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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
decreased/absent 
breath sounds
– PercussionÆ dull
– FremitusÆ decreased
– EgophanyÆabsent
• Consolidation
– AuscultationÆ broncial
breath sounds
– PercussionÆdull
– FremitusÆincreased
– EgophanyÆ present
Vs
Summary of Skills 
□Wash hands
Spine
□ Inspect (shape, curves); Examine (range of motion, palpation)
Lungs and Thorax
Observation & Inspection 
□ Patient breathing
□ Chest shape
□ Fingers/nails
Palpation
□ Chest excursion 
□ Fremitus 
Percussion
□ Alternating R & L lung fields posteriorly topÆbottom; & anteriorly
□ Determines diaphragmatic excursion
Auscultation
□ 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�
	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
	Palpation – Assessing Fremitus 
	Lung Pathology - Simplified
	Fremitus - Pathophysiology
	Percussion
	Percussion - Technique
	Percussion (cont)
	Expect To Be Frustrated!
	Percussion: Normal, Dull/Decreased or Hyper/Increased Resonance
	Ausculatation
	Lobes Of Lung
	Lobes Of The Lung (cont)
	Trachea
	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