Which term describes rough, grating sounds produced by inflamed pleural surfaces rubbing together?

• A. Crackles
• B. Wheeze
• C. Rhonchi
• D. Pleural friction rub

Answer: (D)

Rough, grating sounds arise from inflamed pleural surfaces rubbing together, producing a pleural friction rub. The two pleural layers with inflammation slide against one another during breathing, creating a harsh, scratchy noise that is often described as leather rubbing on leather. It’s typically heard best with the patient leaning forward and with the stethoscope over the lower chest, and it can be heard during both inspiration and expiration. This sound points to pleuritis or pleurisy and is sometimes seen with pneumonia, pulmonary embolism, or chest trauma.

Crackles are discrete pops from airways reopening and are usually heard on inspiration given their origin in small airways or alveoli. Wheezes are musical, continuous sounds from narrowed airways, often more expiratory. Rhonchi are coarse, snoring sounds due to secretions in larger airways and may vary with coughing. The grating, pleural rubbing sound is distinct in its mechanism and timing, making it the best description for this scenario.