Pharmacology exam

Question 1

What is inspection of the posterior thorax?

Answer 1

Looking for signs of respiratory distress.
Observe for deformities, abnormal breathing patterns + skin colour changes that might suggest issues of asthma or acute bronchitis.

Question 2

What is the significance of inspection in the posterior thorax examination?

Answer 2

To assess the condition of the thorax for any abnormalities.

Question 3

What is a normal thorax?

Answer 3

Is an elliptical shape with an anteroposterior diameter being less than the transverse diameter.

Question 4

What is are the normal positions of the ribs, spine and scapula?

Answer 4

1. Ribs are orientated and sloping downwards
2. Both scapulae are symmetrical
3. Spinous processes are in a straight line (level of T8, kyphosis / scoliosis

Question 5

What is the purpose of palpation of the posterior thorax?

Answer 5

Helps to identify skin temperature, moisture, tenderness, any lumps or masses or visible skin lesions.

Question 6

What are you palpating the posterior thorax for?

Answer 6

Pain or tenderness
Lumps or bumps
Temperature

Question 7

What is symmetric expansion?

Answer 7

Confirms the equal expansion of the thorax on both sides as the patient breathes in

Question 8

What is unequal expansion?

Answer 8

Can occur with atelectasis, lobar pneumonia, pleural effusion, thoracic trauma or pneumothorax

Question 9

What is tactile fremitis?

Answer 9

Palpable vibration

Question 10

What is decreased fremitis?

Answer 10

Occurs when obstructed bronchus, pleural effusion or thickening, pneumothorax or emphysema.

Question 11

What is increased fremitis?

Answer 11

Occurs with compression or consolidation of lung tissue

Question 12

What is significance of percussion?

Answer 12

percussion on the posterior chest wall helps to identify healthy lung tissues

Question 13

What is a normal percussion sound?

Answer 13

Healthy = resonant, low-pitched, clear, hollow sound

Question 14

What is hyper resonance?

Answer 14

low pitch, booming sound. Produced if there is too much air such as in emphysema or pneumothorax

Question 15

What is a dull note?

Answer 15

soft, muffled, thud - indicates abnormal density in the lungs
could be pneumonia, pleural effusion, atclecatasis or tumour

Question 16

What are bronchovesicular sounds?

Answer 16

Sounds are heard in the posterior chest between the scapulae and the centre part of the anterior chest. In the bronchi and some alveoli

Question 17

What are vesicular sounds?

Answer 17

below the second rib at the base of the lungs, from the bronchioles

Question 18

What are abnormal breathing sounds?

Answer 18

wheezing, crackles or diminished breath sounds = pneumonia or COPD

Question 19

What is the auscultatory area for aortic sounds?

Answer 19

The auscultatory area for this valve is in the 2nd left intercostal space, next to sternum.

Question 20

What is the auscultatory area for pulmonic valve sounds?

Answer 20

The auscultatory area for this valve is in the 2nd right intercostal space, next to sternum.

Question 21

What is the auscultatory area for tricuspid valve sounds?

Answer 21

This valve can be best auscultated along the left lower sternal border, 4th or 5th intercostal space.`

Question 22

What is the auscultatory area for mitral valve sounds?

Answer 22

The mitral valve can be best auscultated for an
apex beat in the left 5th intercostal space, mid
clavicular line.

Question 23

What are peripheral disorders?

Answer 23

Peripheral vascular disorders may affect the arterial or venous circulations. Venous disorders are much more common than arterial disorders.

Question 24

What are common presentations of peripheral disorders?

Answer 24

• Leg pain
• Intermittent claudication: Pain in calf muscles precipitated by walking and relieved by rest
• Critical limb ischemia presenting as:
• Diminished or absent peripheral pulses
• Pallor on elevation
• Reduced skin temperature of the affected part
• Visible swelling or oedema
• Non healing lesions, including ulcers and gangrene
• Skin changes on arms and legs

Question 25

What are the major arteries supplying the limb?

Answer 25

o Brachiocephalic o Subclavian o Axillary artery o Brachial artery o Radial artery o The ulnar artery

Question 26

What is the location of the brachial pulse?

Answer 26

Located medial to the biceps tendon in the antecubital fossa.

Question 27

What is the location of the radial pulse?

Answer 27

Lateral to the palmaris longus tension and medical to the radius bone, laterally on the flexor aspect of the wrist

Question 28

What are the major arteries supplying the lower limb?

Answer 28

o Femoral o Popliteal o Posterior tibial o Dorsalis pedis

Question 29

What is the location of the posterior tibial pulse?

Answer 29

behind the medial malleolus and the achilles tendon

Question 30

What is the location of the dorsalis pedis pulse?

Answer 30

On the dorsum of the foot, lateral to the extensor hallucis longus tendon at the high point of the foot

Question 31

What is capillary refill?

Answer 31

Capillary refill is the time taken for the colour to return to an external capillary bed after pressure is applied to cause blanching.

Question 32

What is the significance of capillary refill?

Answer 32

Assessing the blood flow to this helps us to determine the peripheral perfusion and cardiac output.

Question 33

How quickly should cardiac refill occur?

Answer 33

Normally, the colour should return to normal within 1 to 2 seconds. Any delay in refill could be caused by vasoconstriction, decreased cardiac output or cold temperature of the room.

Question 34

What is mobility of the skin?

Answer 34

Mobility of the skin is the ease of skin to rise and the turgor is the ability to return to place promptly when released. This reflects the elasticity of the skin.

Question 35

When is poor tutor evident?

Answer 35

Poor turgor is evident in severe dehydration and extreme weight loss.

Question 36

What is oedema?

Answer 36

Oedema is the excess accumulation of fluid in the interstitial spaces of the tissue. The interstitial fluid balance is regulated by four types of pressures.

Question 37

What is the rating of oedema?

Answer 37

1+ Mild pitting , slight indentation/ no noticeable swelling of legs 2+ Moderate pitting, indentation subsides rapidly 3+ Deep pitting, indentation remains for short time/ leg look swollen 4+ Very deep pitting, indentation lasts long time, leg is grossly swollen