MINISTRY OF EDUCATION AND SCIENCE OF UKRAINE

V.N. Karazin Kharkiv National University

AUSCULTATION OF THE LUNGS:

MAIN BREATH SOUNDS
(VESICULAR AND BRONCHIAL
BREATH)

Methodological recommendations

for independent preparation for practical classes

for the 3“ year higher medical education applicants
in the discipline «Propaedeutic of internal medicine»

Kharkiv — 2020
UDC 616.24-071.6(072)
A93

Reviewers:

Evgeniy Y. Nikolenko — Doctor of Medicine, Professor, Head of

Department of General practice — family medicine of V. N. Karazin
Kharkiv National University;
Oksana V. Doroshenko — PhD, Associate Professor of Therapy
Department of Kharkiv Medical Academy of Postgraduate
Education, Ministry of Health of Ukraine.

Approved to the print by the decision of Scientific and Methodological Council of

V. N. Karazin Kharkiv National University
(protocol Ne 4 dated 24 June 2020)

Auscultation of the lungs: main breath sounds (vesicular and

bronchial breath) : methodological recommendations for independent
A93
preparation for practical classes for the 3" year higher medical
education applicants in the discipline «Propaedeutic of internal
medicine» : translation from Ukrainian language / edited by :
Mariia S. Brynza, Ella V. Karnaukh, Pavlo V. Matiukhin and others.
— Kharkiv : V. N. Karazin KhNU, 2020. — 20 p. : website:
http://medicine.karazin.ua/en/kafedri/kafedra-propedevtiki-
vnutrishnoi-meditsini-i-fizichnoi-reabilitatsii-/navchalno-metodichni-
materiali-dlya-studentiv

The methodological recommendations were developed by the team of

teachers of the Propaedeutic of Internal Medicine and Physical Rehabilitation
Department of V. N. Karazin Kharkiv National University of the School of
Medicine. An indicative map of the applicants work for higher medical education
is provided, with clear, consistent and detailed recommendations for preparation
at each stage of the practical training. The list of basic theoretical questions and
practical skills, structure and content of topics, test modules for the initial and
final level of knowledge control are given, the basic and additional literature is
specified, there are references to the electronic resources of department's
educational materials in the Annexes.

UDC 616.24-071.6(072)
© V.N. Karazin Kharkiv National University, 2020
© The group of editors, 2020
 CONTENTS

Estimated map of work for higher medical education applicants for

practical classes Preparation orc srssvescusererapmover
mares renuesemeuseor 4

Purpose and main tasks of the work on the topic of the practical lesson
AUSCULTATION OF THE LUNGS: MAIN BREATH SOUNDS
(VESICULAR AND BRONCHIAL BREATH) ...................0eeee 7
MAIN QUESTIONS (the main theoretical questions and basic practical

skills'on the topie of the practieal 1Ess00) csccrs resem eee 7

Tests to control the INITIAL LEVEL OF KNOWLEDGE ..................... 8
SIRUCTURE AND CONTENT OF THE TOPIC. ssiccccsssecssmmarawans 10
Test to control the FINAL LEVEL OF KNOWLEDGE ...................... 13
SELF-WORK of the 3™ year higher medical education applicants on the
topic of the practical lesson ......... 0. ccc cece cence eee eee een eeeeeeeeeeeeeeenaeas 15

Recommended literature (Basic, Additional) ..................:cccceeeeeee

eee 16
Annex |. Official site of V. N. Karazin Kharkiv National University and
page of the Propaedeutic of Internal Medicine and Physical Rehabilitation
Department of the School of Medicine ...........c
cece eee ce eee ee ene eneaeenaees 17
Annex 2. Electronic V. N. Karazin Kharkiv National University
institutional Repository (CKHNUIR) ......0. 60. e cece ee eee eee ee es 18
Annex 3. The official Facebook group of the Propaedeutic of Internal

