Question 1

What are the normal breath sounds heard during respiratory auscultation?

Accepted Answer

Normal breathing produces two distinct breath sounds: bronchial sound, which is tubular and hollow, heard over large airways in the anterior chest; and vesicular sound, which is soft, low-pitched, and rustling, heard over most lung tissue. Both sounds should be symmetrical when comparing side-to-side during auscultation and working mechanism of a stethoscope assessment.

Question 2

How do you perform percussion on the respiratory system?

Accepted Answer

Ask the patient to sit upright or lean forward. Place your non-dominant hand's middle finger firmly over the mid-back, then tap it twice with your dominant hand's middle finger. Repeat at four to five levels posteriorly, then anteriorly, comparing side-to-side. Ensure the middle finger rests in intercostal spaces, not on ribs, to accurately assess percussion sounds.

Question 3

What do abnormal percussion sounds indicate about lung pathology?

Accepted Answer

Dullness during percussion suggests solid tissue or fluid accumulation, such as pleural effusion. Hyper-resonance indicates hollow spaces or air trapping, suggesting pneumothorax. Normal air-filled lungs produce resonant, low-pitched, hollow sounds. Tympanic notes resemble drum sounds and occur over hollow spaces like Traube's space.

Question 4

What abnormal breath sounds indicate airway obstruction or fluid?

Accepted Answer

Crackles, also called rales, indicate fluid in small airways. Wheezes or rhonchi suggest airway constriction or swelling causing partial obstruction. Stridor indicates upper airway obstruction. Pleural rubs occur when inflamed pleural surfaces slide against each other during respiration. These abnormal sounds help identify specific pulmonary conditions during clinical percussion examination.

Question 5

How do you assess for lung consolidation during auscultation?

Accepted Answer

Three tests identify consolidation: bronchophony—ask the patient to say "99" and listen for increased sound transmission; egophony—ask for "E" and listen for it changing to "A" through the stethoscope; and whispering pectoriloquy—ask the patient to whisper "99" and listen for clearer sound transmission. Perform these tests posteriorly at multiple locations covering the entire lung area.

Question 6

What is the anatomical relationship between lung lobes and the chest wall?

Accepted Answer

The right lung has three lobes—superior, middle, and inferior—separated by horizontal and oblique fissures. The left lung has two lobes—superior and inferior—separated by an oblique fissure. Each lobe projects beneath the chest wall and corresponds to specific percussion and auscultation zones. Understanding this anatomy helps clinicians locate pathology during respiratory exam inspection and palpation.

Question 7

What pulmonary conditions can be diagnosed through percussion and auscultation?

Accepted Answer

Percussion and auscultation can identify chronic obstructive pulmonary disease, asthma, pneumonia, and pneumothorax. Abnormal sounds and percussion notes provide almost immediate diagnostic clues. With practice, clinicians develop the ability to recognize characteristic sound patterns associated with specific lung pathologies, enabling spot diagnosis at the bedside.

Odgłosy oddechu	Opis
Oskrzelowe	Ostre lub puste dźwięki oddechu, podobne do tych, które usłyszysz, jeśli umieścisz stetoskop nad tchawicą lub głównymi oskrzelami. W innych obszarach mogą one być oznaką konsolidacji
Oskrzelowo-pęcherzykowa	Normalne na dużych drogach oddechowych i mostku, nienormalne w innych obszarach
Trzaski, trzaski lub zgrzyty	Spowodowane przez płyn w drogach oddechowych i są częściej słyszane podczas wdechu u podstawy płuc. Można je sklasyfikować jako grzywnę; które są miękkimi, krótkimi, wysokimi dźwiękami lub "trzaskami" lub szorstkimi; które są głośniejsze i niższe niż drobne trzaski. Delikatne trzaski słychać w zwłóknieniu płuc i trzeszczenia przebiegu w POChP i zapaleniu płuc. Zwróć uwagę na czas trzasków. Zastoinowa niewydolność serca zazwyczaj powoduje późne trzaski
Świszczący oddech	Charakterystyczny, wysoki, ciągły dźwięk słyszalny w astmie i POChP
Rhonchi	Niski dźwięk "chrapania", który może być osłuchiwany w dowolnym stanie powodującym reaktywną chorobę dróg oddechowych, w tym zapalenie płuc, POChP i CHF
Stridor	Nienormalny, wysoki dźwięk generowany przez górne drogi oddechowe, zwykle podczas wdechu (często jest to nagły przypadek medyczny)
Rub	Spowodowane ocieraniem się o siebie powierzchni opłucnej (tarcie opłucnej) i słyszalne częściej w zapaleniu opłucnej, a także w innych stanach, takich jak zapalenie osierdzia

Badanie oddechowe II: Udar i osłuchiwanie

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