Week 4 Lung and Thorax Diagnostic Reasoning 2022(1)

Question 1

What is the purpose of diagnostic reasoning in health assessment?

Answer 1

To identify potential problems, narrow down diagnoses, and determine appropriate actions.

Question 2

What is Forced Vital Capacity (FVC)?

Answer 2

The total amount of air a person is able to forcefully expel.

Question 3

Define Forced Expiratory Volume in 1-second (FEV1).

Answer 3

The amount of air a person is able to forcefully expel in one second.

Question 4

What is the normal FEV1 to FVC ratio?

Answer 4

> 70% (0.70)

Question 5

What are the key pathophysiological components of asthma?

Answer 5

• Inflammation
• Bronchial constriction
• Bronchial hyperresponsiveness

Question 6

List subjective findings in asthma.

Answer 6

• Shortness of breath
• Wheezing
• Non-productive cough
• Chest tightness
• Sleep disturbances
• Exercise intolerance
• Atopic dermatitis

Question 7

What objective findings may be present in asthma?

Answer 7

• Inspiratory/expiratory wheezing
• Respiratory distress
• Hyperresonance on percussion

Question 8

What is the FEV1/FVC ratio in a patient with COPD?

Answer 8

<70% (0.70) post-bronchodilator

Question 9

Identify historical risk factors for Chronic Obstructive Pulmonary Disease (COPD).

Answer 9

• Cigarette smoking
• Occupational exposures
• Family history
• Alpha-1 anti-trypsin deficiency

Question 10

What are common subjective findings in a patient with pneumonia?

Answer 10

• Productive cough with thick, yellow/green mucus
• Fever
• Chills
• Malaise
• Chest discomfort

Question 11

What are the common pathogens associated with pneumonia?

Answer 11

• S. Pneumoniae (Gram+)
• M. Pneumoniae
• C. Pneumoniae
• H. Influenzae (Gram-)
• Legionella (Gram-)
• Pseudomonas (in-patient environment)

Question 12

What are the subjective findings of a pulmonary embolism?

Answer 12

• Acute onset shortness of breath
• Pleuritic chest pain
• Cough
• Hemoptysis

Question 13

What are the objective findings in a patient with pneumothorax?

Answer 13

• Tachycardia
• Tachypnea
• Hyperresonance on percussion
• Diminished or absent lung sounds

Question 14

What is the first step in assessing chest pain?

Answer 14

Ask broad questions such as, ‘Do you have any discomfort or unpleasant feelings in your chest?’

Question 15

What are the five ‘A’s in tobacco cessation?

Answer 15

• Ask
• Advise
• Assess
• Assist
• Arrange

Question 16

What is the role of percussion in lung examination?

Answer 16

To establish underlying tissue characteristics: fluid filled, air filled, or consolidated.

Question 17

What is the significance of egophony in lung auscultation?

Answer 17

Normal is a long muffled ‘E’ sound when the patient says ‘eee’.

Question 18

What does a diminished lung sound indicate in COPD?

Answer 18

Possible presence of obstructive airway disease.

Question 19

What is the typical FEV1/FVC ratio in asthma?

Answer 19

83% (0.83)

Question 20

What are the key differential diagnoses for asthma?

Answer 20

• COPD
• Pneumonia
• Pulmonary embolism
• Heart failure
• Carcinoid syndrome
• Foreign body

Question 21

What findings on a chest x-ray are indicative of pneumonia?

Answer 21

Consolidation in a specific area of the lung.

Question 22

What characterizes the cough in chronic bronchitis?

Answer 22

Persistent cough with possible mucous production.

Question 23

What are the common diagnostic studies for diagnosing COPD?

Answer 23

• Chest x-ray
• Pulmonary function testing

Question 24

What subjective findings are associated with COPD?

Answer 24

• Shortness of breath
• Intermittent wheezing
• Persistent cough
• Chest tightness

Question 25

What is the purpose of spirometry in lung function testing?

Answer 25

To diagnose obstructive airway disease and assess reversibility.

Question 26

What is the primary management plan for a patient diagnosed with COPD?

Answer 26

Pharmacology based on evidence-based practice guidelines.

Question 27

What is the purpose of auscultation in lung sounds?

Answer 27

To assess respiratory function and identify abnormalities ## Footnote Auscultation is a key technique in physical examinations of the lungs.

Question 28

What is Egophony?

Answer 28

A special technique in auscultation where the patient says 'eee' ## Footnote Normal result is a long muffled E sound.

Question 29

What should be heard during a normal Egophony test?

Answer 29

Long muffled E sound ## Footnote If the sound changes, it may indicate lung pathology.

Question 30

What is Bronchophony?

Answer 30

A technique where the patient says 'ninety-nine' to assess lung sounds ## Footnote Normal result is a muffled sound; a clearer sound indicates bronchophony.

Question 31

What indicates a positive Bronchophony test?

Answer 31

A louder and more distinct sound when the patient says 'ninety-nine' ## Footnote This can suggest underlying lung issues.

Question 32

What is Pectoriloquy?

Answer 32

A technique where the patient whispers 'ninety-nine' or 'one-two-three' ## Footnote Used to assess lung sound clarity.

Question 33

What is the normal result for Pectoriloquy?

Answer 33

Faint or indistinct sound, if heard at all ## Footnote Clear sounds may indicate lung pathology.

Question 34

What is the diaphragm used for during lung auscultation?

Answer 34

To enhance the clarity of lung sounds being assessed ## Footnote It is placed on the patient's chest to listen for abnormalities.

Question 35

Fill in the blank: During Egophony, the patient is asked to say '______'.

Answer 35

'eee' ## Footnote This helps identify changes in lung sounds.

Question 36

True or False: A normal Bronchophony test results in a clear sound.

Answer 36

False ## Footnote Normal results should be muffled; clear sounds suggest bronchophony.