IPPA review

Question 1

best practices for auscultation

Answer 1

quiet environment, upright position, stethoscope on bare skin, arms crossed over chest for posterior side, deeper breaths through the mouth, and ensure the patient doesn’t get dizzy

Question 2

what are 3 normal breath sounds?

Answer 2

vesticular, bronchial, and bronchovesicular

Question 3

what are vesicular breath sounds?

Answer 3

heard over the peripheral lung fields and longer inhale than exhale (exhale is only about 1/3), no distinct pause

Question 4

what are bronchial breath sounds?

Answer 4

heard over the manubrium and are high-pitched with a pause between inspiration and expiration; if heard elsewhere, this is abnormal

Question 5

what are bronchovesicular breath sounds?

Answer 5

around heard around the 1st and 2nd intercostal spaces and are high pitched with equal inspiration and expiration segments

Question 6

3 types of abnormal breath sounds

Answer 6

decreased or absent, bronchial breathing, or adventitious sounds

Question 7

types of adventitious breath sounds

Answer 7

crackles (rales), wheezes, rhonchi, pleural friction rub, and stridor

Question 8

what do decreased or diminished vesicular breath sounds indicate?

Answer 8

poor air entry or reduced ventilation

Question 9

what are decreased or absent breath sounds?

Answer 9

lower than expected intensity of normal vesicular breath sounds

Question 10

what populations are decreased or absent breath sounds common in?

Answer 10

post-op patients, frail or debilitated patients, or those with hyperinflated lungs

Question 11

when are bronchial sounds abnormal?

Answer 11

when heard in the peripheral lung fields

Question 12

common causes of bronchial breath sounds?

Answer 12

consolidation, tumor/mass, lobar collapse, or atelectasis

Question 13

what are crackles?

Answer 13

discontinuous rattling, bubbling, clicking, or non-musical sounds heard during breathing and these are usually classified as early or late inspiratory crackles

Question 14

when do crackles occur?

Answer 14

usually during inspiration, less common during expiration

Question 15

what do early inspiratory crackles indicate?

Answer 15

air moving through secretions and is common in COPD or bronchitis

Question 16

what do late inspiratory crackles indicate?

Answer 16

opening of collapsed alveoli or small airways and is common in atelectasis or pulmonary edema

Question 17

what are wheeezes?

Answer 17

continuous, high-pitched squeaking or wheezing sounds, caused by airflow through narrowed airways, most often heard on expiration

Question 18

when are wheezes common?

Answer 18

with airway narrowing such as with bronchoconstriction/ asthma, secretions, or airway inflammation

Question 19

what does wheezes on inspiration and expiration indicate?

Answer 19

more severe airway narrowing

Question 20

what are rhonchi?

Answer 20

continuous breath sounds that are similar to wheezes, but low pitched and often described as snoring or gurgling, heard on both inspiration and expiration

Question 21

what do rhonchi breath sounds indicate?

Answer 21

obstruction of larger airways, most commonly by secretions

Question 22

what is a pleural friction rub?

Answer 22

a creaking or grating sound, often described as leather rubbing on leather, heard at the end of inspiration or early expiration

Question 23

what does a pleural friction rub indicate?

Answer 23

inflammation of the pleural membranes

Question 24

what are stridor sounds?

Answer 24

high-pitched sounds heard or the trachea or larynx, predominately on inspiration

Question 25

what does a stridor breath sound indicate?

Answer 25

upper airway obstruction (trachea or larynx) and this may be a medical emergency - no PT intervention, consult MD

Question 26

what to chart after auscultation?

Answer 26

type of breath sounds, timing in the respiratory cycle, location on the chest wall, and changes after PT treatment