Medicine and Physical Rehabilitation Department of the

V.N. Karazin Kharkiv National University.
News, announcements, useful information for students ..........0cc.cece
eee 19
ESTIMATED MAP OF WORK FOR HIGHER MEDICAL EDUCATION
APPLICANTS FOR PRACTICAL CLASSES PREPARATION

PREPARATORY phase:

1. To know the interdisciplinary integration of practical classes topics with

acquired theoretical knowledge and practical skills in basic disciplines
(medical biology, medical and biological physics, Latin language, human
anatomy, normal and pathological physiology, biological and bioorganic
chemistry, pathological anatomy, microbiology, virology and
immunology, pharmacology, philosophy etc.). Acknowledge the
terminology (including Latin transcription).
2. Motivational characteristic and substantiation of the topic of the
practical lesson on behalf of the formation of clinical thinking, in
particular for the further development of skills in knowledge application in
diagnosing of the main symptoms and syndromes and the possibilities of
modern laboratory and instrumental methods of internal organs
examination in the process of further study and future professional work.
3. To give better insights into the types of student’s educational activity,
information provided on the reference stands of the department: thematic
calendar plans of lectures, practical classes and extra-curriculum
independent work of the 3 year higher medical education applicants
corresponding to the curriculum of the model and working program of the
discipline "Propedeutics of internal medicine".
4. Utilization of the basic and additional educational and methodical
literature:
e textbooks and tutorials (printed and electronic versions), which are
listed in these guidance after the theoretical section;
e educational and methodological materials of the department
(methodical recommendations for independent preparation for practical
classes for the 3 year higher medical education applicants in the
discipline "Propaedeutic of internal medicine" and methodical
 recommendations for independent student’s work);
e attendance of lectures (on-site supply of the educational process using
multi-media presentations during lectures) - according to the thematic-
calendar plan. Usage of printed publications for classes preparation, they
can be obtained from the library and / or electronic versions of it
available on the official site of the V. N. Karazin KhNU
http://www.univer.kharkov.ua/en/departments (navigation for sections: ... /
Faculties / Departments / Propaedeutics of internal medicine and physical
rehabilitation) - ref. Annex 1;
and in the open interactive database of the electronic archive of the
Repository of the V. N. Karazin. KhNU _ resources
http://ekhnuir.univer.kharkov.ua (navigation: Faculty of Medicine /
Educational editions, Medical Faculty) - ref. Annex 2.
It is advisable to note the main issues in the form of notes.

MAIN phase:
Practical classes duration is 4 academic hours, they are held at the clinical base
of the department - specialized medical and sanitary department number 13
(Kharkiv, Kyivsky district, Akademika Kurchatov avenue, 29) —
future V. N. Karazin KhNU clinic - see Annex 3.

ATTENTION!
Its forbidden to attend department classes without a medical uniform,
replaceable shoes, medical cap, mask, shoe covers, stethofonendoscope.
To achieve the educational goal of practical classes and mastering the
theoretical part of the subject, it is necessary to LEARN and
ASKNOWLEDGE the answers to the main theoretical questions of the
lesson’s topic (ref. to the list of the main theoretical questions) that will be
checked by the lecturer through an oral and / or written survey (correction,
refinement, additional answers) on the main phase of practical classes
conduction.

TO BE ABLE TO solve with explanations of theoretical, multiple choice

 (for control of the initial and final level of knowledge), situational tasks
proposed for the mastering of the topic.
3. TO MASTER PRACTICAL SKILLS on the topic
e Take active part in the teacher’s demonstration of the methodology of
patient’s examination, and to assign practical skills near the patient's bed
under the supervision of a teacher.
To perform the patient’s examination, interpret the received laboratory and
instrumental investigations data, be able to use tools needed.
e Make syndromic diagnosis. To perform a differential diagnosis, to
analyze the principles of the treatment, to give prescriptions for essential
medicines prescribed.
4. EXECUTE obligatory tasks foreseen for independent student work.
FINAL phase:
1. On the basis of theoretical knowledge and practical skills mastering on the
topic to form clinical thinking and syndromic diagnosis making skills for
further study in the medical profession.
2. Writing of the appropriate section of the history of the disease - according
to the plan.

