Which lung sound was observed in the elderly patient with tuberculosis and left lower-lobe rhonchi?

• A. crackles
• B. rhonchi
• C. wheezes
• D. absent

Answer: (B)

Rhonchi are low-pitched, coarse, snoring-like sounds heard with auscultation when there are secretions in the larger airways. In an elderly patient with tuberculosis, mucus can collect in a lower-lobe bronchus, producing a rhonchus in that region. The sound is usually due to air moving past secretions and may be heard most prominently during expiration, often easing when coughing. This contrasts with crackles, which are fine or coarse popping sounds from fluid in the alveoli or at the end of inspiration; wheezes, which are continuous musical tones from narrowed airways; and absent breath sounds, which suggest little to no air movement from obstruction, effusion, or pneumothorax. So the observed sound fits rhonchi best.