H&P Exam 2

Question 1

Note special landmarks:● 2nd intercostal space for● 4th intercostal space for ● T4 for the lower margin of an

Answer 1

needle insertion for tension pneumothorax.

chest tube insertion.

endotracheal tube on a chest x-ray.

Question 2

Note the T7–T8 intercostal space as alandmark for

Answer 2

thoracentesis with needle

insertion immediately superior to

the 8th rib.

Question 3

Anteriorly, the apex of each lung rises approximately

Answer 3

2 to 4 cm

above the inner third of the clavicle

Question 4

The lower border of the lung

crosses the _____ rib at the midclavicular line and the _____ rib at the midaxillary line.

Answer 4

6th

8th

Question 5

Aspiration pneumonia is more commonin the

Answer 5

right middle and lower lobe

because the right main bronchus is

more vertical.

Question 6

The trachea bifurcates into its mainstem bronchi at the levels of the _____ anteriorly and the _______ posteriorly

Answer 6

sternal angle

T4 spinous process

Question 7

Accumulations of pleural fluid, or pleural

effusions, may be ______ , seen

in heart failure, cirrhosis, and nephrotic

syndrome, or ________ , seen in numerous

conditions including pneumonia,

malignancy, pulmonary embolism,

tuberculosis, and pancreatitis.

Answer 7

transudates

exudates

Question 8

Irritation of the parietal pleura produces __________, as in viral pleurisy, pneumonia, pulmonary embolism, pericarditis, and collagen vascular diseases.

Answer 8

pleuritic pain with deep inspiration

Question 9

The muscles in the rib cage also expand the thorax, especially

the _______ , which run from the cervical vertebrae to the first two ribs, and

the ____________ , which cross obliquely

from the sternum to the ribs.

Answer 9

scalenes

parasternal intercostal muscles, AKA parasternals

Question 10

Lung tissue has no pain fibers. Pain in conditions such as pneumonia or pulmonary infarction usually arises from inflammation of the adjacent ________?

Answer 10

parietal pleura

Question 11

Cough can signal?

Answer 11

left-sided heart failure

Question 12

______ sputum is translucent, white, or gray and seen in viral infections and cystic fibrosis

_______ sputum is yellow or green and often accompanies bacterial pneumonia.

Answer 12

Mucoid

Purulent

Question 13

Clearing of crackles, wheezes, or rhonchi

after coughing or position change

suggests ___________ , seen

in bronchitis or atelectasis.

Answer 13

inspissated (thickened) secretions

Question 15

Foul-smelling sputum is present in _________.

Thick tenacious sputum is present in _________.

Answer 15

anaerobic lung abscess

cystic fibrosis

Question 16

Large volumes of _________ are present in bronchiectasis and lung abscess.

Answer 16

purulent sputum

Question 17

Diagnostically helpful symptoms:

________ and ________ in pneumonia;

________ in asthma;

________, _________ and _______

in acute coronary syndromes.

Answer 17

fever and productive cough

wheezing

chest pain, dyspnea, and orthopnea

Question 18

These symptoms, especially__________ and __________, are hallmarks of obstructive sleep apnea

Answer 18

daytime sleepiness and snoring

Question 19

1. ______in the lips, tongue, and oral mucosa signals hypoxia.
2. ______ are common in heart failure.
3. ______occurs in bronchiectasis, congenital heart disease, pulmonary fibrosis, cystic fibrosis, lung abscess, and malignancy.

Answer 19

Cyanosis

Pallor and sweating (diaphoresis)

Clubbing of the nails

Question 20

The ratio of the anteroposterior (AP) diameter to the lateral chest diameter is usually ______ up to 0.9 and increases with aging

This ratio may exceed 0.9 in _______,

producing a barrel-chest appearance,

although evidence of this correlation

is conflicting.

Answer 20

0.7 to 0.75

COPD

Question 21

Asymmetric expansion occurs in large ________.

Answer 21

pleural effusions

Question 22

Retraction occurs in ________.