During of the "Propedeutics of internal medicine" subject studying its

obligatory to write two history cases as provided:

1) Anamnestic patients’ case report (patients data, patient’s complaints,

anamnesis vitae and morbi) - is issued before the end of the autumn semester of
the academic year and should be submitted to the teacher for verification and
evaluation.
2) Complete patients’ case report (patients data, patient complaints, anamnesis
vitae and morbi, objective examination of the patient, mastering of a survey plan,
interpreting the results of the laboratory and instrumental investigations data,
setting up a syndromal diagnosis) - is issued before the end of the spring
semester of the academic year and should be submitted to the teacher for
verification and evaluation.
 Purpose and main tasks of the work on the topic of the practical lesson
AUSCULTATION OF THE LUNGS: MAIN BREATH SOUNDS
(VESICULAR AND BRONCHIAL BREATH)

Increase the level of knowledge on the issues of internal diseases, to teach

students the technique of lung auscultation.

MAIN QUESTIONS

As a result of studying the 3" year higher medical education applicants

must KNOW (the main theoretical questions):
1. What includes the auscultation method.

2. Rules of auscultation performing.

3. The main respiratory sounds formation mechanism.

must BE ABLE (basic practical skills on the topic of the practical lesson):
1. Conduct an interview of patients.
2. Conduct physical examination of patients.
3. Make a preliminary diagnosis.
4. Conduct auscultation of the lungs.

5. Evaluate the general condition of the patient.

 Tests to control the INITIAL LEVEL OF KNOWLEDGE

1. Above the lungs of healthy people during auscultation you can listen:
A. Normal vesicular breathing.
B. Decreased vesicular breathing
C. Increased vesicular breathing.
D. Bronchial breathing.
2. What breathing sound is heard when lung tissue is consolidated:
A. Decreased.
B. Vesicular.
C. Bronchial.
D. Harsh.
E. _Bronchovesicular.
3. Which respiratory sound is saved during performing of "simulated breathing”?
A. — Pleural friction sound.
B. Crepitation.
C. Fine bubbling rales.
D. Wheezing.
4. What can be the reason for the decreasing of the vesicular sound?
A. Obesity.
B. Atelectasis.
C. Fluid in the pleural cavity.
D. All of the above.
5. Vesicular breathing with elongated exhalation is auscultated while:

A. —Pneumothorax.
COPD.
moa

Pneumonia.

Bronchial asthma.

Pleurisy.
6. You can hear wheezing:
A. During inhalation.
B. Only during exhalation.
C. During inhale and exhale.
7. Crepitation can be heard:
A. During inhalation.
B. Only during exhalation.
C. During inhale and exhale.
8. The noise of pleural friction can be heard:
A. During inhalation.
B. Only during exhalation.

C. During inhale and exhale.

9. Rales occur:
A. In the alveoli.
B. In the bronchi.
C. In the oropharynx.
D. In the pleural cavity.
10. Deep, loud and rare breathing:
A. Cheyne-Stokes respiration.
B. Biot's respiration.
C. — Stridor.
D Kussmaul breathing.

Standarts of answers: 1-A, 2—B, 3—A, 4—A, 5—D, 6—-C, 7—A, 8—-C, 9-B, 10—-D.
 STRUCTURE AND CONTENT OF THE TOPIC

Topic relevance. The ability to perform qualitative auscultation of the

lungs and to assess the detected changes in the basic respiratory sounds is

important in the diagnosis of respiratory system disorders.

