Which of the following statements is true about "Auscultation of the chest"?

GMCH - 2015

Medical & Surgical Nursing

Hard

Appeared in: GMCH - 2015

Explanation

In left-sided heart failure, the heart's inability to pump blood effectively causes a pressure buildup in the pulmonary vessels.
This increased pressure forces fluid to leak from the capillaries into the alveoli, a condition known as pulmonary edema.
When a person inspires, air entering these fluid-filled alveoli causes them to pop open, creating discontinuous, crackling sounds called crepitations (or crackles).
These sounds are most commonly heard at the lung bases, as fluid tends to accumulate in the most dependent parts of the lungs.

Option A: Rhonchi are low-pitched sounds caused by secretions in the large airways. A pleural effusion is fluid in the space outside the lung, which acts as a barrier to sound, causing diminished or absent breath sounds, not rhonchi.
Option B: The characteristic adventitious sound of heart failure is crepitations (crackles) due to pulmonary edema. While wheezing ('cardiac asthma') can also occur, rhonchi are not a primary feature.
Option C: Crepitations are produced by fluid inside the alveoli. A pleural effusion is a collection of fluid in the pleural space, which is outside the lung parenchyma. This fluid dampens sound, leading to absent or decreased breath sounds.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Interpretation of adventitious lung sounds (crepitations and rhonchi) in cardiac and respiratory conditions as background academic context rather than a clinical decision trigger.
Accurately identifying and differentiating adventitious lung sounds is a critical nursing skill for early detection of clinical deterioration.
Distinguishing between crepitations (heart failure, pneumonia) and rhonchi (bronchitis) guides appropriate interventions, such as administering diuretics for fluid overload versus suctioning or bronchodilators for airway secretions.
What if? A patient with known COPD presents with new-onset crepitations at the lung bases in addition to their usual rhonchi. This combination strongly suggests an acute exacerbation of heart failure on top of their chronic lung disease, requiring urgent cardiac assessment and intervention.

How to Approach the Question

First, identify that the question asks for a correct (true) statement linking a specific lung sound to a medical condition.
Define the key terms. Crepitations (crackles) are caused by fluid in the small airways/alveoli. Rhonchi are caused by secretions in the larger airways.
Understand the pathophysiology. Heart failure leads to fluid in the alveoli (pulmonary edema). Pleural effusion is fluid in the space outside the lungs.
Evaluate each option: Does the sound match the pathophysiology of the condition?
Option A/C (Pleural Effusion): Fluid outside the lung would muffle sound, not create crepitations or rhonchi. Eliminate these.
Option B (Rhonchi/Heart Failure): Heart failure causes fluid in alveoli, not secretions in large airways. This is a mismatch. Eliminate this.

Concept Tested & Keywords

Concept Tested: Interpretation of adventitious lung sounds (crepitations and rhonchi) in cardiac and respiratory conditions.
Stem keywords: Auscultation of the chest, Rhonchi, Crepitations, pleural effusion, heart failure
Lead-in keywords: true

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

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