Answer 22

severe asthma, COPD, or upper airway obstruction

Question 23

Intercostal tenderness can develop over ________

Answer 23

inflamed pleurae

Question 24

Unilateral impairment or lagging suggests pleural disease from _________; it is also seen in phrenic nerve damage or trauma.

Answer 24

asbestosis or silicosis

Question 25

*Test chest expansion*. Place your thumbs at about the level of the \_\_\_\_\_ ribs, with your fingers loosely grasping and parallel to the lateral rib cage

Answer 25

10th

Question 26

\_\_\_\_\_\_\_is decreased or absent when the voice is higher pitched or soft or when the transmission of vibrations from the larynx to the surface of the chest is impeded by a thick chest wall, an obstructed bronchus, COPD, or pleural effusion, fibrosis, air (pneumothorax), or an infiltrating tumor.

Answer 26

Fremitus

Question 27

**Asymmetric decreased fremitus** raises the likelihood of \_\_\_\_\_\_\_\_, which decreases transmission of low-frequency sounds; asymmetric increased fremitus occurs in unilateral pneumonia which increases transmission through consolidated tissue.

Answer 27

unilateral pleural effusion, pneumothorax, or neoplasm

Question 28

An abnormally high diaphragm level found during percussion suggests a ______ or ______ from atelectasis or phrenic nerve paralysis.

Answer 28

pleural effusion or an elevated hemidiaphragm

Question 29

Is there a silent gap between the inspiratory and expiratory sounds? ## Footnote **A gap suggests?**

Answer 29

bronchial breath sounds.

Question 30

Normal breath sound heard throughout inspiration, continue without pause through expiration, and then fade away about one third of the way through expiration?

Answer 30

Vesicular, or soft and low pitched

Question 31

Normal breath sound, with inspiratory and expiratory sounds about equal in length, at times separated by a silent interval. Detecting differences in pitch and intensity is often easier during expiration.

Answer 31

Bronchovesicular

Question 32

Normal breath sounds that are louder, harsher and higher in pitch, with a short silence between inspiratory and expiratory sounds. Expiratory sounds last longer than inspiratory sounds.

Answer 32

Bronchial

Question 33

Normal breath sounds that are loud, harsh sounds heard over the trachea in the neck.

Answer 33

Tracheal

Question 34

Fine late inspiratory crackles that persist from breath to breath suggest?

Answer 34

abnormal lung tissue.

Question 35

The crackles of heart failure are usually best heard in the?

Answer 35

posterior inferior lung fields.

Question 36

Stridor and laryngeal sounds are loudest over the neck, whereas true wheezes and rhonchi are ________ over the neck.

Answer 36

faint or absent

Question 37

Pleural rubs may be heard in?

Answer 37

pleurisy, pneumonia, and pulmonary embolism.

Question 38

Increased transmission of voice sounds suggests that embedded airways are?

Answer 38

blocked by inflammation or secretions

Question 39

Localized bronchophony and egophony are seen in\_\_\_\_\_\_\_ . In patients with fever and cough, the presence of bronchial breath sounds and egophony more than triples the likelihood?

Answer 39

lobar consolidation of pneumonia pneumonia

Question 40

The hyperresonance of COPD during percussion may obscure \_\_\_\_\_\_

Answer 40

dullness over the heart.

Question 41

Breathing is irregular—periods of apnea alternate with regular deep breaths which stop suddenly for short intervals. Causes include meningitis, respiratory depression, and brain injury, typically at the medullary level.

Answer 41

Ataxic Breathing (Biot Breathing)

Question 42

Periods of deep breathing alternate with periods of apnea (no breathing). This pattern is normal in children and older adults during sleep. Causes include heart failure, uremia, drug-induced respiratory depression, and brain injury (typically bihemispheric).

Answer 42

Cheyne–Stokes Breathing

Question 43

In obstructive lung disease, expiration is prolonged due to narrowed airways increase the resistance to air flow. Causes include asthma, chronic bronchitis, and COPD.

Answer 43

Obstructive Breathing

Question 44

Kussmaul breathing is compensatory overbreathing due to?

Answer 44

systemic acidosis.