chest motion, heart and lung sounds

S1

normal, lub, closing of tricuspid and mitral valves
onset of ventricular systole

S2

normal, dub, closing of aortic and pulmonic valves
start of ventricular diastole

S3

abnormal, possible CHF indicative of ventricular dysfunction
rapid ventricular filling during diastolic, best heard apex of heart

S4

abnormal, increased resistance to ventricular filling
extra beat before S1, best heard at apex of heart

heart auscultation

aortic: second intercostal space right
pulmonic: second intercostal space left
erb’s point: third intercostal space left
tricuspid: fourth intercostal space left
mitral: fifth intercostal space left, midline on rib

normal/vesicular lung sounds

normal, soft and low, best heard during inspiration and beginning of expiration

bronchovesicular lung sounds

normal, softer version of bronchial, best heard during inspiration and expiration, junction of main bronchi and segmental bronchi

bronchial lung sounds

normal, loud and high/tubular, heard during break between inspiration and expiration, over trachea and manubrium

egophony

pt says e, abnormal if hear “a” during auscultation

bronchophony

pt says 99, abnormal if clearly hear 99 in areas other than main bronchi

whispering pectoriloquy

pt whispers 99, abnormal if hear 99 sound

tactile fremitus

pt says 99 while therapist palpates along posterior lobes, abnormal if asymmetrical vibration

wheezing (rhonchi)

continuous, frequently on expiration can be on inspiration if severe obstruction, high or low pitched
from bronchospasm or secretions narrowing the airway

crackles (rales)

discontinuous, more common on inspiration, bubbles bursting
from atelectasis, pulm edema, fibrosis, pleural effusion, pneumonia, CHF

pleural rub

continuous or discontinuous, on inspiration or expiration, rubbing of leather or sandpaper together
from pleural inflammation

anterior auscultation inf to clavicle

upper lobe apical

anterior auscultation sup to 4th rib

upper lobe anterior

anterior auscultation between 4th and 5th rib

middle lobe medial and lingula, med of midclavicular line

anterior auscultation 6th rib

lower lobe anterior, med of midaxillary line

posterior auscultation inf to clavicle/sup to spine of scap

upper lobe apical left, upper lobe apical and posterior right

posterior auscultation inf to spine of scap/sup to inf angle

lower lobe superior

posterior auscultation near inf angle/sup to 10th rib

lower lobe posterior basal

posterior auscultation midaxillary of inf angle sup to 10th rib

lower lobe lateral basal