Sunday, January 31, 2010

Anatomy of a Stethoscope

The signature tool of the trade, stethoscopes have heard it all. Despite being a well crafted instrument, their versatility makes them a "must have" in the field of medicine.


Originally a device made of wood, stethoscopes and their evolution have given diagnosticians enhanced hearing capabilities. Ranging from drug store knockoffs to professional Littmann stethoscopes, pediatric to cardiology, short or long, there is certain to be one that will meet your needs. Through the years I have used many, never really understanding their least until a few weeks ago.

I was recently gifted my first Littmann stethoscope. From experience, I know having eartips in for extended periods of time gets uncomfortable after a while, and draping the tubing around my neck can be awkward if it is stiff. My new stethoscope has extremely soft earpieces and tubing which permit greater comfort than I previously knew. As for auscultating breath, heart, digestive and vascular sounds, my lack of experience at this stage limits my judgment. Nonetheless, I like what I am hearing. Now I just have to find willing subjects for more auscultatory practice.

Board Prep Question of the Week

A 48 year-old female presents with progressive shortness of breath and anxiety. She has no notable prior medical history, and on physical exam, auscultation reveals an opening snap over the cardiac apex followed by a mid-diastolic rumble. The most common cause of her disease process is which of the following?

A. chronic hypertension causing dilatation of the left ventricle
B. repeated attacks of Streptococci causing valvular lesions
C. primary pulmonary hypertension causing atrial dilatation
D. a congenital atrial-septal defect causing chronic hypoxemia
E. a congenital bicuspid valve causing increased afterload of th
e left ventricle

Answer & Explanation


  1. Let me give you an important piece of advice given to me a long time ago by a family practice physician I used to work with in the ED. He said "labs, x-rays, and all the other tests are just tools to help you make the correct diagnosis. You have to first and foremost listen to the patient".
    Your blog came to me as I have a Google Alert set up to pull in anything new for pulmonary hypertension. I am a nurse who worked many years in the ED. I also have pulmonary atrial hypertension secondary to scleroderma. We need more bright minds to help find a cure for this devastating disease. Over the past 10 years great strides have been made in medical management but still no cure. The average life expectancy for untreated PH is 2.8 years. PH is under diagnosed and mis-diagnosed many times. It took 2.5 years and 4 pulmonologist (2 being top in the country) before the correct diagnosis was made in my case. Totally unacceptable in the USA.
    Maybe this note will spark an interest. Visit for more PH info. There are also free CME online articles.
    Thanks for listening. Best to you on this career path. It can be emotional but very rewarding.

  2. Thanks for your comment Cindy. I completely agree with you and your doctor friend concerning the critical nature of listening to the patient. I can only imagine the difficult nature of your illness and wish you the best as you continue to fight for your health.

  3. Littmann sold his stethoscope company, Cardiosonics, Inc., in 1967 to IBM. The larger company's vast research and development budget allowed for further advancement in stethoscope technology. These include the tunable stethoscope which allows a single chest piece able to hear both low- and high-frequency sounds.

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  4. Hi....Im a med student in India...

    I hav to buy my 1st stethescope...Im thinking of a Littman....any suggestions as to which specific model???

  5. Deepak, you want to make sure you get something that provides quality and functionality.

    This is what I purchased and I am very satisfied - Littmann Classic II SE

    You might consider one with a pediatric/adult diaphragm so you are not constantly changing them - Littmann Cardiology III

    I would avoid any stethoscope with two tubes or hard plastic ear pieces. Unless you have a hearing deficit, you probably do not need an electronic stethoscope. Good Luck!


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