AUSCULTATION OF THE LUNGS
Auscultation - a method of examining the sound phenomena that arise
during listening. Auscultation involves listening to the main and additional

respiratory sounds, as well as the determination of bronchophony. There are two

types of auscultation: direct (performed by putting the ear to the chest) and
indirect (through a stethoscope or a phonendoscope). Auscultation with the use of
a stethoscope has several advantages:
e louder sound;

e itis more comfortable in a hygienic way;

e allows you to listen the sounds on a smaller area.
Auscultation of the lungs should observe some rules:
the room should be quiet and warm;
e the chest should be nude;

e the stethoscope should be tightly fitted to the body, avoiding friction;

e do not touch the stethoscope tubes during auscultation;

e depending on the patient's condition, auscultation is performed in standing,

sitting or lying position;
e auscultation is performed at the points of comparative percussion;
e when auscultation is performed from the lateral side the patient's hands
should be at the head, and from the back - crossed ahead;

e at first, with a quiet breath, the main respiratory sounds are auscultated,
then additional and indirect.

10
 The main respiratory sounds include vesicular and laryngotracheal. The latter

category also includes bronchial breath sounds.

Breathing noises occur in the larynx, trachea and bronchi, due to the
turbulent movement of the air.
Vesicular breathing (alveolar) — is a soft, blowing noise that resembles the
sound of "F", produced at the moment of inhalation and associated with vibration
alveoli walls. This sound can be heard throughout the inhalation and in the first
third part of the exhalation. Between inhalation and exhalation are no pauses, the
ratio is 5:3.
Laryngotracheal (bronchial) breathing — is a loud, high-frequency and
rough noise that occurs when the air passes through the vocal cavity and forming
a turbulent flow. It resembles the sound of "H". Auscultated best over the
pharynx and trachea. Above other areas of the chest of a healthy person it is not
heeded. Ratio of inhalation and exhalation phases 4: 5.

Major changes in vesicular breathing. Decreasing of vesicular

breathing, which is associated with a decrease in the duration and intensity of the
breathing phases. Ratio of inhale and exhale 2:1. The reasons for such changes
can be:
e Physiological: due to excessive development of muscle and adipose tissue
in the chest area; above the top of the lungs, because the mass of alveoli in
that area small.
e Pathological: extrapulmonary (obstruction of the upper respiratory tract
with narrowing of the larynx and trachea, reduction of chest mobility);
pleural causes (hydrothorax, pneumothorax, pleurisy); bronchial causes
(obstructive atelectasis syndrome, bronchial obstruction); pulmonary
causes (emphysema, inflammation).
The increasing of vesicular breathing is characterized by an increase of
inhale and exhail without changing their ratio. Physiological causes of increased

11
vesicular breathing are: thin chest, considerable exercise etc. Pathological causes

are: hyperthyroidism, hyperventilation etc.

The types of increased vesicular respiration include: puerile respiration,
cogwheel (saccade) respiration, harsh respiration.

Puerile respiration — it is louder but more gentle breathing. The ratio of

inhalation and exhalation phase is 5: 5. Causes: resonant properties of the "small"
chest; increase in airflow velocity.

Harsh respiration occurs due to the appearance of a vortex airflow, as a

result of narrowing of the bronchus. Increases the intensity and volume of both
phases of breathing with a slight extension of exhalation. The ratio of inhalation
and exhalation phases is 5: 4.

Cogwheel (saccade) respiration. It is characterized by a break due to the

same pauses of inhalation with normal exhalation. The reasons are diseases of the
respiratory muscles, hypothermia, impaired patency of the small bronchi.

Pathological bronchial respiration. When creating conditions to improve

the breathing noise of the trachea and bronchi with the preserved patency of the
bronchi, you can listen the bronchial respiration in the area where vesicular
breathing is heard. This respiration is called pathological bronchial. It appears
when: pulmonary tissue thickening, in case of compression atelectasis syndrome,
appearance of the cavity in the lungs.
In some conditions bronchial respiration can become metallic, for example

in case of pneumothorax development. In some cases, amphoric breathing occurs.

It is noisy due to the good resonance. It resembles a breathing sound when
blowing air in the empty bottle with a narrow neck.
Bronchovesicular (mixed) breathing is characterized by a longer phase of

exhalation and has both the properties of vesicular and bronchial respiration. In
pathology, such breathing occurs with segmental pneumonia. The ratio of
inhalation and exhalation phase is 5: 5.

