Question

•On auscultating a client, you note a coarse, low-pitched sound during both inspiration and expiration. This client reports pain with breathing. These findings are consistent with:

1.Fine crackles

2.Wheezes

3.Atelectatic crackles

4.Pleural friction rub

Answer 1

On auscultation two types of normal breath sounds can be heard. One is tracheal and another vesicular. The tracheal breath sound are heard over sternum due to flow of air through it. Vesicular breath sounds are heard over chest due to passage of air through lungs, larger airways and bronchi during inspiration and expiration.

Any breath sound heard on auscultation apart from these two normal sounds is considered abnormal or adventitious breath sound. They generate due to pathology of the respiratory system.

Wheezes are type of abnormal breath sound characterised by a musical note. It can be heard during inspiration or expiration. It is seen in respiratory conditions like infections, cystic fibrosis, bronchiectasis.

Crackles are another type of advetitious breath sounds. They can be divided into fine and coarse. Fine crackles are high pitched and short duration. They are heard in COPD, pulmonary infections.

A pleural friction rub is a coarse, grating and high pitched sound. It is heard when the inflamed and thickened parietal and visceral pleura of lung rub against each other with movement of chest wall. Thus these are heard during inspiration as well as expiration. It is seen in pleuritis, pulmonary embolism, pneumonia.

So a coarse, low-pitched sound heard during both inspiration and expiration accompanied by pain on breathing indicates pleural friction rub.