A patient admitted to the hospital with complaints of pulmonary edema and history reveals 10-year emphysema. Which of the following adventitious lung sound would be seen in this patient?

1. A

   Ronchi

2. B

   Crackling

3. C

   Stridor

4. D

   Wheezing

Appeared in: NORCET 5 mains

Explanation

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• Pulmonary edema is characterized by the accumulation of fluid in the lung's alveoli.
• Crackles (or rales) are short, popping sounds produced when these fluid-filled or collapsed alveoli are forced open by inspired air.
• These sounds are most prominent during inspiration and are a classic sign of fluid in the lungs, making it the expected finding in this patient's acute condition.

Why Other Options Were Wrong

• Option A: Rhonchi are low-pitched sounds caused by secretions in the larger airways, not fluid in the alveoli. The primary pathology in pulmonary edema is alveolar fluid.
• Option C: Stridor is a high-pitched sound indicating an obstruction in the upper airway (larynx or trachea). Pulmonary edema affects the lower respiratory tract (alveoli).
• Option D: While the patient's history of emphysema makes wheezing possible due to airway narrowing, the acute problem is pulmonary edema. Crackles are the more direct and specific sign of fluid in the alveoli.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Identification of adventitious lung sounds in pulmonary edema to guide bedside assessment, documentation, and the next nursing action.
• Accurate identification of lung sounds is a critical nursing skill for assessing respiratory status and detecting life-threatening conditions like pulmonary edema.
• Auscultating crackles in a patient with risk factors for fluid overload (like heart failure or kidney disease) prompts immediate nursing interventions, such as elevating the head of the bed, administering oxygen, and preparing to give diuretics as ordered.
• What if the patient presented with an emphysema exacerbation without pulmonary edema? In that case, the most likely finding would be wheezing and diminished breath sounds due to bronchoconstriction and air trapping, rather than crackles.

How to Approach the Question

• First, identify the key clinical condition presented in the question stem. Here, the patient is admitted for 'pulmonary edema'.
• Recall the underlying pathophysiology of this condition. Pulmonary edema means fluid is filling the alveoli.
• Consider how this pathophysiology would manifest as a sound. Air moving through fluid-filled sacs creates a 'popping' or 'crackling' noise.
• Evaluate each option based on this understanding. 'Crackling' directly matches the pathophysiology of pulmonary edema.
• Consider the other information (history of emphysema) as context, but focus on the acute reason for admission to determine the most prominent and relevant sign.

Concept Tested & Keywords

• Concept Tested: Identification of adventitious lung sounds in pulmonary edema.
• Stem keywords: pulmonary edema, emphysema, adventitious lung sound
• Lead-in keywords: Which of the following
• Clinical cues: Patient admitted with pulmonary edema, which is the acute condition.
• Clinical cues: History of emphysema, which is a chronic condition.

Question ID

QhRgikNBn7MWHZtgLl9QfZ

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 2 p. 104-106

E6 Medicine Macleod Clinical Examination 15e p. 105-107