1D
 Test to control the FINAL LEVEL OF KNOWLEDGE

1. What causes the crepitation?

A. The presence of a small amount of exudate and transudate in the
alveoli.
B. Inflammation of pleurae ("dry" pleurisy.)
C. Alveoli are replete with exudate and transudate.
D. Viscous sputum in the main bronchi.
E. Viscous sputum in tertiary bronchi and / or it is spasm.
2. Specify the primary mechanism of bronchovesicular respiration:
A. Reducing the elasticity of the lung tissue.
B. Conducting laryngo-tracheal respiration (with change of its tone) to
the chest surface when the lung is compacted or there is a cavity connected
with the bronchus.
C. Narrowing of the bronchi (spasm, viscous sputum).
D. The presence of a large foci of compaction of the lung tissue,
surrounded by unchanged alveoli.
E. Increasing fluctuations of the alveoli walls during breathing.
3. What is the main respiratory noise most often heard in case of closed
pneumothorax?
A. Decreased or impaired vesicular respiration.
B. Amphoric breathing.
C. Bronchial respiration.
D. Harsh respiration.
E. Mixed bronchovesicular respiration.
4. Specify the main mechanism of harsh breathing:
A. Reducing the elasticity of the lung tissue.
B. Conducting laryngo-tracheal respiration (with change of its tone) to
the chest surface when the lung is compacted or there is a cavity connected
with the bronchus.

13
 C. Narrowing of the bronchi (spasm, viscous sputum).
D. The presence of a large foci of compaction of the lung tissue,
surrounded by unchanged alveoli.
E. Increasing fluctuations of the alveoli walls during breathing.
5. What causes the occurrence of fine bubbling rales?
A. Viscous sputum in the main bronchi.
B. Viscous sputum in tertiary bronchi and / or it is spasm.
i. Liquid sputum in large bronchi or cavities, combined with bronchus.
D. Liquid sputum in small bronchi at kept airiness of the surrounding
lung tissue.
E. Liquid sputum in tertiary bronchi bronchi and inflammatory
induration of surrounding lung tissue.
6. What causes of dry discounted rales?
A. The presence of a small amount of exudate and transudate in the
alveoli.
B. Inflammation of pleurae ("dry" pleurisy).
C. Alveoli are replete with exudate and transudate.
D. Viscous sputum in the main bronchi.
E. Viscous sputum in tertiary bronchi bronchi and/or its spasm.
7. For what purpose the additional method of pulmonary auscultation is used such
as stimulating respiration with a closed glottis?
A. To distinguish pleural friction noise from crepitation and wheezing.
B. For the detection of latent bronchial obstruction.
u, In order to distinguish dry rales from wet rales.
D. In order to distinguish crepitation from pleural friction.
E, For better listening to abnormal bronchial respiration.
8. What is the basic respiratory noise often heard in case of smooth-walled cavity
(diameter more than 5 cm) that connects with the bronchi?
A. Decreased or impaired vesicular respiration.
B. Amphoric breathing.

14
 C. Bronchial respiration.
D. Harsh respiration.
E. Mixed bronchovesicular respiration.
9. What causes dry, humming (bass) wheezing?
A. The presence of a small amount of exudate and transudate in the
alveoli.
B. Inflammation of pleurae ("dry" pleurisy).
C. Alveoli are replete with exudate and transudate.
D. Viscous sputum in the main bronchi.
E. Viscous sputum in tertiary bronchi bronchi and/or its spasm.
10. The pleural friction is heard:
A. During inhalation.
During exhalation.
C. Through all the inhalation and exhalation.
D. After coughing.
E. After changing body position.

Standarts of answers: 1-A, 2—D, 3—A, 4-C, 5—D, 6—E, 7—A, 8-B, 9—D, 10-C.

SELF-WORK
of the 3™ year higher medical education applicants
on the topic of the practical lesson

1. Survey of patient.
2. Interpretation of laboratory data.
3. Interpretation of obtained instrumental investigation methods.
4. To conduct auscultation of the lungs.
5. Interpretation of data obtained during auscultation.

