One Nurse Practitioner's Learning Process

Short Summary: Two most common root causes of inspiratory crackles are CHF and pneumonia. CHF is most likely to present as bilateral inspiratory crackles while pneumonia is most likely to present as unilateral inspiratory crackles. Ruling out one of the two ailments is simple and often only requires a history and physical exam.  Pneumonia and congestive heart failure (CHF): Both diagnoses can present with inspiratory crackles An 85 year old male patient is complaining of shortness of breath with activity as well as lethargy for two weeks. Inspiratory crackles can be heard on auscultation over the posterior aspect of the left lower lobe. Knowing nothing else about the patient, which diagnosis is more likely? Pneumonia. Why do we hear inspiratory crackles? Pleural effusion, indirectly. A common misconception is that the fluid involved in a pleural effusion is the direct cause of the inspiratory crackles. In reality, the crackles result from mucus in the alveolar space. I...