Chapter 2 Physical Exam

Question 1

Angle of Louis correlates to what rib?

Answer 1

Second rib

Question 2

Usually no more than 90 degrees, with ribs inserted at 45-degree angles

Answer 2

Costal angle

Question 3

Vertebrae prominences are what two bony processes?

Answer 3

C7 and T1

Question 4

In pregnant women, what causes the ligaments of the rib cage to relax, and the chest expansion to increase

Answer 4

Estrogen increase

Question 5

Pregnant:

An increase in the lateral diameter of ___ cm.

An increase in circumference of ______ cm.

Answer 5

2 cm

5-7 cm

Question 6

Pregnant:

Major work of breathing is done by:

Answer 6

The diaphragm

Question 7

Type of breathing

Pregnant women have:

Answer 7

Deeper breathing and slightly increased rate of respirations

Question 8

Results from loss of muscle strength in thorax and diaphragm, coupled with a decreased lung resiliency.

Answer 8

Barrel chest

Question 9

Alveoli in older adults

Answer 9

Less elastic and more fibrous

Question 10

Aging mucous membranes become:

Answer 10

Drier

Question 11

(Number of years smoking) x (Number of packs smoked per day)

Answer 11

Pack years

Question 12

Hobbies that could cause respiratory problems

Answer 12

Owning pigeons

Parrots or other animals

Woodworking

Welding

Question 13

Sequence of steps in examination of the chest and lungs

Answer 13

Inspection, Palpation, Percussion, Auscultation

Question 14

What lighting is used to highlight chest movement?

Answer 14

Tangential lighting

Question 15

Inferior border of lungs cross at what rib?

Answer 15

6th rib

Question 16

Best place to listen to the R middle Lobe

Answer 16

5th intercostal space, Anterior Axillary

Question 17

Indicative of prolonged respiratory/cardiac distress

Answer 17

Clubbing of the fingernails

Question 18

Odor:

Sweet Smell

Answer 18

Diabetic ketoacidosis

Question 19

Odor:

Ammonia

Answer 19

Uremia

Question 20

Odor:

Musty fish

Answer 20

Hepatic failure

Question 21

Odor:

Foul/putrid

Answer 21

Respiratory infection

Question 22

Odor:

Foul/feculent

Answer 22

Intestinal obstruction/diverticulum

Question 23

Odor:

Halitosis

Answer 23

Gingivitis, Vincent’s angina

Question 24

Odor:

Cinnamon

Answer 24

Tuberculosis

Question 25

Ratio of respirations to heartbeats is approximately:

Answer 25

1:4

Question 26

So the patient does not mislead you, count the respiratory rate while:

Answer 26

Holding the radial artery

Question 27

Breathing: Chest goes up, belly goes down and vice versa

Answer 27

Paradoxical breathing

Question 28

Absence of spontaneous respirations

Answer 28

Apnea

Question 29

Feeling or sensation that one cannot breath well enough. Distict sensations include effort/work, chest tightness, and air hunger.

Answer 29

Dyspnea

Question 30

Grave condition in which breathing stops and will not spontaneously start again unless resuscitative measures are immediately instituted.

Answer 30

Secondary Apnea

Question 31

Shortness of breath that begins or increases when the patient lies down; ask whether the patient needs to sleep on more than one pillow and whether that helps.

Answer 31

Orthopnea

Question 32

Sudden onset of shortness of breath after a period of sleep; sitting upright is helpful.

Answer 32

Paroxysmal nocturnal dyspnea

Question 33

Dyspnea increase in the upright posture

Answer 33

Platypnea

Question 34

Persistent respiratory rate faster than 20 and approaching 25 breaths per minute

Answer 34

Tachypnea

Question 35

Rate slower than 12 breaths per minute. May indicate neurologic or electrolyte disturbance, infection or a sensible response to protect against the pain of pleurisy.

Answer 35

Bradypnea

Question 36

A regular periodic pattern of breathing, with intervals of apnea followed by crescendo/decrescendo

Answer 36

Cheyne Stokes Respirations

Question 37

Somewhat irregular respirations varying in depth and interrupted by intervals of apnea but lacking the repetitive pattern of periodic respirations of Cheyne Stokes

Answer 37

Biot Respirations

Question 38

Respirations greater than 20 and deep

Answer 38

Hyperpnea

Question 39

Rapid, deep and labored respiratory pattern associated with metabolic acidosis

Answer 39

Kussmaul breathing

Question 40

Regular comfortable breathing at a rate of 12-20 breaths per minute

Answer 40

Eupnea

Question 41

Percuss at intervals of

Answer 41

4-5cm

Question 42

Diaphragm is usually higher on what side?

Answer 42

Right (because of the liver)

Question 43

Length of diaphragmatic excursion is usually:

Answer 43

3-6cm

Question 44

Breath sounds can be characterized same as percussion notes:

Answer 44

Intensity, pitch, quality, and duration

Question 45

Greater clarity and increased loudness of spoken sounds during auscultation, can be seen with what test?

Answer 45

Bronchophony

Question 46

Test for whispered sounds, normally will not be heard or completely unintelligible

Answer 46

Whispered pectoriloquy

Question 47

Consolidation is present and the patient speaks the letter "e", what is actually auscultated is "a"

Answer 47

Egophony

Question 48

Decreased tactile or vocal fremitus is associated with:

Answer 48

Emphysema

Question 49

Lateral curvature/deviation of the spine

Answer 49

Scoliosis

Question 50

Excessive curvature of the lumbar spine

Answer 50

Lordosis

Question 51

Hyper-resonance indicates:

Answer 51

Hyperinflation of the lungs

Question 52

Dullness indicates:

Answer 52

Lung consolidation

Question 53

Costal angle can reach up to ____ degrees in pregnancy

Answer 53

103

Question 54

A persistent cough may be the only manifestation. Peak expiratory flow rates should be obtained before and after nebulizer treatments to verify improved lung function.

Answer 54

Asthma

Question 55

Inflammatory process involving the pleural and parietal pleura The resultant rub can be heard and felt during exam

Answer 55

Pleurisy

Question 56

Diminished breath sounds and dullness to percussion occur over the area of consolidation. Involvement of the right lower lobe can stimulate the tenth and eleventh thoracic nerves to cause right lower quadrant pain and simulate abdominal pain

Answer 56

Pneumonia

Question 57

Presence of air or gas in the pleural space Positive coin click can help diagnose, place a coin over the suspicious area in the chest, and while listening to the opposite side, have someone strike the coin with the edge of another. A positive finding is when you hear a clear click.

Answer 57

Pneumothorax

Question 58

A collection of purulent exudates in the pleural space

Answer 58

Empyema

Question 59

Both characterized by dullness heard on percussion

Answer 59

Pleural effusion and lobar pneumonia

Question 60

A condition where pH levels of the entire body has decreased (increased hydrogen ion concentration) which will trigger increased respiratory rate.

Answer 60

Metabolic acidosis

Question 61

An autosomal recessive disorder of the exocrine glands involving the lungs, pancreas and sweat glands. Characterized by abnormally thick mucus and subsequent pulmonary infections.

Answer 61

Cystic Fibrosis