15
 Recommended literature
Basic:
1. Kovalyova O. M. Propaedeutics to internal medicine : Diagnostics ; textbook
for English learning students of higher medical schools ; Part | ; Ed. 3 /O. M.
Kovalyova, T. V. Ashscheulova. — Vinnytsia : Nova Knyha publishers, 2017.
— 424 p.
2. Kovalyova O. M. Propaedeutics of Internal Medicine : Part 2. Syndromes and
diseases; textbook for English learning students of higher medical schools / O.
M. Kovalyova, S. O. Shapovalova, O. O. Nizhegorodtseva. — Ed.3. —
Vinnytsia : Nova Knyha publishers, 2017. — 264 p.
3. Jameson J. L., Fauci A. S., Kasper D. L., Hauser S. L., Longo D. |., Loscalzo J.
(eds.). Harrison’s Principles of Internal Medicine 20" edition. — McGraw-Hill,
2018. — 3790 p. — ISBN 978-1-259-64403-0 — MHID 1-259-64403-0
4. Bickley L. S. Bates' Guide to Physical Examination 12" edition. — Wolters
Kluwer, 2017. — 1066 p.
Additional:
1. Innes J. Alastair, Dover Anna R., Fairhurst Karen (eds.). Macleod's Clinical
Examination 14" edition. — Elsevier, 2018. — 400 p.
2. Phillips Raymond E. The Physical Exam. An Innovative Approach in the Age
of Imaging. — New York : Springer, 2018. — 322 p. — ISBN 978-3-319-
63846.
3. Jarvis C. Physical Examination and Health Assessment.— New York :
Saunders, 2015. — 897 p.
4. Priftis K. N., Hadjileontiadis L. J., Everard M. L. (eds.). Breath Sounds From
Basic Science to Clinical Practice. — New York : Springer, 2018. — 314 p.
5. Wilkinson L, Raine T., Wiles K., Goodhart A., Hall C., O’Neill H. Oxford
Handbook of Clinical Medicine 10" edition. — Oxford : Oxford University
Press, 2017. —912 p.
6. CyaacHa TpakTHKa BHYTPIUIHbO! MeMUMHH : HaBYaIbBHuM MOciOHHK / 3a per.
O. M. binosona, Il. T. Kpaspuyna, JI. A. Jlanumuol. — X. : XHY imeni
B.H. Kapa3ina, 2012. — 644 c. URI :_ http://repo.knmu.edu.ua/handle/
123456789/1658

16
 Annex |
Official site: http://www.univer.kharkov.ua/en/departments

V. N. Karazin Kharkiv National University (Official Site)

About Students Life Admissions Academics Research & Innovation jee

School of Medicine
Depariments

Department of propaedeutics of internal medicine and

physical rehabilitation V. N. Karazin University
http://medicine.karazin.ua/departments/kafedri/kafedra-propedevtiki-vnutrishnoi-
meditsini-i-fizichnot-reabilitatsu-
Se Schools beh il pet RO Beem t- Lee ali Mts)

V. N. Karazin
Kharkiv National University
School of Medicine

News Baise) acs Research For Students. Admissions For staff

« Department of Propaedeutics of Internal Medicine and Physical Rehabilitation

« History of the Department of Propaedeutics of Internal Medicine and Physical Rehabilitation
* Logistic of the Department of Propaedeutics of Internal Medicine and Physical Rehabilitation
« Head of the Depariment of Propaedeutics of Intemal Medicine and Physical Rehabilitation
* Staff of the Department of Propaedeutics of Internal Medicine and Physical Rehabilitation
Educational work of the Department of Propaedeutics of Internal Medicine and Physical Rehabilitation
Disciplines of the Department of Propaedeutics of Intemal Medicine and Physical Rehabilitation
« Methodical work of the Department of Propaedeutics of Internal Medicine and Physical Rehabilitation
« Scientific work of the Department of Propaedeutics of Intemal Medicine and Physical Rehabilitation
* Clinical bases of the Department of Propaedeutics of Internal Medicine and Physical Rehabilitation
* Contact information of the Department of Propaedeutics of Internal Medicine and Physical Rehabilitation
* Educational materials for students

