Thoracic Auscultation & Breath Sounds

18 Q&A flashcards covering lung surface anatomy for auscultation, normal and adventitious breath sounds, anatomical fissure landmarks, and proper clinical technique.

What are the three normal breath sounds commonly assessed during lung auscultation?

Vesicular, Bronchovesicular, and Bronchial breath sounds.

Describe the quality, pitch, and inspiration-to-expiration (I:E) ratio of vesicular breath sounds.

Soft, rustling quality; low pitch; I:E ratio of about 3:1 (inspiration longer than expiration).

Where are vesicular breath sounds normally heard?

Over the peripheral lung areas—essentially most of the lung surface.

Describe the quality, pitch, and I:E ratio of bronchovesicular breath sounds.

Medium loudness and pitch; I:E ratio of 1:1 (inspiration equals expiration).

In which anatomic areas are bronchovesicular breath sounds considered normal?

Mid-chest anteriorly and between the scapulae posteriorly.

Describe the quality, pitch, and I:E ratio of bronchial breath sounds.

Hollow, tubular, high-pitched; inspiration shorter than expiration with a 1:3 ratio and a distinct pause between the two phases.

Over which structures are bronchial breath sounds normally heard?

The trachea and mainstem bronchi (main bronchus area, upper posterior lung fields).

What does the presence of fine crackles (rales) sound like and when are they typically heard?

High-pitched popping similar to Velcro or a wood fire; discontinuous and heard mainly during inspiration, most often at the lung bases.

How do coarse crackles differ from fine crackles?

Coarse crackles are louder, lower-pitched popping/bubbling sounds of longer duration, heard intermittently and often in larger airways.

What causes wheezes, and how does the portion of the respiratory cycle occupied by a wheeze relate to airway obstruction?

Airway narrowing produces continuous musical sounds; the longer the wheeze occupies the respiratory cycle, the greater the airway obstruction.

Which rib and anatomical line mark the lateral starting point of both right and left oblique fissures?

The 5th rib at the midaxillary line.

To which rib and anatomical line do the oblique fissures run anteriorly?

The 6th rib at the midclavicular line.

Where is the horizontal (minor) fissure of the right lung located anteriorly?

From the level of the 4th rib at the sternum extending laterally to meet the 5th rib at the midaxillary line.

What lung lobe is auscultated in the right mid-clavicular region just below the 4th rib?

The Right Middle Lobe (RML).

List four key preparatory steps you should take before auscultating a patient’s lungs.

Perform hand hygiene and don proper PPE, introduce yourself with professional designation and explain the procedure, ensure privacy and maintain patient modesty, clean/warm the stethoscope.

Why is auscultation ideally performed against bare skin rather than through clothing?

Clothing can dampen or distort breath sounds, leading to missed or inaccurate findings.

What I:E ratio characterizes healthy vesicular breath sounds?

Approximately 3:1 (inspiration three times as long as expiration).

What does it signify when a wheeze is heard throughout almost the entire respiratory cycle?

Severe airway obstruction.