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Clinical Review Quiz

  Pulmonary Auscultation

Bernard Karnath, MD, and Michael C. Boyars, MD

Dr. Karnath is an Assistant Professor of Internal Medicine and Dr. Boyars is a Professor in the Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX.

The questions below are based on the January 2002 cover article, “Pulmonary Auscultation.”
The response options for each question are presented immediately below. Each question may have more than 1 correct answer. For each case study, select the appropriate auscultatory finding(s). Each option may be used once, more than once, or not at all.


  1. Absent breath sounds
  2. Bronchial breath sounds
  3. Diminished breath sounds
  4. Egophony
  5. Inspiratory crackles
  6. Rhonchi
  7. Vesicular breath sounds
  8. Wheezes
1. A 40-year-old man goes to his physician because of a 3-day history of shaking chills, fever, and cough productive of rust-colored sputum. A chest radiograph is shown (FIGURE 1). What is (are) the most likely auscultatory finding(s)?


FIGURE 1. Chest radiograph showing lobar pneumonia.

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2. A 50-year-old man reports a 3-month history of worsening dyspnea. He has smoked a pack of cigarettes daily for the past 30 years. A chest radiograph is shown (FIGURE 2). What is (are) the most likely auscultatory finding(s)?


FIGURE 2. Lateral chest radiograph showing severe emphysema. Note the descended diaphragms.

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3. A 60-year-old man is hospitalized because of a 2-day history of dyspnea. A chest radiograph obtained in the emergency department is shown (FIGURE 3). What is (are) the most likely auscultatory finding(s)?


FIGURE 3. Chest radiograph showing pulmonary edema.

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4. A 70-year-old woman reports having progressive dyspnea over the past few months. A chest radiograph is shown (FIGURE 4). What is (are) the most likely auscultatory finding(s)?


FIGURE 4. Chest radiograph showing pulmonary fibrosis.

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5. A 60-year-old man presents with worsening dyspnea for the past month. A chest radiograph is obtained (FIGURE 5). What is (are) the most likely auscultatory finding(s)?


FIGURE 5. Chest radiograph showing left pleural effusion.

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6. A 60-year-old woman reports acute onset of dyspnea after undergoing thoracentesis. A chest radiograph is shown (FIGURE 6). What is (are) the most likely auscultatory finding(s)?


FIGURE 6. Chest radiograph showing left pneumothorax.

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Updated 1/04/08 • kkj