Transcription
Hello everyone. Welcome back to Medical My Life. Today, we will experience different lung sounds, whether it is normal or not, how they sound, and their characteristic features. In between the video, we will solve some MCQs. I want you to watch this video using earphones or headphones because it will help you better appreciate the lung sounds.
When we examine the respiratory system, we follow a pattern: inspection, palpation, percussion. What do we need to listen for in the respiratory system examination? Breath sounds. This video is also important from your clinical point of view. So, let's start the video. First, we will read [music] continuous or discontinuous. If someone tells you abnormal continuous breath sound, what do you understand by this? See, when we breathe, there is an inspiratory phase and an expiratory phase. If you are hearing this abnormal breath sound, it may be present in the inspiratory phase, it may be present in the expiratory phase, or it may be present in both phases.
Let's suppose you are hearing an abnormal breath sound which is present in the inspiratory phase. If it is throughout the inspiratory phase, it is continuous, and if it is present in a particular part of the inspiratory phase, it is discontinuous. So, first of all, you have to differentiate between normal and discontinuous. Another feature to differentiate continuous and discontinuous is that our continuous adventitious sounds are musical in quality, and discontinuous adventitious sounds are non-musical in quality. Now, we will see what is the mechanism of production of continuous adventitious sounds. I have already told you, continuous adventitious sounds are musical in quality. Now, see, if there is an obstruction somewhere in our respiratory tract, then the airflow from this part will be limited, and the sound produced will be [music].
So, just now you have listened to me. You experienced something like less than 200 Hertz. Our snoring or gargling quality is of small airway obstructions. Our continuous adventitious sounds are produced due to the narrowing of the airway. Wheezes are produced by small airway obstructions, and rhonchi are produced by large airway obstructions. In the case of wheezes and rhonchi, it is bronchial asthma and COPD. So now, let's listen to rhonchi, and you have to differentiate between rhonchi and wheezes. [music]
Now, let's solve an MCQ which I got from my online coaching. Here, you can watch the video in both Hindi and English languages. It is focusing more on clinical questions. Here, they have added clinical video sound. In that, I want to show you the question. Show the question. Of respiratory sounds, it is heard, and it is of single intensity. So, the answer to this question is lung cancer. Our answer is lung cancer. They have also included case discussion videos. Here, clinical case discussion videos have been added. Common cases in different subjects are discussed here. For example, in surgery, acute, called scrotal swelling, which is the most common case you will get to see in OPD settings. Note, only PG exams. These videos will also help you in university exams. If you want to enhance your clinical knowledge and prepare for PG, you can try a prepaid one. Good point is, for new users, the content is absolutely free for the first 24 hours. So, you can download the app. The link is given in the description.
So, we have completed continuous adventitious sounds. Now, we will read discontinuous adventitious sounds, and in this, we have to read about crackles and pleural rub. As I told you, our discontinuous adventitious sounds are non-musical in quality or we also call them crackles. These are mainly found in the inspiratory phase of breathing. Wheezes and rhonchi were mainly found in the expiratory phase. These are found in the inspiratory phase of breathing. Crackles can be fine crackles or coarse crackles. First, we will listen to the audio difference between fine and coarse crackles. After that, we will differentiate fine and coarse crackles. So, as you have listened, our fine crackles are high-pitched, and coarse crackles are low-pitched. What is the mechanism of production of fine crackles? See, if our alveoli are closed, and air flows through it, then the sound produced due to sudden snapping opening is fine crackles. What is the mechanism of production of coarse crackles? Bubbling sound produced by the passage of air through accumulated secretions. Our respiratory tract has accumulated secretions, and air is passing through it. The bubbling sound produced due to this results in coarse crackles. Coarse crackles, if you keep your hand on the chest and if you are hearing a bubbling sound, it is coarse crackles. If you are hearing a bubbling sound only by auscultation, it is an example of fine crackles. Initial stage of pneumonia and pulmonary edema is also the initial stage. In coarse crackles, if pneumonia is in the late stage or pulmonary edema is in the late phase. It is very easy to remember the examples.
So, we have completed crackles, rales. Next is pleural rub. First, listen to how pleural rub sounds. After that, we will read about pleural rub. [music] So, the sound you have just heard is pleural rub. These are grating sounds, a rubbing sound, which is produced due to rubbing of inflamed pleural surfaces against each other. It occurs during both inspiration and expiration. Pericardial rub sounds exactly like pleural rub. How to differentiate it? See, our pleural rub disappears on holding the breath. So, what you have to do to the patient? You have to tell the patient to hold his or her breath, and then you have to auscultate. Even after holding the breath, if you are hearing the rub, it is pericardial rub. If the rub disappears after holding the breath, it is pleural rub. So, we have completed all the adventitious or abnormal breath sounds. We read crackles, pleural rub, and how to differentiate them and their auscultatory findings. Now we will read normal breath sounds. In normal breath sounds, we have to read vesicular breathing and bronchial breathing. Vesicular breath sounds, first. [music]
Now, you have to differentiate vesicular breath sounds. See, vesicular breath sounds have a longer duration of the inspiratory phase, but in bronchial breath sounds, there is a longer duration of the expiratory phase. In vesicular breath sounds, there is no gap between the inspiratory and expiratory phases, but in bronchial breath sounds, a gap is present here. Here, the ratio of inspiration and expiration is 2:1 or in some books 3:1. But in bronchial breath sounds, this ratio becomes opposite, it becomes 1:2. See, I am telling you the format behind it. What happens when we inspire? Our air travels in the large airways. Then, the sound produced by traveling in the large airway is bronchial breath sound, and the sound produced by traveling in the small airway is vesicular breath sound. When air travels in the small airway during inspiration, breath sound occurs, and then when we expire, vesicular breath sounds occur. Here, there is no gap between inspiration and expiration. But if we talk about bronchial breath sounds, air is traveling in the large airway, and then when the air comes back to the large airway, a gap will be created in between. That is why we say that in bronchial breath sounds, there is a gap between the inspiratory and expiratory phases. It is heard because of the air traveling. If it is heard elsewhere, it reveals lower pneumonia. So, now we will hear bronchial breath sounds. Last bronchovesicular breath sounds. It is intermediate between bronchial and vesicular breath sounds. Here, the inspiratory phase is equal to the expiratory phase. So, this is all about breath sounds.
First of all, thank you so much for watching the complete video. If you have benefited from this video, please share this video with your medico friends. And the notes of this topic will be available in my Telegram group. The link is in the description. See you in the next video. Happy learning.