Bronchophonia (bronchophonia), i.e. conduction of the voice, consists in the fact that when the lung is compacted, the latter conducts well the sounds formed when the patient pronounces individual words, which under these conditions can be heard directly by attaching the ear to the chest, or through a stethoscope. Under normal conditions, if you put your ear to the chest or put a stethoscope, the words spoken by the patient will be perceived as an indistinct quiet, sometimes difficult to catch muttering, while individual words cannot be made out at all.

Technically, bronchophonia should be determined by listening directly to the thorax of the ear or through a stethoscope, which should be applied to strictly symmetrical places on the right and left sides of the chest. In this case, the patient pronounces, as low as possible, individual words that better have the letter "o", for example: "one, two, three"; "Thirty-three", etc. With a pronounced compaction of the lungs, words spoken in a whisper are also heard.

Novinsky proposed an original method for determining bronchophonia, which consists in taking two phonendoscopes and removing one rubber tube from each, plugging the place from where they were taken out with cotton wool. Then the examiner simultaneously puts the phonendoscopes on symmetrical places of the chest, listening to each side with a separate phonendoscope.
When the lung tissue is compacted, due to the fact that the latter becomes a good conductor for the sounds pronounced by the patient, the words will be clearly audible, which is called bronchophonia.

In some cases, with severe bronchophonia, well-audible words are also characterized by a certain metallic tint. This is pectorilokvia, i.e. chest talk, highest degree conduction of voice (bronchophonia).
Thus, bronchophonia is of great diagnostic value. It indicates foci of compaction in the lungs due to inflammatory infiltration or other reasons. Consequently, bronchophonia is noted when, under physical conditions, bronchial breathing can be heard, and usually opa corresponds to increased vocal tremor.

However, bronchophonia has an advantage over voice tremor in the greater accuracy of the method, in the ability to identify with its help small foci of compaction in the lungs.

Outstanding therapists M. V. Yanovsky, K. K. Degio, K. G. Tritschel, Yu. T. Chudpovsky and others highly appreciated bronchophonia and emphasized its importance for early recognition of pneumonia, “when dullness is not very pronounced, breathing is indefinite, and the voice is already amplified” (NI Kotovshchikov). A prominent domestic clinician FG Yanovsky pointed out that bronchophonia in pneumonia usually appears earlier than other physical symptoms. It is also defined above the cavities due to the fact that the latter are surrounded by compacted tissue. Bronchophonia above the cavities, similar to bronchial breathing, often acquires a soft amphoric character, which is called amphophony, sometimes it has a metallic shade (pectorilokvia). In some cases, bronchophonia acquires a rattling character with a somewhat nasal tinge, reminiscent of goat bleating. This egophony is usually heard at the upper border of the pleuritic effusion. However, egophony is sometimes heard when the lung tissue is compacted.

Bronchophonia is a method of listening to a person's voice using a phonendoscope on the surface of the chest. Sound vibrations arising from the pronunciation of words from the larynx along the air column and bronchial tree are transmitted to the periphery up to the outer surface of the chest wall. As in the study of voice tremor (see the section on Palpation of the chest), these sounds can also be assessed auscultatory.
The lungs are heard in the same places as with comparative auscultation, strictly observing symmetry, only the apexes are not heard, where the auscultatory picture is difficult to differentiate. The patient is asked to pronounce words containing the letter "P" in a calm voice, as in the study of go
salmon shake. Listening to the lungs is carried out with a phonendoscope, but direct listening with the ear is considered ideal.
In healthy people, it is difficult to make out the words pronounced by the patient on auscultation; instead of words, only a vague, quiet, inarticulate muttering is heard, sometimes only buzzing and humming sounds are heard. In men with a low voice, in the elderly, sounds are more distinguishable.
The weakening and strengthening of bronchophonia is of diagnostic value. This happens for the same reasons as the weakening and amplification of vocal tremors. Weakening of bronchophonia is observed in conditions of deterioration of the conduction of sounds along the bronchial tree, with emphysema of the lungs, accumulation of fluid and air in the pleural cavity. Strengthening of bronchophonia occurs in conditions of better sound transmission - when the lung tissue is compacted with preserved bronchial patency and in the presence of a cavity drained by the bronchus. Enhanced bronchophonia will be heard only over the affected area, if the sound of the words will be louder, the words are more distinguishable. Words are heard especially clearly over large cavities in the lungs, while a metallic shade of speech is noted.
A kind of bronchophonia is listening to whispering speech. This method is used in doubtful cases when determining vocal tremor and bronchophonia and is usually used in limited areas, comparing them with healthy symmetrical areas. The patient is asked to whisper words containing the sound "CH" - "a cup of tea." In healthy people, the spoken words are also indistinct. With compaction of the lung tissue and in the presence of a cavity in easy words become distinguishable. Many clinicians prefer whispering speech to bronchophonia as the most informative.
Additional (side) breathing sounds
They form in the pleural cavity, respiratory tract, and alveoli. With only a few exceptions (physiological crepitus), they indicate pathology.
Additional breathing sounds include:

