Random PCM I Exam 2

Question 1

Landmark for needle decompression?

Answer 1

• 2nd intercostal space just superior to the 3rd rib margin at the midclavicular line
• Emergent decompression of tension pneumothorax

Question 2

Landmark for thoracentesis?

Answer 2

7th ICS

Question 3

Landmark for Chest Tube insertion?

Answer 3

4th ICS at mid or anterior axillary line in the 4th ICS just superior to the margin of the 5th rib

Question 4

Decreased or absent tactile fremitus in what diseases?

Answer 4

COPD, pleural effusions, fibrosis, pneumothorax, thick chest wall, or an infiltrating tumor

Question 5

Increased tactile fremitus in what condition?

Answer 5

Pneumonia

Question 6

Generalized hyperresonance may be heard over lungs in what conditions?

Answer 6

COPD/emphysema

Asthma

Question 7

Unilateral hyperresonance of lungs suggest?

Answer 7

Large pneumothorax

Large air-filled bulla in lung

Question 8

Which breath sound is heard best in 1st and 2nd interspaces anteriorly and between the scapulae?

Answer 8

Bronchovesicular

Question 9

Which breath sounds are loud, high pitched and heard over the manubrium?

Answer 9

Bronchial

Question 10

Rhonchi are associated with what in the airways?

Answer 10

Secretions in large airways

Question 11

In patients with fever and cough, the presence of bronchial breath sounds and egophany more than triple the likelihood of?

Answer 11

Pneumonia

Question 12

4 steps in order for CV exam?

Answer 12

1) Inspection
2) Palpation
3) Percussion
4) Auscultation

Question 13

Point of maximal impulse (PMI) is usually palpated where?

Answer 13

4th-5th ICS in the mid-clavicular line

Question 14

Where are the listening posts for the aortic valve, pulmonic valve, tricuspid valve, and mitral valve ?

Answer 14

Aortic - R 2nd ICS at SB

Pulmonic - L 2nd ICS at SB

Tricuspid - L 4th ICS at SB

Mitral - L 5th ICS at Mid-Clavicular line

Question 15

What is Erb’s point and where is it heard?

Answer 15

• L 3rd ICS at SB
• Point at which S1 and S2 heard equally

Question 16

S1 heart sound is closure of and indicates?

S2?

Which valves close first?

Answer 16

S1 = closure of mitral (1st) and tricuspid (2nd) valves (beginning of systole)

S2 = closure of aortic and pulmonic valves (end of systole, beginning of diastolic)

Question 17

What is the S3 sound due to?

Answer 17

Due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase

Question 18

Sound of a grade 3 heart murmur?

Grade 4?

Answer 18

• Moderately loud, no thrill
• Loud with palpable thrill

Question 19

Dullness replacing resonance in the lungs during percussion can be due to?

Answer 19

Pneumonia, pleural effusions, pus, or blood

Question 20

The “A wave” coincides with what events in the heart?

Answer 20

• Right atrial contraction
• Tricuspid valve open
• Coincides with S1

Question 21

The C wave coincides with what events in heart?

Answer 21

Backward push by closure of tricuspid valve during isovolumetric systole

Question 22

The V wave coincides with what events in the heart?

Answer 22

• Atrial filling
• Increasing volume and pressure in RA when TV closed

Question 23

The “Y slope or descent” coincides with what event in the heart?

Answer 23

• Open TV and rapid RV filling in RV diastole

Question 24

S1 is heard loudest where?

S2 heard loudest?

Answer 24

S1 at the apex

S2 at the base

Question 25

What is Kussmauls sign?

Seen in what diseases?

Answer 25

• Venous column (JVP) rises during inspiration, rather than falls
• Seen in right heart failure, constrictive pericarditis or RV infarction

Question 26

Clubbing nails seen in?

Answer 26

• CHD
• Cystic fibrosis
• Interstitial Lung Disease

Question 27

Presentation with pink tinge to urine is associated with?

Genetically associated with?

Answer 27

• Renal Cell Carcinoma
• VHL (Von Hippel Lindau) association