Bates- Final Exam- Lung/thorax

Front 1

Angina pectoris and MI are examples of

Back 1

myocardium problems

Front 2

pericarditis is an example of what two problems?

Back 2

1. pericarditis
2. parietal pleura problem

Front 3

dissecting aortic aneurysm is an example of what type of problem?

Back 3

aortic problem

Front 4

bronchitis is an example what types of problems?

Back 4

trachea & large bronchi

Front 5

pericarditis and pneumonia are examples of what type of problems?

Back 5

parietal pleura

Front 6

Costochondritis and Herpes Zoster are examples of what type of problems?

Back 6

Chest wall (musculoskeletal and skin)

Front 7

esophageal spasm and GERD are examples of what type of problems?

Back 7

esophagus problems

Front 8

cervical arthritis, biliary colic, and gastritis are examples of what kind of problems?

Back 8

extrathoracic problems

Front 9

clenched fist over sternum suggests

Back 9

angina pectoris

Front 10

finger pointing to a tender area on the chest wall suggests:

Back 10

musculoskeletal pain

Front 11

hand moving from neck to epigastrum suggests:

Back 11

heartburn

Front 12

what is the most frequent cause of chest pain in children? What is another common cause?

Back 12

most common = anxiety
other: costochondritis

Front 13

describe symptoms that an anxious patient may experience

Back 13

1. episodic dyspnea during both rest and activity
2. hyperventilation (rapid, shallow breathing)
3. frequent sighs

Front 14

what is suggestive of partial airway obstruction?

Back 14

wheezing

Front 15

when a patient is wheezing, what are 3 common causes of the airway obstruction?

Back 15

1. secretions
2. excess inflammation
3. foreign body

Front 16

What type of HF is associated with cough?

Back 16

Left Sided

Front 17

dry hacking cough is present in:

Back 17

mycoplasma pneumoniae

Front 18

productive cough is present in:

Back 18

bronchitis
viral/bacterial pneumoniae

Front 19

transluscent white or gray sputum

Back 19

mucoid

Front 20

yellowish or green sputum

Back 20

purulent

Front 21

foul-smelling sputum is found in

Back 21

anaerobic lung abscesses

Front 22

tenacious sputum is found in:

Back 22

cystic fibrosis

Front 23

large volumes of purulent sputum is found in:

Back 23

bronchiectasis or
lung abscess

Front 24

Name some diagnostically helpful symptoms:

Back 24

1. fever
2. chest pain
3. dyspnea
4. orthopnea
5. wheezing

Front 25

Hemoptysis is most often seen in:

Back 25

CF

Front 26

hemoptysis is rarely seen in:

Back 26

infants, children, & adolescents

Front 27

describe the variation of blood form the stomach vs that in the respiratory tract

Back 27

stomach blood: darker; may be mixed with food particles

Front 28

5 A's of smoking cessation (in order)

Back 28

1. Ask
2. Advise
3. Assess
4. Assist
5. Arrange

Front 29

Cyanosis is indicative of

Back 29

hypoxia

Front 30

clubbing of the nails is present in

Back 30

1. lung abscesses
2. malignancy
3. congenital heart disease

Front 31

a high-pitched wheeze is called:

Back 31

audible stridor

Front 32

audible stridor is indicative of:

Back 32

airway obstruction in larynx or trachea

Front 33

inspiratory contraction of SCM muscles at rest signals:

Back 33

severe breathing difficulty

Front 34

lateral displacement of the trachea is present in:

Back 34

1. pneumothorax
2. pleural effusion
3. COPD

Front 35

Lung retraction is found in:

Back 35

1. severe asthma
2. COPD
3. upper airway obstruction

Front 36

unilateral impairment/lagging of respiratory movement suggests disease in the:

Back 36

lung or pleura

Front 37

what are some physical abnormalities that may be felt on a Chest Exam?

Back 37

1. intercostal tenderness- over inflamed pleura
2. bruises over fractured rib

Front 38

sinus tracts, although rare, usually indicate infection of:

Back 38

underlying pleura & lung

Front 39

sinus tracts are seen in:

Back 39

1. TB
2. actinomycosis

Front 40

what are some causes of unilateral decrease/delay in chest expansion?

Back 40

1. chronic fibrotic disease of underlying lung/pleura
2. pleural effusion
3. lobar pneumoniae
4. pleural pain with assoc splinting and unilateral bronchial obstruction.

Front 41

when is fremitus decreased/absent?

Back 41

1. voice is soft
2. transmission of vibrations from larynx to chest surface is impeded

Front 42

What are some causes of decreased/absent fremitus?

Back 42

1. obstructed bronchus
2. COPD
3. pleural effusion
4. fibrosis (pleural thickening)
5. pneumothorax (air)
6. infiltrating tumor
7. very thick chest wall

Front 43

dullness replaces resonance when:

Back 43

fluid or solid replaces air-containing lung or occupies the plueral space beneath your percussing fingers

Front 44

examples of when dullness is heard while percussing:

Back 44

1. lobar pneumonia- alveoli fill with fluid and blood cells
2. pleural accumulations of serous fluid, blood, pus, fibrous tissue, or tumor

Front 45

What may be heard over the hyperinflated lungs of emphysema or asthma, but is not considered a reliable sign?