• wheezing;
• crepitus;
• pleural friction noise;
• pleuropericardial murmur.

Wheezing is a murmur that forms in the trachea, bronchi, or lung cavities. They are always associated with the act of breathing and can be heard on inhalation, exhalation, or in both phases at the same time (Fig. 312). They are unstable, can disappear or intensify during a deep breath, after coughing. Wheezing is classified as dry or wet.
The term "dry wheezing" is somewhat arbitrary, it indicates that there is a viscous secretion or local narrowing of the lumen in the lumen of the bronchi.
The term "wet wheezing" means that there is a liquid secretion in the lumen of the bronchi, through which air passes during inhalation and exhalation, creating a lump of bees. Therefore, such wheezing is also called n / a; wheezing or blistering.
Dry wheezing
They can be heard over the entire surface of the lungs or on limited area chest. Widespread dry wheezing (often whistling) indicates a total interest of the bronchi - bronchial spasm in bronchial asthma, allergies, inhalation of organophosphates. Local dry wheezing

CREPITATION FRICTION NOISE
Pleura
Rice. 312. Graphic image the occurrence of side respiratory noises depending on the phase of breathing.

talk about limited bronchitis, which happens with ordinary bronchitis, pulmonary tuberculosis, tumors.
Dry wheezing is heard in one or both phases of breathing, but sometimes it is better on inspiration, during the period of the highest air flow rate in the bronchi. Dry wheezing is often prolonged, audible during the entire breathing phase.
The volume, height, timbre of dry wheezing depends on the caliber of the bronchus, the viscosity of the secretion and the speed of the air stream.Dry wheezing is usually subdivided into:

• high - treble, hanging;
• low - bass, droning, buzzing (Fig. 313-L).

A B


Rice. 313. Places of occurrence of side respiratory noises A. Dry wheezing:
1 - low (bass, walking, buzzing), occur in the trachea, in the large and medium bronchi.
2 ~ 3 - high (treble) wheezing, occur in the small bronchi and bronchioles.
B. Moist wheezing, crepitus, pleural friction rub:

1. - coarsely bubbly, occur in the trachea and in the large bronchi.
2. - medium vesicular, occur in the middle bronchi.
3. - finely bubbly, occur in small bronchi.
4. - crepitus, occurs in the alveoli
5. - pleural friction noise, occurs in the pleural cavity with inflammation of the pervral leaves, their roughness.

High-pitched (whistling) wheezes are high-pitched wheezes, their sound is similar to a whistle, squeak. They are formed in the small bronchi and bronchioles and are distinguished by auscultatory stability. The main reason for their occurrence is the narrowing of the lumen of the bronchi, which is facilitated by:

• spasm of small bronchi and bronchioles;
• swelling of their mucous membranes;
• the accumulation of a viscous secret in them.

