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Ohio State University School of Medicine 
Interactive Learning Center – Lung Sounds
R.A.L.E Lung Sound Repository
UCLA Heart & Lung Sound Simmulator
Other Auscultation “Tools”
• Egophany – in setting of suspected 
consolidation, ask patient to say “eee” while 
auscultating. Normally, sounds like “eee”..
Listening over consolidated area generates a 
nasally “aaay” sound.
Putting It All Together: Few findings 
pathognomonic Æ put ‘em together to paint 
best picture.
• Effusion 
– AuscultationÆ
breath sounds
– PercussionÆ dull
– FremitusÆ decreased
– EgophanyÆabsent
• Consolidation
– AuscultationÆ broncial
breath sounds
– PercussionÆdull
– FremitusÆincreased
– EgophanyÆ present
Summary of Skills 
□Wash hands
□ Inspect (shape, curves); Examine (range of motion, palpation)
Lungs and Thorax
Observation & Inspection 
□ Patient breathing
□ Chest shape
□ Fingers/nails
□ Chest excursion 
□ Fremitus 
□ Alternating R & L lung fields posteriorly topÆbottom; & anteriorly
□ Determines diaphragmatic excursion
□ R & L lung fields posteriorly, top Æbottom, comparing side to side
□ R middle lobe
□ Anterior fields bilaterally
Time Target: < 10 minutes
	Lung, Thorax & Spine Exams
	Exposure Is Key – You Cant Examine What You Can’t See!
	Anatomy Of The Spine
	Spine Exam
	Pathologic Changes In Shape Of Spine
	Lung Exam
	Observation (cont)
	Pathologic Changes In Shape Of Chest
	Clubbing and Cyanosis
	Slide Number 11
	Thoughts On Gown Management & Appropriately/Respectfully Touching Your Patients
	Keys To Performing a Respectful & Effective Exam
	Slide Number 14
	Good Exam Options
	Palpation – Assessing Fremitus 
	Lung Pathology - Simplified
	Fremitus - Pathophysiology
	Percussion - Technique
	Percussion (cont)
	Expect To Be Frustrated!
	Percussion: Normal, Dull/Decreased or Hyper/Increased Resonance
	Lobes Of Lung
	Lobes Of The Lung (cont)
	Auscultation (listening w/Stethescope) - Technique
	Pathologic Lung Sounds
	Pathologic Lung Sounds (cont)
	Lung Sounds
	Other Auscultation “Tools”
	Putting It All Together: Few findings pathognomonic  put ‘em together to paint best picture.
	Summary of Skills

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