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- What does the S1 sound signify?
- Where is it auscultated?
- What is used to listen to it? What does it sound like?
- What are abnormal sounds? What does it indicate?
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- Mitral (1º) and tricuspid (2º) valve closure, onset of systole
- Mitral area; 5th intercostal space, (L) mid-clavicular line
- The diaphragm; Lub (short pause 2º short duration of systole)
- "Swooshing" is indicative of a murmur
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- What does the S2 sound signify?
- Where is it auscultated?
- What is used to listen to it? What does it sound like?
- What are abnormal sounds? What does it indicate?
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- Aortic (1º) and pulmonary (2º) valve closure, onset of diastole
- Aortic area; (R) sternal border, 2nd intercostal space
- The diaphragm; Dub (long pause 2º long duration of diastole)
- "Swooshing" is indicative of a murmur
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- What does the S3 sound signify?
- Where is it auscultated?
- What is used to listen to it? What does it sound like?
- What may an S3 sound indicate?
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- Blood striking a hyper-compliant ventricular wall
- Mitral area; 5th intercostal space, (L) mid-clavicular line, easier to hear in (L) S/L
- The bell; lub... dub-DUB
- Systolic heart failure as the walls are over-compliant (anything causing hyper-compliant walls)
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- What does the S4 sound signify?
- Where is it auscultated?
- What is used to listen to it? What does it sound like?
- What may an S4 sound indicate?
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- Blood striking a hypo-compliant ventricular wall
- Mitral area; 5th intercostal space, (L) mid-clavicular line, easier to hear in (L) S/L
- The bell; LA-lub... dub
- Anything with hypo-compliant LV → MI, CHF, CABG, HTN, CAD, pulmonary disease, active ischemia (↓ ATP prevents release of actin-myosin)
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- What is used to assess breath sounds?
- What is of note regarding duration of breaths?
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- The diaphragm
- Breaths should be calm, normal, and full inhalation/exhalation should be heard
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Where are the lungs auscultated anteriorly?
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Where are the lungs auscultated posteriorly?
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- What are wheezes aka? What do they signify?
- When are they most commonly heard? What might this indicate?
- When are they less commonly heard? What may this indicate?
- What is stridor? How is it heard?
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- aka Rhonchi, they signify constriction
- Expiration; possibly indicative of airway constriction from bronchospasm or secretions
- Inspiration; possibly indicative of severe obstruction
- Wheezing of the large airways, heard without a stethoscope
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- What are crackles aka? What may they signify?
- When are they more commonly heard? What do they sound like?
- How does timing of crackles change significance?
- When are crackles associated with secretions heard?
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- aka Rales; signify opening of airways or presence of secretions (XS mucous, pleural effusion)
- Inspiration, sounds like popping bubbles
- Heard in early inspiration → opening of proximal airways; late inspiration → opening of peripheral airways
- Inspiration, expiration, or both
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- What is a pleural rub? What does it sound like?
- When is it typically heard?
- What is it possibly indicative of?
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- Pain-associated grating sound
- End of inspiration
- Inflammation, trauma, cancer, pneumonia, or a mass
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- How do you assess for tactile fremitus?
- What is normal?
- Abnormal?
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- Hands over various bronchopulmonary segments and have patient repeat “99” or “eeeee”
- Typically, peripheral lung areas have less density (more air, less solid/liquid) and lower fremitus
- If peripheral areas have equal or greater fremitus, then there may be secretion (mucus, pneumonia, pulmonary edema, tumor) build-up
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- What is being assessed by measuring chest wall expansion?
- At what landmarks is the tape measure placed to assess chest expansion? What segment does each measurement approximate?
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- If ventilation is occurring the chest wall will move. Thus assessing chest wall expansion assesses ventilation
- Axillary folds (upper lobes), level of the xiphoid (middle lobe/lingula), and midpoint between xiphoid and umbilicus (lower lobes)
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- How can chest motion symmetry be assessed during inspiration/expiration?
- How is the upper lobe assessed?
- Middle lobe?
- Lower lobe?
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- Manually, with hands placed flat
- Thumbs at sternal notch, palm over chest, fingers extensing toward UTs
- Thumbs just superior to xiphoid, fingers wrapped lateral towards mid-axillaryline
- Thumbs at T₇-T₈ spinous process, fingers tracing ribs anteriorly toward mid-axilla
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- How is bronchophony assessed?
- What would be considered normal?
- What would be considered abnormal? Why?
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- Listening to the lung segments, ask the pt to say, "ninety-nine"
- The "ninety-nine" sounds should be indistinct and quieter along more peripheral lung areas
- Clearly discernible, possibly louder peripheral areas indicate a consolidation because liquids/solids transmit sound better than air
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- How is egophony assessed?
- What would be considered normal?
- What would be considered abnormal? Why?
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- Listening to the lung segments, ask the pt to say, "eeeee"
- The sounds should resemble the same "eeeee," becoming quieter more peripherally
- The "eeeee" sounds more like "aaaay" over consolidations. It may also be louder
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- How is whispered pectoriloquy assessed?
- What would be considered normal?
- What would be considered abnormal? Why?
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- Listening to the lung segments, ask the pt to whisper, "ninety-nine"
- The "ninety-nine" sounds should be indistinct and faint
- Discernible, louder areas indicate a consolidation
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