Wheezing caused by spasm or swelling of the mucous membrane, after coughing, does not change either quantitatively or qualitatively. The main diagnostic value of the wheezing bronchi is the presence of bronchospasm (bronchial asthma, allergic or toxicogenic bronchospasm) or inflammation of the bronchi (bronchiolitis, bronchitis). Such rales are almost all heard over the entire surface of the lungs and are often heard at a distance. In the supine position of the patient, the number of such wheezing increases due to an increase in the tone of the vagus, leading to spasm of the bronchi.
If wheezing rales are heard in a limited area, then the cause of their occurrence is inflammation of the small bronchi, which happens with focal pneumonia, pulmonary tuberculosis. Whistling wheezing caused by the accumulation of secretion in the small bronchi, after coughing, disappear or change its tone due to the movement of the secretion into the larger bronchi.
Low dry wheezing is formed in the bronchi of medium, large caliber and even in the trachea as a result of the accumulation of sticky, viscous secretion in their lumen in the form of parietal plugs narrowing the inner diameter of the tube. When a powerful air flow passes during breathing, especially during inhalation, the secret forms vibrating "tongues", threads, membranes, and bridges in the form of a string that generate sounds of various strengths, heights and timbre, which depends on the caliber of the bronchus, the viscosity of the secretion and the air flow rate ...
Sometimes parietal mucous plugs create whistle conditions, but the resulting wheezing rales will have a lower pitch. This can be the case with deforming bronchitis in places of narrowing of the lumen of the bronchus.
The amount of low dry wheezing depends on the prevalence of bronchitis. More often they are scattered. The humming rales are lower, deaf. Whirring wheezing - the loudest, coarse, lingering They are so strong that it is easy to identify
vortex currents impart musical coloring to such wheezing. Whirring rales are better heard on inspiration during the entire phase. By localization, they are more often heard in the interscapular space, since they are formed in the bronchi of the pre-root zones.
The diagnostic value of low dry wheezing is great, they are heard in acute and chronic bronchitis with damage to the bronchi of medium and large caliber.
Moist wheezing (Fig. 313 ~ B)
The place of their occurrence is the bronchi of any caliber containing a liquid secretion of the mucous membrane, edematous fluid, blood or liquid pus. Air bubbles, passing through these media during breathing, burst on the surface of the liquid and create a kind of sound phenomenon called wet or bubbly wheezing. Wet rales are short, often multiple sounds of different caliber. Their size depends on the diameter of the bronchus, where they have arisen, small-bubbly, medium-bubbly, large-bubbly rales are completely distinguished. Wet rales can form in cavities with liquid contents (tuberculous cavity, abscess, gangrene by lungs). Above them, medium and large perforated rales are often heard.
Moist wheezing is usually heard in both phases of breathing, while their number and sonority are greater during inhalation than during exhalation, which is due to the speed of the air flow; during inhalation, it is greater. Moist wheezing is characterized by significant inconsistency, after forced breathing, after a few deep breaths, they may disappear, and then reappear. After coughing, they may disappear, change their caliber, or appear in more, which is associated with the advancement of secretions from small to larger bronchi. Large bubble wheezing sounds longer, lower and louder.
By the nature of the sound of moist rales, it is possible to assume the localization of the pathological process, the interest of the bronchi of a certain caliber, however, it is necessary to take into account the ability of the liquid secretion to move from small bronchi to larger ones.
The number and localization of heard wet wheezing depends on the nature of the pathological process. With limited pathology, their number will be small and they are heard in a limited area (focal pneumonia, tuberculosis, abscess)

With a common pathological process, their number increases sharply, and the listening area becomes significant. This is observed with total pneumonia, pulmonary edema.
Moist rales are classified into:

• dissonant (quiet, non-consonant);
• sonorous (sonorous, high, consonant).

Dissonant (quiet) moist rales occur in the bronchi of any caliber during their inflammation, the lung tissue does not suffer, and therefore, it is difficult to conduct these sounds to the periphery. Sometimes such sounds are barely perceptible to the ear. Dissonant wet wheezing occurs with common bronchitis, which means that they are usually heard on large area at both sides. These sounds are muffled, heard in the distance.
Slow humid wheezing from a small to a huge amount occurs with pulmonary edema of any genesis. Pulmonary edema of venous origin (acute or chronic left ventricular, left atrial failure) in the initial phases is manifested by stagnant dissonant moist fine bubbling rales in the posterior-lower parts of the lungs, with an increase in edema upper level listening rises up to the tops, the number of wheezing also increases, they become different-sized, bubbling breathing appears due to the accumulation of fluid in the large bronchi and trachea. Wheezing is always heard in symmetrical places, but slightly more on the right. Bubbling wet rales also occur with significant pulmonary hemorrhage.
Sound (high) moist rales are heard when there is an airless, compacted lung tissue around the bronchus, in which a moist rale has arisen (Fig. 314). That is, there is a combination of local bronchitis with inflammatory infiltration of lung tissue (focal pneumonia, tuberculosis, allergic infiltration). Under these conditions, the sounds arising in the bronchi are well conducted to the periphery, heard more clearly, loudly, sharply and with some musicality. Sometimes they take on a noisy character.
The presence of a smooth-walled cavity communicating with the bronchus and especially having a liquid level promotes the resonance of moist rales, and the inflammatory cushion around the cavity improves their conduction to the periphery.
Thus, the infiltration around the affected bronchus, the cavity drained by the bronchus, give rise to sonorous moist rales. Their you-

