A patient has a high-pitched grating sound over the third intercostal space to the left of the sternum. Upon further examination, you determine that the patient has a pericardial friction rub because
a. the sound does not change with respiration.
b. the sound radiates to the right side.
c. she is complaining of pain with breathing.
d. the sound disappears when she holds her breath.
A
A pericardial friction rub, an abnormal finding, produces a high-pitched, multiphasic, and scratchy (may be leathery or grating) sound that does not change with respiration. It is a sign of pericardial inflammation and is caused by the rubbing together of the inflamed visceral and parietal layers of the pericardium. A pericardial friction rub is auscultated from the sternum (third to fifth ICS) to the apex (mitral area) with the diaphragm. A pleural friction rub produces a low-pitched, coarse, and grating sound that does change with respiration. When the patient holds her breath, the sound disappears. The patient may also complain of pain upon breathing, which is a sign of visceral and parietal pleurae inflammation.
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