PE of Thorax / Cough

Question 1

Breathing pattern seen in increased ICP; meningitis; stroke

Answer 1

Biot’s

Question 2

Increased depth and rate of respiration; seen in metabolic acidosis, hyperventilating patients

Answer 2

Kussmaul’s

Question 3

Apneic followed by gradually increasing depth and ventilation rate

Answer 3

Cheyne-Stokes

Question 4

Prolonged expiration is seen in

Answer 4

COPD
asthma
severe bilateral pulmonary fibrosis

Question 5

High pressure / low pH in breathing centers will stimulate this pattern of breathin

Answer 5

Biot’s

Question 6

Most resistant to fatigue; last to fail in respiration

Answer 6

diaphragm

Question 7

Breathing caused by heart failure, uremia, drug-induced depression, brain damage

Answer 7

Cheyne-Stokes

Question 8

Unpredictable, chaotic pattern

Answer 8

Biot’s

Question 9

Coughing reflex that happens when cleaning ear

Answer 9

Arnold’s nerve stimulaion

Question 10

Breathing pattern response to accumulation and loss of CO2

Answer 10

Cheyne-Stokes

Question 11

Pigeon chest; sternum is convex

Answer 11

pectus carinatum

Question 12

Concave sternum

Answer 12

pectus excavatum

Question 13

Jugular engorgement is seen in

Answer 13

RVF
CHF
facial edema
engorged UE
SVC syndrome (compressed SVC)

Question 14

Chest shape that explains why right nipple is closer to middle than left

Answer 14

pectus excavatum

Question 15

Chest deformity: nipples looking in opposite directions

Answer 15

pectus carinatum

Question 16

Massive atelectasis to the RIGHT results in what tracheal deviation

Answer 16

RIGHT (same side)

atelectasis, PF = ipsilateral

Question 17

Left pneumothorax results in what tracheal devation

Answer 17

RIGHT (opposite side)

pneumothorax, tumor, pleural effusion = contralateral

Question 18

Decreased volume of air that is inspired in an affected lung -- seen in 
pneumothorax 
pleural effusion, 
pleural fibrosis, 
significant atelectasis

Answer 18

inspiratory lag

Question 19

Pressure between pleural surfaces becomes so high, the lung and mediastinal structures are pushed inward

Answer 19

tension pneumothorax

Question 20

lung does not slide off smoothly

Answer 20

pleural fibrosis

Question 21

flail chest =

Answer 21

multiple rib fractures

Question 22

Tracheal deviation in pleural fibrosis

Answer 22

ipsilateral side

Question 23

costochondritis is similar to

Answer 23

Tietze syndrome

Question 24

pinpoint tenderness of ribs =

Answer 24

rib fracture

Question 25

intercostal pain seen in

Answer 25

pleuritis empyema supradiaphragmatic extension of a liver abscess

Question 26

increased fremitus seen in

Answer 26

``` pneumonia atelectasis pulmonary edema lung tumors thin chest walls ```

Question 27

decreased fremitus seen in

Answer 27

(when air increases, sound is dampened...or solid mass obstructing sound) COPD, pleural tumors, pleural fibrosis, pleural effusion, massive atelectasis

Question 28

crackling sensation over skin surface on chest palpitation

Answer 28

crepitus

Question 29

crepitus is seen in

Answer 29

pneumothorax tracheostomy barotrauma (air escaping to subcu areas) rule out gas gangrene

Question 30

Consolidation sound on percussion

Answer 30

dull

Question 31

COPD, pneumothorax sound on percussino

Answer 31

hyperresonant

Question 32

High pitched percussion on abdomen or lower left chest (gastric bubble)

Answer 32

tympany

Question 33

Auscultation I>E

Answer 33

vesicular

Question 34

Auscultation I

Answer 34

bronchial

Question 35

Auscultation I=E

Answer 35

bronchovesicular, tracheal

Question 36

Location of bronchovesicular sounds

Answer 36

ICS 1&2, between scapula

Question 37

Decreased breath sounds:

Answer 37

emphysema pleural effusion pneumothorax obesity

Question 38

like wheezes but inspiratory

Answer 38

stridor emergency - large airway obstruction

Question 39

usually due to secretions change in character (sonorous wheezes)

Answer 39

rhonchi

Question 40

stridor is seen in

Answer 40

epiglottitis, fbao, laryngeal edema, anaphylactic shock large airway obstruction

Question 41

due to forceful (inspiratory) opening of previously closed alveoli

Answer 41

crackles

Question 42

rhonchi associated with

Answer 42

(thick secretion) bronchiectasis bronchitis

Question 43

dry rales =

Answer 43

pleural friction rubs

Question 44

pleural friction rub is seen generally when there is

Answer 44

loss of pleural fluids (due to pleuritis) friction rub between parietal and visceral

Question 45

When eee sound becomes aaay

Answer 45

egophony (more nasal)

Question 46

whispered pectoriloquy is seen in

Answer 46

alveolar consolidation partial atelectasis Sounds become amplified and more intelligible -- absence of normal alveoli cannot muffle voice sounds

Question 47

Egophony is seen when there is

Answer 47

consolidation above pleural effusion

Question 48

Most common cause of Upper Airway Cough Synd

Answer 48

postnasal drip

Question 49

Chronic stimulation of submnucosal lymphoid tissue results in a cobblestone appearance of posterior oropharyngeal mucosa:

Answer 49

UACS

Question 50

Asthma without wheezing but cough is termed

Answer 50

cough variant asthma common in children, DDx: COPD

Question 51

``` Normal CXR Normal PFT (-) airflow obstruction (-) airway hyper-responsiveness (+) eosinophil ```

Answer 51

non-asthmatic eosinophilic bronchitis (NAEB)

Question 52

Non-smoker with normal CXR. Heartburn ater meals.

Answer 52

GERD

Question 53

Bronchiectasis is rarely affected when it is located where

Answer 53

upper lungs | lower lungs = infection, mucus pooling

Question 54

Wheezing, dyspnea, cough. Treated with bronchodilators and steroids. No recurrence.

Answer 54

postinfective bronchial hyper-responsiveness

Question 55

Cough and normal CXR. What kind of lung cancer?

Answer 55

small lesions such as adenoma

Question 56

Lack of stretch receptor stimulation induces cough =

Answer 56

restrictive lung diseases

Question 57

Drug associated with cough

Answer 57

ACE inhibitors | Beta blockers

Question 58

Nocturnal cough is absent in

Answer 58

psychogenic cough GERD, asthma, and COPD have nocturnal cough

Question 59

Paroxysmal coughing can cause

Answer 59

syncope intrathoracic pressure increases --> pressure on vena cava and aorta --> coronary circulation compromised

Question 60

What other complication of cough aside from paroxysms can cause syncope?

Answer 60

post-tussive inhalation