Rice. 314. Conditions conducive to the occurrence of sonorous moist wheezing.
A. Sounding moist fine bubbling rales occur in the presence of inflammatory infiltration around the bronchus (pneumonia, tuberculosis, allergic edema), infiltration improves the conduction of sound to the chest wall.
B. Sounding moist large-bubble rales occur when there is a large cavity in the lungs (tuberculous cavity, abscess, large bronchiectasis, festering cyst). Wet rales that form in large draining bronchi resonate! in the cavity, and the inflammatory roller promotes their better conduction to the ore wall. Wet rales arising in the bronchi of the inflammatory roller are well conducted to the [ore S1enka, the adjacent stripe enhances the sonority of the rales due to resonance.
listening is of great diagnostic value and suggesting focal pneumonia, tuberculous focus (infiltration), a cavity in the lung, gangrene of the lungs, staphylococcal pneumonia, a disintegrating tumor. It should be borne in mind that sonorous small bubbling rales are characteristic of pneumonia and tuberculosis without decay, and large bubbling in most cases are in the presence of a cavity (tuberculous cavity or abscess). Wet rales with a metallic tinge may be heard over large, smooth-walled cavities with amphorae breathing. In these cases, the metallic tint is associated with the pronounced resonance of the existing cavities.

Irina Karkina from Samara asks:

Why is bronchophonia determined for, and what can it be?

Our expert answers:

Radiography is the most objective research method to determine inflammatory process in the lung tissue. But before sending the patient for an X-ray, the doctor conducts an objective examination, including examination, palpation, percussion and auscultation. The results obtained during the auscultation process are the reason for referring a sick person for instrumental examination.

Auscultation is performed using a phonendoscope, which allows you to listen. Bronchophonia (chest conversation) is one of the methods of listening. Using this method, the specialist manages to identify areas of compaction in the respiratory organ, which is characteristic of pneumonia.

During the procedure, the patient is asked to whisper phrases and individual words containing hissing sounds. Some of the most commonly spoken words include:

• a cup of tea;
• sixty six;
• cone;
• fur coat.

With the help of a phonendoscope, a specialist listens to the lungs, determining in which areas the voice conduction is enhanced. Normally, bronchophonia is absent, that is, the doctor hears indistinct sounds merging with each other.

How is the result deciphered

There are the following types of breast talk:

• negative (if the pathological process is absent);
• reinforced;
• weakened.

With increased sound conduction, words are heard clearly, which indicates the presence of seals in the lung tissue, which are a good conductor of sounds. Such a result is possible with the following pathologies:

• inflammation of the lung tissue;
• lung infarction;
• abscess;
• other conditions characterized by the formation of seals and cavities in the respiratory organ.

Sound conduction may not increase if the pathological formation has small size or too deep from the surface of the body.

With the weakening of the chest conversation, the words uttered by the patient in a whisper are not heard at all. This is possible in the following cases:

• with the accumulation of exudate, air or gases in the pleural cavity;
• with the development of obstructive atelectasis;
• with emphysema of the lungs.

Sound conduction is reduced not only with pneumonia. This condition is observed in people with overweight, or a well-developed shoulder girdle.

This survey technique is often the only possible way diagnosis of the disease at an early stage, when its main manifestations are absent.

1. Tympanic sound (loud, prolonged, low, tympanic) observed:

1. In the presence of an air cavity in the lung:

a) lung abscess stage II, when there is a separation of liquid contents through the bronchus communicating with the abscess and an air cavity is formed;

b) tuberculous cavity.

2. When air accumulates in the pleural cavity (pneumothorax). Types of tympanic sound:

Metallic - resembles the sound of a blow to metal, defined above a large, at least 6-8 cm in diameter, smooth-walled cavity located superficially, at a depth of no more than 1-2 cm. This sound is typical for pneumothorax, especially open. Less commonly, it is observed with a large abscess, cavity.

The noise of a cracked pot resembles the sound that is obtained when tapping a closed and empty pot, in the wall of which there is a crack. Such a percussion sound is defined over a large, smooth-walled, superficially located cavity communicating with the bronchus with a narrow slit-like opening (abscess, cavity).

Dull tympanic sound

With the simultaneous accumulation of air and fluid in the alveoli, which is typical for croupous pneumonia of I and III stages. The appearance of an inflammatory exudate in the cavity of the alveoli leads to compaction of the lung tissue and the appearance of a dull sound. The simultaneous presence of air in the alveolar cavity with a reduced elasticity of the alveolar wall contributes to the appearance of a tympanic shade of percussion sound.

