Clinical Correlations

Question 1

Which way would a foreign object in the trachea go at the carina and why?

Answer 1

Right (in all likelihood) because it is more vertical

Question 2

The costal cartilage of what rib is found at the sternal angle of louis?

Answer 2

2nd rib

Question 3

We auscultate for breath sounds along what vertical (sagittal) lines?

Answer 3

Mid-clavicular and mid-axillary

Question 4

In what lobes of the lung is pneumonia most common?

Answer 4

Lower, next most common is middle (or lingula)

Question 5

In what lung lobe is Tb most likely to be found and why?

Answer 5

Upper lobes, because they have higher O2 concentration (Tb loves lots of oxygen)

Question 6

We auscultate the lingula by going to what level of what line?

Answer 6

The 5th rib level of the midaxillary line

Question 7

Which lung lobes do we listen to posteriorly and which do we listen to anteriorly?

Answer 7

Upper lobes anteriorly, lower lobes posteriorly (middle lobe and lingula midaxillary)

Question 8

What types of disease processes that are found in the right lung middle lobe are also found in the left lung lingula?

Answer 8

Pretty much everything. In terms of disease it is a good analog

Question 9

What are some symptoms of an enlarged LA, and why?

Answer 9

Hoarsness, dysphagia (difficulty swallowing). Because enlarged left atrium can compress the esophagus (which is right behind it)

Question 10

When blood is ejected from the left atrium into the left ventricle, in which direction is the blood moving?

Answer 10

Almost directly anteriorly (make sure you can picture this given the angling of the heart)

Question 11

In what position do we have the patient lie to listen to heart sounds?

Answer 11

Left lateral decubitus (assuming it is comfortable for the patient)

Question 12

First two steps of a cardiac exam

Answer 12

Find point of maximal impact (PMI) with hand. Auscultate at this point

Question 13

Approximately how large should the point of maximal impact (PMI) be?

Answer 13

About the size of a quarter

Question 14

What two heart sounds are heard best at the apex of the heart and at this location, which is louder, S1 or S2?

Answer 14

Mitral and Tricuspid are heard at apex. S1 is louder than S2

Question 15

What heart sounds are best heard on right side of the base of the heart and at this location, which is louder, S1 or S2?

Answer 15

Aortic and Pulmonic sounds are heard here. S2 is louder than S1 at this location

Question 16

The closing of mitral + tricupsid, and atrial + pulmonic valves make up S1 and S2 respectively. For S1 and S2 respectively, can a difference be heard between the two component heart sounds?

Answer 16

For S1 no. Mitral is 1-3 ms before Tricuspid, but this is imperceptible. For S2 yes. Atrial is slightly before Pulmonary, enough so that a difference may be heard