17
 Annex 2

Electronic Kharkiv National University Institutional Repository

http://ekhnuir.univer.kharkov.ua/

aKhNUIR
eKhNUIR >
Advanced Search
ject Search English ykpailceka pyccKwi
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@ Author
® Title 2014/03/21 repository Karazin Kharkiv National University received at the International Center ISSN
@ Subject (within the project ROAR supported by the information sector UNESCO) own ISSN 2310-8665. Thus, the
@ Submit Date repository to a full online edition (a continuously updated resource), where you can publish the results of
research as in the original, along with printed periodicals.

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@ Edit Profil Domanovski A.N. (2016, 2015, 2013, School of History), Yabluchanskiy N.I. (2015, 2014, 2013, 2012,
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18
 Annex 3

| ff Propaedeutics of internal Medicine and Phy. Rehab. DepV... Q

The official Facebook group
of the Propaedeutics of Internal
Medicine and Physical
Rehabilitation Department
of the V. N. Karazin Kharkiv
National University.
News, announcements, useful
information for students

rc T2as /
How to get there? Jee /
The base of the department is in a beautiful, <r fe
quite place, farfrom the bustle of the big city. era fe $f
Our address: Academika Kurchatova Avenue, 29. 8 : 7
You can get to this place from the city center, e :
using the 296e bus (from «Derjprom» metro : 9: /
station), go to the "Church" stop, :
and continue to walk about 600 meters. df os?
You are on the spot! >.<

{nstagram — instagram.com/pim_and_phr_karazin/
NBM | OP PIM and Phy R
iW] Department of Propedeutics of Internal Medicine and Physical Rehabilitation
S_ Teach, treat , do science.
The most official informal department Instagram
te ree www.youtube.com/channel/UCFOqggRbBKJIdV806IUtRNMQ

mS emeieioen preg et ete)

9 AA. * oe
PRED
2 ypOprewres)
YouTube aes rraboot a =,
A ype eee e ne =
Pete 9 tele Gale ow co a

. Dep ee Cm athe etsme eheCe bs

Mapia bpvH3a ob OF Se Es ar Eb Oy

“seer ee Signs and symptoms of Syndromes in diseases of

urinary system disorders blood system

19
 Educational edition

Mariia S. Brynza — Head of the department, PhD, Associate professor

Ella V. Karnaukh — PhD, Associate professor
Pavlo V. Matiukhin — PhD, Associate professor
Elvira A. Aydinova — assistant professor of department
Olena S. Voronenko — assistant professor of department
Nina P. Galdzytska — assistant professor of department
Tetiana V. Zolotarova — assistant professor of department
Viola M. Larionova — assistant professor of department
Aryna I. Lakhonina — assistant professor of department
Nataliia O. Lisova — assistant professor of department
Irina I. Oktiabrova — assistant professor of department
Daiana Y. Pavlova — assistant professor of department
Olena O. Prokhorova — assistant professor of department
Natalia E. Tselik — assistant professor of department
Olena Y. Shmidt — assistant professor of department
Yulian M. Shvets — assistant professor of department
Iryna V. Shokalo — assistant professor of department

Responsible for translation author — Nina P. Galdzytska

AUSCULTATION OF THE LUNGS: MAIN BREATH SOUNDS

(VESICULAR AND BRONCHIAL BREATH)

Methodological recommendations for independent preparation

for practical classes for the 3" year higher medical education applicants
in the discipline "Propaedeutic of internal medicine"

Electronic publication on official website of

V.N. Karazin Kharkiv National University —
page of the Propaedeutic of Internal Medicine
and Physical Rehabilitation Department of the
School of Medicine, section "Educational
materials for students / Guidelines"