With a decrease in the airiness of the lung tissue and a decrease in its elasticity (compression atelectasis). Compression atelectasis occurs over the area of ​​fluid accumulation in the pleural cavity. In this case, there is a compression of the lung tissue, a decrease in its airiness and the appearance of compaction, which explains the presence of a dull sound. In addition, in the zone of compression atelectasis, there is a decrease in the elasticity of the lung tissue, which gives the sound a tympanic tone. It is known that the tympanicity of the sound is inversely proportional to the elasticity of the tissue.

Box sound(loud, prolonged, very low, tympanic) resembles the sound that occurs when a pillow or box is tapped. It appears with an increase in the airiness of the lung tissue and a decrease in its elasticity (emphysema of the lungs, an attack of bronchial asthma).

2. Dull-tympanic sound (quiet, short, high, tympanic) is defined by:

1. With the simultaneous accumulation of air and fluid in the alveoli, which is typical for croupous pneumonia of I and III stages. The appearance of an inflammatory exudate in the cavity of the alveoli leads to compaction of the lung tissue and the appearance of a dull sound. The simultaneous presence of air in the alveolar cavity with a reduced elasticity of the alveolar wall contributes to the appearance of a tympanic shade of percussion sound.

2. With a decrease in the airiness of the lung tissue and a decrease in its elasticity (compression atelectasis). Compression atelectasis occurs over the area of ​​fluid accumulation in the pleural cavity. In this case, there is a compression of the lung tissue, a decrease in its airiness and the appearance of compaction, which explains the presence of a dull sound. In addition, in the zone of compression atelectasis, there is a decrease in the elasticity of the lung tissue, which gives the sound a tympanic tone. It is known that the tympanicity of the sound is inversely proportional to the elasticity of the tissue

3.Bronchophonia.

Stand in front to the right of the patient. Position the phonendoscope in the supraclavicular fossa on the right. Ask the patient to whisper words containing hissing sounds ("a cup of tea"), move the phonendoscope to a symmetrical area and ask them to repeat similar words. Evaluate the research results. Perform bronchophonia in the same way at all points of auscultation.

Strengthening bronchophonia:

Compaction of lung tissue (pneumonia, fibrosis, pulmonary infarction, infiltrative tuberculosis).

Air cavity communicating with the bronchus (open pneumothorax, abscess, cavity, bronchiectasis).

Collapse of the lung tissue due to external compression (compression atelectasis).

Weakening of bronchophonia:

Blockage of the bronchus (obstructive atelectasis).

Fluid, air, connective tissue, in the pleural cavity (exudative pleurisy, hemothorax, closed pneumothorax, hydropneumothorax, fibrothorax).

4 wet wheezing

Wet wheezing appear in short, abrupt sounds, reminiscent of the bursting of bubbles, and are heard in both phases of breathing, but better in the inhalation phase. Wet wheezing occurs when there is a liquid secretion (sputum, transudate, blood) in the trachea, bronchi, cavities communicating with the bronchus (sputum, transudate, blood) and the passage of air through this secret with the formation of air bubbles of different diameters, which burst and emit peculiar sounds.

Depending on the caliber of the bronchi, in which moist rales occur, large, medium and small bubbling rales are emitted:

1. Large bubbling wet rales are formed when fluid secretion accumulates in the trachea, large bronchi, large cavities communicating with the bronchus (pulmonary edema, pulmonary hemorrhage, stage II lung abscess, tuberculous cavity).

Mid-vesicular moist rales are observed with the accumulation of liquid secretion in the medium-sized bronchi, in bronchiectasis (bronchitis, pulmonary edema, bronchiectasis, pulmonary hemorrhage).

Small bubbly rales occur when liquid secretions accumulate in the lumen of small bronchi, bronchioles (focal pneumonia, bronchitis, congestion in the pulmonary circulation, bronchiolitis). Small bubbling rales sound sometimes like crepitus.

In terms of volume (sonority), wet rales are divided into sonorous (voiced, consonant) and non-voiced (non-voiced, non-consonant), which depends on the nature of the pathological process in the lungs:

1. Sound humid wheezing occurs in small bronchi, bronchioles, air cavities communicating with the bronchus, in the presence of changes in the surrounding lung tissue, which contribute to better conduction of sounds:

a) compaction of lung tissue (focal pneumonia, chronic bronchitis with symptoms of pneumosclerosis).

b) the air cavity communicating with the bronchus due to resonance and compaction of the lung tissue around the cavity due to perifocal inflammation (stage II lung abscess, tuberculous cavity).

