Crackles (fine)only on inspiration -Crumpling cellophane or rubbing hair between fingers – DOES NOT go away with cough -alveolar secretion – POPPING (alveolar opening)
What diseases for fine cracklesatelectasis, pulmonary edema, pneumonia
Crackles (coarse)SNORING -clear with cough -POPPING indicates secretions in airway
What diseases for coarse cracklesbronchitis, pneumonia
WheezingHIGH Pitch noise, MUSICAL – Does not clear with cough – small airway constriction
What diseases are for wheezingasthma, emphysema
Stridorinpsiration high pitch CROWING sound – -large airway constriction of partial obstruction
What are the diseases for stridorcroup, swelling trachea, large airway partial obstruction
Pleural Friction RubCREAKY LEATHER sound, -indicates of inflamed pleural lining
What are the diseases for pleural friction rubpleural effusion, and pleurisy
Flatnessabsolute short dead, solid material tumor or atelectasis, consolidation
DullnessTHUD pneumonia
ResonanceNORMAL low pitch sound (easily heard)
HyperressonanceLOUD BOOM sound easily heard in kids
TymphanyMUSICAL (wheezing) – air filled stomach, not normal with if air filled in chest Pneumothorax and asthma
What has decreased resonanceflatness and dullness
What had increased resonancehyperressonance and Tymphany(wheezing)
bronchialover trachea
bronchial vesicularupper half of sternum
vesicularsoft muffled over lung peripheral area


More  Breath Sounds Practice Questions:


Adventitious Breath Sounds(abnormal Breath Sounds) Crackles/rales, Rhonchi, Wheeze, Pleural Friction Rub, Stridor, Diminished
Bronchial Breath Sounds(normal breath sounds) E
bronchophony(99 or 123 will be louder) increased intensity and clarity of vocal resonance, more tissue density than air (consolidation), easier to detect unilaterally, dull percussion, increased vocal fremitus bronchovesicular breath sounds
crackles/rales(adventitious BS) bubbling-crackling sounds, mainly on I, air flow through fluid, discontinuous-specific locations, does not clear with cough. caused by pulmonary edema, pneumonia, emphysema, atelectasis, pulmonary fibrosis
decrease tactile fermitisedecreased vibrations, caused by pleural effusion, fluid, pneumothorax
Dullness(hyporesonance percussion sound) medium sound, more tissue than air, caused by atelectasis, consolidation, pleural effusion, pleural thickening, pulmonary edema
egophonyincreased consolidation, patient says “eee”
flatness(hyporesonance percussion sound) low volume more tissue than air, caused by massive pleural effusion, massive atelectasis, or pneumonectomy Hyperresonance
Hyporesonance(percussion sound) decreased resonance caused by atelectasis, consolidation, pleural thickening, pleural effusion
Increased tactile fermitesincreased vibrations, caused by atelectasis, pneumonia, lung mass
Normal breath soundsvesicular, bronchial, bronchovesicular, tracheal
Palpationtouching the chest wall to evaluate underlying structure and function, evaluates vocal fremitus, estimate thoracic expansion and assesses skin and subcutaneous tissue, hands on back, breathe in, measures thoracic expansion, skin
Percussiontapping on surface to evaluate underlying structure, vibrations and sound help to evaluate lung structure, produces 5 sounds, hyperresonance and tympani, resonance, hyporesonance-dullness &flatness.
Pleural Effusiondecreased vibrations (tactile fremitus) dullness-medium-more tissue than air, caused by abnormal collection of fluid in the pleural space
Pleural Friction Rub(adventitious BS) clicking or grating sound caused by friction of the parietal and visceral rubbing, very painful heard on I & E, caused by pleural effusion and pleurisy
Pneumoniainflammation of the lung parincima, usually caused by infection
Pneumothoraxair in the plural space
resonance(percussion sound) low pitch, equal air and tissue, normal lung tissue
Rhonchi(adventitious BS) ruble sound, fluid filled large airways heard on E, clears with cough, caused by asthma, emphysema, mucus plug, stenosis
strider(adventitious BS) DO NOT NEED A STETHOSCOPE TO HEAR, barking sound on I, heard when upper airways are constricted, caused by croup, epiglottis, post extubation
Tactile FremitisFremitus (voice vibrations)that can be felt. increased by solids like consolidation and atelectasis, decreased by obesity, pneumothorax, emphysema, COPD
Tracheal Breath Sounds(normal breath sounds) High pitch, loud intensity, harsh, located over trachea, I & E equal or E may be slightly longer
Tracheal Positioningthumbs on ea side of trachea-look for shift, away from affected side in tension pneumothorax, large pleural effusion and massive atelectasis, toward affected side in atelectasis and spontaneous pneumothorax
Tympani(hyperresonance percussion sound) drum like sound (tinny) caused by tension pneumothorax
Unilateral reduction in chest expansion isNot evenly reduced, caused by atelectasis, pneumothorax, pleural effusion
vesicular breath sounds(normal breath sounds) low pitch, soft intensity-gentle, peripheral lung areas, longer I, clear sounds
vocal fremitusvibrations created by the vocal cords during speech
tactile fremitusfremitus that can be felt
wheeze and rhonchirumble with musical tone, constricted airways, mainly on E, does not clear with cough, caused by asthma and CHF
Whispering Pectoriloquy(99 or 123) normal lung sounds muffled, consolidation sounds clear