Quiz 3 pulmonary

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Answer

Which chest structure contains all the thoracic viscera except the lungs?

Mediastinum

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The apex of the lung is:

4 cm above the first rib.

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Which structure transports air and removes noxious materials?

Bronchi

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What is the barrel chest that is characteristic of many older adults the results of?

Decreased muscle strength and loss of lung resiliency

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The number of each intercostal space corresponds to that of:

the rib immediately above it.

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The costal angle is:

formed by the blending together of the costal margins at the sternum.

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At what gestational age does the lung begin forming in a groove on the ventral wall of the gut?

4 weeks

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Increased oxygen tension in the arterial blood of a newborn infant causes:

closure of the ductus arteriosus.

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Which statement best describes the chest of a 2 year old child?

The AP diameter approximates the transverse diameter.

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During what age period is the xiphoid process more prominent, more moveable, and more cartilaginous?

Infancy

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Both pleural effusion and lobar pneumonia are characterized by:

dullness heard on percussion.

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Ms. Randolph, who is 74 years of age, has no known health problems or diseases. You are doing a preventive health care history and examination. Which finding suggests a somewhat less concerning structural variation?

Pectus carinatum

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Mr. Sanchez is a 62-year-old patient who presents with chronic obstructive lung disease. On examination you note a barrel chest. Which of the following is true regarding barrel chest?

There is an increase in the anteroposterior diameter.

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The right and left scapular lines are located:

parallel to the vertebral line.

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Respiratory effort usually exhibited by the patient with metabolic acidosis is called:

Kussmaul breathing.

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What term describes abnormally shallow respirations with limited excursion due to pleuritic pain?

Hypopnea

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Which type of apnea is considered less worrisome?

Periodic apnea of the newborn

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While observing a patient’s respirations, you note that, on inspiration, the lower thorax is drawn in and the abdomen protrudes. On expiration, the opposite occurs. This may be described as:

paradoxic breathing.

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The degree and level of retractions depends on:

the level of obstruction.

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An expected finding from chest palpation in the adult would be:

inflexibility of the xiphoid.

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The feel of “leather rubbing on leather” describes the sensation that may be palpable with:

pleural friction rub.

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Mrs. Janker is a 58-year-old patient who presents to your office with recurrent respiratory problems. Tactile fremitus is best felt:

parasternally at the second intercostal space.

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What structure can be displaced by atelectasis, pleural effusion, or thyroid enlargement?

Trachea

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Percussion of the back should be done with the patient’s arms folded in front in order to:

expose maximum lung area.

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The usual landmark at which the examiner percusses for diaphragmatic excursion is:

the scapular line.

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The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because it:

transmits high-pitched sounds.

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Mrs. Bowers is a 57-year-old patient who presents to your office with complaints of shortness of breath. Breath sounds normally auscultated over most of the lung fields are called:

vesicular.

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Breath sounds normally heard over the trachea are called:

bronchial.

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When auscultating the lungs, listen to the breath sounds:

throughout inspiration and expiration.

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The middle lobe of the right lung is best auscultated in the:

axilla.

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Your trauma patient has no auscultated breath sounds in the right lung field. You can hear adequate sounds in the left side. A likely cause of this abnormality could be that the patient:

has fluid in the pleural space.

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The American Thoracic Society suggests replacing the term rales with:

crackles.

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Mrs. Alexander is a 36-year-old patient who has asthma. As the examiner, you understand that a musical squeaking noise heard on auscultation of the lungs is called:

wheezing.

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Mr. Bowers is a 63-year-old patient who presents to your office with a complaint of shortness of breath. On examination to distinguish between a respiratory friction rub and a cardiac friction rub, ask the patient to:

hold his or her breath.

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The mediastinal crunch (Hamman sign) can best be heard with the patient:

lying on the left side.

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Changes in clarity and volume of spoken sounds during auscultation of the lungs can help you distinguish:

consolidation from obstruction.

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During assessment of vocal resonance, you note that sound is intensified, that there is a nasal quality to the voice, and that e’s sound like a’s. This is indicative of:

lung consolidation.

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When sound is intensified, there is a nasal quality to the voice, and e’s sound like a’s, this is called:

egophony.

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Yellow, green, or rust-colored sputum usually indicates the presence of:

bacterial infection.

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Assuming that the newborn is not crying, you would expect a respiratory rate per minute of about:

31 to 80.

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Acrocyanosis in the newborn that persists for a couple of days is:

common in a cool environment.

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Breath sounds in young children that are loud, harsh, and bronchovesicular are associated with:

normal, thin chest wall structures.

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Mrs. Tucker is a 29-year-old patient who is pregnant and presents to your office with shortness of breath. The pregnant woman may be expected to:

breathe more deeply.

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Which condition is variable and may migrate rapidly from one lung field to another?

Asthma

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A “rubbing” that can be felt and heard is most closely associated with:

pleurisy

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Dullness to percussion in intercostal spaces suggests the presence of:

pneumonia.

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Atelectasis is a condition that occurs:

at any age.