Dissonant wet wheezing occurs in the bronchi of all calibers, the trachea in the absence of changes in the lung tissue, contributing to a better conduction of sounds. In this case, the sound of bursting bubbles arising in the bronchi is drowned out by the lung tissue surrounding the bronchi (bronchitis, congestion in the pulmonary circulation, pulmonary edema).

The doctor listens with a stethoscope to various symmetrical areas of the lung, while the patient pronounces, as low as possible, words containing the letter "r" (n.p. - "thirty-three"), and with pronounced compaction of the lung tissue, words containing hissing sounds can be heard ( n.p., "a cup of tea"), pronounced in a whisper. A prerequisite for bronchophonia (as well as bronchial breathing) is the patency of the bronchus lying in the compacted tissue.

Normally, bronchophonia is absent. Bronchophonia is an early and sometimes the only sign of compaction of the lung tissue, since the compacted lung tissue is a good conductor of sounds and the words pronounced by the patient will be clearly audible. Academician F.G. Yanovsky pointed out that bronchophonia in pneumonia appears earlier than other physical symptoms.

Bronchophonia can be determined over air-containing cavities (cavities) with a dense capsule due to resonance phenomena. In this case, bronchophonia over the cavities often acquires a loud, amphoric character and is called amphophony. Sometimes it can have a metallic tint, which is called pectorilokvia. Bronchophonia can be defined above the zone of compression atelectasis, formed as a result of compression of the lung by pleural effusion, it is heard at the upper border of the pleural effusion, it can have a rattling, nasal sound. It is called egoophony.

Bronchophonia is noted when, according to physical conditions, bronchial breathing, increased vocal tremor, can be determined.

6. Questions for self-control of knowledge. Tasks for test control.

1... Mixed breathing can be heard at:

a) focal pneumonia;

b) bronchitis;

c) incomplete compression atelectasis;

d) in the jugular fossa;

e) above the apex of the right lung.

2. For hard breathing are characterized by the following P Signs:

a) is heard with bronchitis;

b) is heard only during inhalation;

c) due to a slight narrowing of the lumen of the bronchi;

d) all answers are correct.

3. Consonant wet wheezing is heard when:

1) pneumonia;

2) bronchitis;

3) lung abscess;

4) dry pleurisy;

5) cavernous tuberculosis.

Correct: A - 1, 2, 3. B - 2, 3, 4. C - 1, 3, 5. D - 1, 2.

4. Indicate where wet rales may form:

a) alveoli;

b) bronchi;

c) trachea;

d) pleural cavity;

e) caverns.

5. The causes of pathological bronchial breathing are:

a) pulmonary emphysema;

b) acute bronchitis;

c) lobar pneumonia;

d) tuberculous cavity of the lung;

e) compression atelectasis;

f) valvular pneumothorax.

6. Wet sonorous rales over the lungs are heard when:

a) pulmonary edema;

b) during the height of acute bronchitis;

c) pneumonia;

d) lung abscess;

e) in all of the above cases.

7... Bronchophonia is detected when:

a) pulmonary emphysema;

b) pneumonia;

c) bronchitis;

d) bronchial asthma;

e) none of the listed options.

8. What are the additional noises are heard with hydropneumothorax:

a) wet wheezing;

b) the sound of a falling drop;

c) saccadic breathing;

d) the noise of the splash of Hippocrates;

e) all answers are correct.

9. Distinctive features crepitus:

a) audible only during inhalation;

b) changes when coughing;

c) increases with pressure on the chest with a stethoscope;

d) accompanied by pain in the chest;

e) none of the above.

10. Pathological weakening vesicular respiration is observed when:

a) bronchitis;

b) pneumothorax;

c) hydrothorax;

d) pulmonary emphysema;

e) in all of the above cases.

11. To the main features fine bubbling rales include everything except:

a) arise in small bronchi and bronchioles;

b) arise in the alveoli;

c) are heard during inhalation and exhalation;

d) intensified when the stethoscope is pressed on the chest;

e) change after coughing.

12. The sound of a falling drop can listen over the chest To taphole at:

a) croupous pneumonia;

b) focal pneumonia;

c) pulmonary edema;

d) pneumothorax;

e) hydropneumothorax;

f) a large cavity of the lungs containing viscous pus.