snoring sound (rhonchi), heard in asthma, COPD, bronchitis.
• Stridor: Airflow obstruction at upper airway; continuous, high pitched, heard during inspiration/exhalation; associated with epiglottis, foreign body, laryngeal edema.
• Pleural Rub: Visceral and parietal pleura rubbing together; continuous, creaking or grating sound, heard during inspiration and exhalation, associated with pleuritis, pleural effusion.

Mediate Percussion

• Resonant: Loud/low pitched, heard over air-filled lungs.
• Hyper Resonant: Very low pitched, heard over tissue with decreased density (ex diseased lungs, emphysema).
• Tympanic: High pitched, heard over hollow organs.
• Dull: Low amplitude medium to high pitched, over solid organs.
• Flat: Very dull sound/high pitch, over very dense tissues/muscle.

Lung Diseases/Pathology

• Bronchitis: Airway disease, inflammation of bronchi, obstruction of airways, alveolar wall destruction, often associated with a barrel chest, faster shallow breathing, and increased vibration over mucosal areas.
• Emphysema: Abnormal, irreversible enlargement of airways distal to terminal bronchioles, decreased breath sounds, often associated with a barrel chest and pursed lips.
• Asthma: Chronic inflammation of airways, reversible obstruction to airflow, bronchospasm, often associated with wheezing exhalation greater than inhalation.
• Bronchiectasis: Abnormal permanent dilation of bronchi/bronchioles, chronic inflammation/infection, destruction of elastic and muscular, often associated with more air in lungs and hyper resonant sounds.
• Cystic Fibrosis: Thick, excessive secretions and poor ciliary function, obstruction of small bronchi, affects bronchial hygiene, often associated with a barrel chest, faster shallow breaths, and increased vibration over mucosal areas.
• Bronchopulmonary Dysplasia (BPD): Underdeveloped lungs, inflammation and scarring of the lungs, often in children, often associated with mechanical ventilation.
• Pulmonary Fibrosis: Restrictive, inflammation of alveolar wall, scarring, stiffness, and decreased compliance, often associated with diminished breath sounds.
• Pneumonia: Restrictive, inflammation of the lung, crackles and low-pitched wheezing, bronchial breath sounds over area of consolidation.
• Acute Respiratory Distress Syndrome (ARDS): Restrictive, sudden respiratory failure, diffuse crackles, wet breath sounds, decreased breath sounds.
• Lung Carcinoma: Restrictive, malignant lung tumor, diminished breath sounds, crackles/wheezing.
• Pleural Effusion: Restrictive, fluid in the pleural space, decreased breath sounds, pleural rub.
• Atelectasis: Restrictive, partial or total collapse of alveoli/lung segments, diminished or absent breath sounds.
• Pneumothorax: Restrictive, presence of air in the pleural cavity, Hemothorax is blood in pleural cavity, often associated with absent or diminished breath sounds.
• Tuberculosis: Infection of the lungs, often associated with crackles and bronchial breath sounds.

COVID-19

• Hypoxemic disease, can progress to ARDS, scarring in the lungs, fever, chills, shortness of breath, cough, fatigue, body/muscle aches, headaches, loss of taste/smell.

Diagnostic Testing

• Pulmonary Function Tests (PFTs): Used to diagnose and monitor respiratory symptoms and disease. Measures volume and flow of air. Includes FEV1, FEV1/FVC, RV, TLC, and other tests that show obstruction or restriction.

Additional

• ABGs: Could be an early sign of interstitial lung disease (ILD). Important values are pH (7.35-7.45), PCO2 (35-45), PO2 (80-100), HCO3 (22-28), Hgb (12-16).
• Oxygenation Status: Normal PO2 values are 80-100. Mild/Moderate/Severe Hypoxemia means PO2 is around 60-80, 40-60, and under 40 mmHg respectively.
• Imaging: includes radiographs (x-rays), and CT scans.
• Pulmonary Angiogram: Catheter with dye injected into the heart to see how dye moves through lungs arteries to diagnose blockages.
• Bronchoscopy: visualizes bronchial tree using scope for diagnostic and therapeutic purposes.
• Radionuclide V/Q Scans: Ventilation and perfusion scan should match; poor ventilation or perfusion suggests airway obstruction or PE (pulmonary embolism).
• Lung Volumes/Capacities: Includes tidal volume, inspiratory reserve volume, expiratory reserve volume, residual volume, inspiratory capacity, functional residual capacity, and vital capacity.
• Surgical Interventions: Includes Wedge Resection, Bullectomies, Lobectomies, and Pneumonectomies.
• Lung Transplant: Advanced stage pulmonary disease, absolute and relative criteria.
• Positive Pressure Ventilation: includes Constant Pressure, Positive End Expiratory Pressure (PEEP), Continuous Positive Airway Pressure (CPAP).
• Negative Pressure Ventilation: Iron lung, vacuum pump created negative pressure chamber.
• Ventilator Alarms: High pressure, Low pressure, Apnea.
• Oxygen Therapy: Indications include, Hypoxemia, Increased work of breathing, and Increased myocardial work.
• Cough Maneuvers: Aimed at removing secretions from the lungs using forceful exhalation.
• Active Cycles of Breathing (ACB): Series of 3 steps to facilitate breathing control through inspiratory, thoracic, and expiratory exercises.
• Autogenic Drainage (AD): Use of controlled breathing to mobilize secretions to remove mucus from lungs using varying degrees of expiratory airflow.
• Paced Breathing: Facilitates diaphragmatic breathing, paired with breathing and activity, with specific instructions for inspiration and expiration.