Physical examination maneuver
Physical Exam
Lung Auscultation
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Video coming soon
How to Perform
Using the diaphragm of the stethoscope directly on the skin, listen over symmetric upper, middle, and lower posterior lung fields while the patient breathes slowly and deeply through an open mouth. Compare side to side at each level, listening through at least one full respiratory cycle at each point, and auscultate additional posterior, anterior, or lateral areas as clinically indicated. Note the intensity and quality of the breath sounds and any added sounds, such as crackles, wheezes, rhonchi, or a pleural rub.
How to Interpret
Showing 27 of 56 findings
Acute Coronary Syndrome
Pulmonary crackles in a patient with chest pain
Rule in
InconclusiveWide CI
Rule out
Not helpful
Evidence:Moderate
Chronic Obstructive Pulmonary Disease
Early inspiratory crackles
Rule in
HelpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Expiratory wheezing on auscultation in an adult with respiratory symptoms
Rule in
Somewhat helpful
Rule out
Not helpful
Evidence:Moderate
Any crackles
Rule in
Not helpful
Rule out
Not helpfulDerived CI
Evidence:Moderate
Early inspiratory crackles in a patient with chronic airflow obstruction
Rule in
Very helpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Moderate
Foreign Body Aspiration
Wheezing in children
Rule in
Minimally helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Heart Failure
Fine inspiratory crackles (rales) on auscultation
Rule in
Somewhat helpful
Rule out
Minimally helpful
Evidence:Strong
Wheezing in an adult presenting with dyspnea to the emergency department
Rule in
Not helpful
Rule out
Minimally helpful
Evidence:Strong
Hypersensitivity Pneumonitis
Inspiratory squawk
Rule in
Somewhat helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Interstitial Lung Disease
Fine inspiratory crackles
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulWide CI
Evidence:Moderate
Mainstem Bronchus Intubation
Asymmetric breath sounds
Rule in
HelpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Moderate
Myocardial Infarction
Crackles, detecting myocardial infarction in patients with chest pain
Rule in
Somewhat helpful
Rule out
—
Evidence:Moderate
Obstructive Lung Disease
Diminished or absent breath sounds in an adult with respiratory symptoms
Rule in
Somewhat helpful
Rule out
Minimally helpful
Evidence:Moderate
Pleural Effusion
Diminished breath sounds
Rule in
Helpful
Rule out
Helpful
Evidence:Moderate
Pleural friction rub
Rule in
InconclusiveWide CI
Rule out
Not helpful
Evidence:Moderate
Pneumonia
Crackles (any type — fine, coarse, or unspecified)
Rule in
Somewhat helpfulWide CI
Rule out
Not helpful
Evidence:Strong
Diminished breath sounds, detecting pneumonia in patients with cough and fever
Rule in
Somewhat helpful
Rule out
Not helpful
Evidence:Strong
Rhonchi
Rule in
Minimally helpful
Rule out
Not helpful
Evidence:Strong
Pleural friction rub
Rule in
InconclusiveWide CI
Rule out
Not helpful
Evidence:Strong
Wheezing
Rule in
Not helpful
Rule out
Not helpful
Evidence:Strong
Bronchial breath sounds in peripheral lung
Rule in
Somewhat helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Pneumothorax
Diminished breath sounds
Rule in
Very helpful
Rule out
Somewhat helpful
Evidence:Strong
Pulmonary Embolism
Wheezes
Rule in
Not helpfulNo CI
Rule out
Somewhat helpfulNo CI
Evidence:Moderate
Crackles
Rule in
Not helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Pleural friction rub
Rule in
Not helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Shock
Lung crackles (bilateral, >1/3 up from the bases) in a hypotensive patient
Rule in
InconclusiveWide CI
Rule out
InconclusiveWide CI
Evidence:Moderate
Esophageal Intubation
Absence of bilateral breath sounds
Rule in
—
Rule out
—
Evidence:Strong
Related Bedside Tests
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Oxygen Saturation
aka Pulse oximetry
Rule in:HMortality, SHPneumonia, MHCardiac Tamponade +8 more
Rule out:ICCardiac Tamponade, NHHepatopulmonary Syndrome, NHMortality +8 more
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Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy +37 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy, VHRight-sided Valvular Lesion +37 more
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Chest Percussion
Rule in:HChronic Obstructive Pulmonary Disease, HPleural Effusion, SHCardiomegaly +10 more
Rule out:VHCardiomegaly, NHChronic Obstructive Pulmonary Disease, ICLeft Ventricular Dilation +10 more
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Respiratory Rate
Rule in:HReduced Left Ventricular Ejection Fraction, SHCardiopulmonary Arrest, SHPneumonia +10 more
Rule out:MHCardiopulmonary Arrest, MHPulmonary Embolism, NHPneumonia +10 more
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Chest and Respiratory Inspection
Rule in:VHMitral Valve Prolapse, HPleural Effusion, HReduced Left Ventricular Ejection Fraction +11 more
Rule out:HRespiratory Neuromuscular Weakness, SHChronic Obstructive Pulmonary Disease, SHPleural Effusion +12 more
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Heart Rate
Rule in:SHAtrial Fibrillation, SHDecompensation, SHHypothyroidism +15 more
Rule out:HDecompensation, SHAtrial Fibrillation, SHPostoperative Complication +15 more