A physiological sensing stethoscope suitable for use in high-noise environments is disclosed. The stethoscope is designed to be substantially matched to the mechanical impedance of monitored physiological activity and substantially mismatched to the mechanical impedance of air-coupled acoustic activity. One embodiment of the stethoscope utilizes a passive acoustic system. Another embodiment utilizes an active Doppler system. The passive and active systems can be combined in one stethoscope enabling switching from a passive mode to an active mode suitable for use in very high-noise environments. The stethoscope is suitable for use in environments having an ambient background noise of 100 dBA and higher. The passive includes a head having a housing, a flexural disc mounted with the housing, and an electromechanical stack positioned between the housing and the flexural disc in contact with the skin of a patient. The active system detects Doppler shifts using a high-frequency transmitter and receiver.