it is very precise topic and it can help many medical student.

3. Auscultation is listening to the internal
sounds of the body usually using a
stethoscope.
Auscultation is performed for the
purpose of examining the circulatory
and respiratory system as well as
gastrointestinal system (bowel sounds)

4.  The auscultation of the respiratory
system is an inexpensive, save, easy
to perform, and one of the oldest
diagnostic techniques used by the
physicians to diagnose various
pulmonary diseases.
 There are three forms of auscultaion
classic(immediate auscultaion)
,mediate auscultaion and doppler
auscultaion.

5. immediate auscultaion
immediate auscultaion is an antiquated
medical term for listening to the internal
sounds of the body. Directly placing the
ear on the body.
Mediate auscultation
mediate auscultation is an antiquated
medical term for listening to the internal
sound of the body using an instrument
(mediate) usualy stethoscope

6. Doppler auscultion
it defined as auscultation of valvular
movements and blood flow sounds that
are undetected during cardiac
examination with a stethoscope in adults
it has sensitivity of 84% for the detection
of aortic regurgitaion while classic
stethoscope auscultation presented a
sensitivity of 58%.

7. Stethoscope
four parts
*bell
low-pitched heart sounds
* diaphragm
high-pitched lung sounds
press firmly
* tubing
not too long or too short
* earpieces
point away

8. Ways to auscultate lung
Anterior lung auscultaion
1. start at the apex of the lung which is right above
the clavicle.
2. then move to the 2nd intercostal space to assess
the right and left upper lobes.
3. at the 4th intercostal space you will be assessing
the right middle lobe and the left upper lobe.
4. then midaxillary at the 6th intercostal space you will
be assessing the right and left lower lobes

10. Posterior lung auscultaion
points.
1. start right above the
scapulae to listen to the apex of
the lungs
2.then find c7 and go to T3 this
will assess the right and left
upper lobes
3. then T3 to T10 you will be
able to assess right and left

12. Normal breath sounds
*tracheal :heard over trachea
tubular quality
lenght: inspiration is equal to
expiration

13. Bronchial
auscultated over anterior chest
and heard over tracheal area
Bronchial breath sounds are hollow,
tubular souns that are lower pitched. They
can be auscultated over the trachea
where they are considered normal.
There is dintinct pause in the sound
between inspiration and expiration. I:E
ratio is 1:3.

14. Bronchovesicular
auscultated anteriorly( 1st and 2nd intercostal
space) and posteriorly( between the scapulae)
and heard over the bronchi.
inspiration to expiration periods are equal. These
are normal sounds in the mild chest area or In the
posterior chest between the scapulae. They
reflect a mixture of the pitch of the bronchial
breath sounds heard near the trachea and the
alveoli with the vesicular sound. They have an I:E
ratio of 1:1.

15. vesicular-normal
vesicular breath sounds are soft and low
pitched with a rustling quality during inspiration
an are ever softer during expiration.
This are most commonly auscultated breath
sounds normaly head over the most lung
surface
.

17. 1. Crackles -fine ( Rales)
fine crackles are brief, discontinous ,
popping lung sounds that are high-pitched
.fine crackles are also similar to the sound
of wood burning in an fireplace.
Crackles previosly termed rale, can be
heard in both phases of respiratory.
* Early ins.and exp. Crackles are hallmark
of chronic bronchitis.
May be heard in patient with edema in the
lungs or ARDS.

18. *While late inspiratory crackles
may mean pneumonia, CHF, or
atelectasis
and pulmonary fibrosis

19. 2.Crackles – course (rales)
course crackles are discontinuous, brief,
popping lung sounds. Compared to fine
crackles they are loader, lower in pitch
and last longer.
They have also been described as a
bubbling sound. You can stimulate this
sound by roling strands of hair between
your fingers near your ear.
May be heard in patient whith fluid
overload , pneumonia

20. 3.Wheeze
wheezes are adventitious lung
sounds that are continuous(more
than 0.2 second during full
inspiration) with a musical quality.
Wheezes can be high or low pitched.
High pitched wheezes may have an
auscultation sound similar to
squeaking.
Lower pitched wheezes have a
snoring or moaning quality.

21.  the proportion of the respiratory cycle
occupied by the wheeze roughly corresponds to
the degree of airway obstruction.
Wheezes are caused by narrowing of the
airways.
The most common cause of recurrent wheezing
are Asthma, emphysema and COPD
low pitched may be heard in patient with(COPD)
high pithced may be heard in patient with ashtma

22. 4.Rhonchi –low pitched wheezes.
Low pitched wheezes(rhonchi) are
continuous, both inspiratory and expiratory,
low pitched adventitious lung sounds that
are similar to wheezes.
They often have a snoring, gurgling or
rattle-like quility.
Rhonchi occur in the bronchi. Sounds
defined as rhonchi are heard in the chest
wall were bronchi occur not over any
alveoli.
Rhonchi usualy clear after coughing.

23. 5. Pleural Rubs
pleural rubs are discontinuous or continuous ,
creaking or grating sounds.
The sound has been described as similar to
walking on fresh snow or a leather –on –
leather type of sound. Coughing will not alter
the sound. They are produced because two
inflamed surfaces are sliding by one another
such as in pleurisy.
During auscultaion pleural rubs can usually
be localized to aparticular place on the chest
wall. They also come and go because these
sounds occur whenever the patient’s chest
wall moves.

24. They appear on inspiration and
expiration. Pleural rubs stop when the
patient holds her or his breath. If the
rubbing sound continues while the patient
holds a breath it may be pericardial
friction rub.
Patients may have pain when breathing
in and out due to inflamation of pleural
layer s
may heard in patients with pleuritis.

25. 6.Stridor
stridor is a load, high pitched, harsh,
vibratory sound produced by upper
respiratory tract obstruction(narrowing of
the trachea), it different fom wheezing by
the following reasons,
*it is louder over the neck than chest
wall, secondly stridor is mainly
inspiratory . If occurs in expiration it is
usualy biphasic . On the other hand
wheeze is mainly expiratory and

26. Continue……
it indicates extrathoracic upper airway
obstruction (supraglottic lesions like
larnygomalacia, vocal cord lesion)

27. Thank you