Back 45

generalized hyperresonance

Front 46

what sound suggests a large pneumothorax or possibly a large air-filled bulla in the lung?

Back 46

unilateral hyperrenosance

Front 47

what finding suggests plueral effusion?

Back 47

abnormally high level of diaphragm

Front 48

a high diaphragm can be found in what conditions?

Back 48

1. pleural effusion
2. atelectasis
3. diaphragmatic paralysis

Front 49

What may generate confusion of sounds when attempting to auscultate?

Back 49

1. sounds from bed clothes
2. paper gowns
3. chest itself

Front 50

what may produce crackling sounds in a normal exam (false crackles)

Back 50

hair on the chest

Front 51

how do you auscultate properly on a person with an exceptionally hairy chest?

Back 51

press harder or wet the hair

Front 52

you hear muffled, low-pitched, rumbling/roaring noises on a pulmonary exam- what situation may produce these in a normal patient?

Back 52

patient is cold or tense

Front 53

breath sounds are likely to ________ when airflow is decreased

Back 53

decreased

Front 54

what are common causes of decreased breath sounds associated with decreased airflow?

Back 54

1. obstructive lung disease
2. muscular weakness

Front 55

what conditions cause poor sound transmission that may be heard as diminished breath sounds?

Back 55

1. pleural effusion
2. pneumothorax
3. emphysema

Front 56

What does a gap suggest?

Back 56

bronchial breath sounds

Front 57

what lung abnormalities may produce a crackling sound?

Back 57

1. pneumonia
2. fibrosis
3. early CHF

Front 58

what airway abnormalities may produce a crackling sound?

Back 58

1. bronchitis
2. bronchiestasis

Front 59

A narrowed airway is likely to be detected on a pulmonary exam by:

Back 59

wheezing

Front 60

conditions that are associated with wheezing due to narrowed airway include:

Back 60

1. COPD
2. asthma
3. bronchitis

Front 61

Rhonchi are suggestive of what?

Back 61

secretions present in large airways

Front 62

fine late inspiratory crackles that persist from breath to breath are indicative of what?

Back 62

abnormal lung tissue

Front 63

inspissated secretions are found in what diseases?

Back 63

1. bronchitis
2. atelecstasis

Front 64

what sound on a pulmonary exam suggests inspissated secretions?

Back 64

clearing of crackles, wheezes, or rhonchi after cough or positional change

Front 65

increased transmission of voice sounds suggests what?

Back 65

that air-filled lung has become airless

Front 66

louder, clearer voice sounds are called:

Back 66

broncophony

Front 67

when "ee" is heard as "ay" an "E to A" change: this is called

Back 67

egophany

Front 68

egophany is present in what conditions?

Back 68

lobar consolidation from pnuemonia

Front 69

what is the sound quality like in a patient with lobar consolidation from pneumonia?

Back 69

nasal

Front 70

louder, clearer, whispered sounds are called:

Back 70

whispered petoriloquy

Front 71

What presentation will a patient with COPD likely have?

Back 71

sitting leaning forward, lips pursed during exhalation, and arms supported on their knees/table (tripod position + pursed lips)

Front 72

abnormal retraction of the lower interspaces during inspiration is indicative of:

Back 72

1. severe asthma
2. COPD
3. upper airway obstruction

Front 73

local lag/impairment in respiratory movement suggests

Back 73

underlying disease of lung/pleura

Front 74

chest pain assocaited with tender pectoral muscles/costal cartilages that corroborate, but do not improve- usually have what origin of pain?

Back 74

musculoskeletal

Front 75

what replaces resonance when fluid/solid tissue replaces air-containing lung or occupies the pleural space?

Back 75

dullness

Front 76

Effusion is better detected, typically, where?

Back 76

posterior inferior part of the chest

Front 77

why does it take a very large effusion in order for detection to be available from the anterior side?

Back 77

because pleural fluid sinks to lowest part of the pleural space (posteriorly in a supine patient)

Front 78

COPD has _______ which may replace cardiac dullness

Back 78

hyperresonance

Front 79

where does dullness of R middle lobe pneumonia occur?

Back 79

behind right breast

Front 80

Why is R middle lobe pneumonia often missed?

Back 80

because you have to displace the breast to note the abnormal percussion note

Front 81

a COPD-infected lung often has what affect on a neighboring organ?

Back 81

displaces the upper border of the liver, downward.

Front 82

a COPD-infected lung does what do the diaphragmatic dullness, posteriorly?

Back 82

lowers it

Front 83

if pt understands & cooperates in performing the test, a forced expiration time of 6+ seconds suggests:

Back 83

obstructive pulmonary disease

Front 84

an increase in local pain distant from your hands suggests what?

Back 84

rib fracture, rather than just soft-tissue injury