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The increasing incidence of HIV infection has led to an increasing incidence of treatment resistance in:

tuberculosis.

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This positive “coin click” sign indicates the presence of which condition?

Pneumothorax

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Early cystic fibrosis is characterized by:

cough with sputum; frequent pulmonary infections.

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As the chest of a newborn is examined, bowel sounds are auscultated in the chest. What is the significance of this finding?

This is abnormal and possibly indicates a diaphragmatic hernia.

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Which of the following patients demonstrates the highest risk factor for respiratory disability?

A patient with paraplegia

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The health care professional is examining the chest of a 22-year-old woman who is 8 months pregnant. The patient has a wide thoracic cage. Which of the following best explains this finding?

This is considered a normal finding with advanced pregnancy.

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In which of the following conditions should the examiner expect the costal angle to be greater than 90 degrees?

Enlarged heart

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Which of the following findings indicates respiratory distress in the infant or young child?

Observation of sternal and supraclavicular retractions with breathing

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During percussion, the patient holds his or her arms in front in order to:

expose maximum lung area.

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Which of the following examination techniques is not often done when examining the chest and lungs of a newborn?

Percussion

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The patient tells the examiner, “I have been coughing up a lot of yellowish-green phlegm.” The examiner should suspect:

bacterial pneumonia.

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Which of the following findings could indicate an intrathoracic infection?

Malodorous breath

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Which finding is considered unusual for a newborn?

Coughing

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In the older adult, which finding can occur in the absence of disease as a result of age-related changes of the chest or lungs?

Hyperresonance

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A newborn infant with a small chest-to-head size ratio is usually associated with:

intrauterine growth retardation.

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The Hamman sign can best be heard when the patient is:

lying on the left side.

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In addition to severe respiratory distress, which of the following findings may be indicative of a pneumothorax with mediastinal shift?

Tracheal deviation away from the midline position

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A mother tells the examiner that her 2-year-old child has a cough that “sounds just like a bark.” Given this history, what other findings should the examiner anticipate with respiratory examination?

Labored breathing and inspiratory stridor

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Which type of apnea is considered normal?

Deglutition apnea

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The best time to evaluate vocal and tactile resonance on a young child is while the child is:

crying.

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The examiner should expect the ratio of respiratory rate to heart rate to be approximately:

1:4.

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A patient with long-standing COPD has come to the clinic complaining that his breathing has been getting more difficult over the last couple of weeks. What would best help the examiner understand the hypoxia a patient is experiencing?

“In what way has your activity level been affected?

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A patient has an undiagnosed tumor in the middle lobe of the right lung, which has caused atelectasis. What finding would exist that might make the examiner suspicious of this problem?

Diminished or absent breath sounds over the area of the right middle lobe

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Which examination finding is consistent with emphysema?

Decreased tactile fremitus

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The third intercostal space is located:

between the third and fourth rib.

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The costal angle is generally no greater than:

90 degrees.

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The AP:lateral diameter of the chest in infants is approximately:

1:1

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An increase in progesterone in the pregnant woman causes which of the following to occur?

Increased tidal volume

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Older adults are more susceptible to respiratory infections as a result of which of the following?

Drier mucous membranes

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Pectus carinatum is best described by which of the following?

Prominent sternal protrusion

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The skin, nails, lips, and nipples are inspected when looking for the presence of:

cyanosis.

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Mr. Telford tells you that he becomes somewhat short of breath and experiences difficulty breathing after climbing the stairs in his home. Based on his description, what term might be used to identify his breathing condition?

Dyspnea

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Periodic breathing patterns are characterized by intervals of respiration separated by periods of:

apnea

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Retractions are generally associated with:

obstruction to inspiration.

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obstruction to inspiration.

air in the subcutaneous spaces.

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Thoracic expansion is assessed by:

observing the distance your thumbs diverge from the midspinal line during quiet and deep breathing.

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Tactile fremitus is increased in conditions where there is:

an increase in lung tissue consolidation.

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Diaphragmatic excursion may be slightly elevated on the right side due to the presence of:

the liver.

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Breath sounds are best heard if the patient:

breathes slowly and deeply through the mouth.

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When auscultating the lungs, which of the following sequences should be used?

Side to side comparison, from apex to base

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Which of the following descriptions helps differentiate crackles from wheezes?

Crackles are discontinuous sounds, wheezes continuous sounds.

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Wheezes are produced by which of the following?

High-velocity air flow through a narrowed airway

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Stridor is usually the result of:

an obstruction high in the respiratory tree.

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The persistence of a round “barrel” chest in a child past the second year of life may be indicative of:

a chronic obstructive problem, such as cystic fibrosis.

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Increased distensibility of the lungs in older adults results in the presence of which of the following?

Hyperresonance

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To begin counting the ribs and the intercostal spaces, you begin by palpating the reference point of the:

manubriosternal junction.

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The lung begins its gestational development from the:

gut.

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The foramen ovale should close by:

within minutes of birth.

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The characteristic barrel chest of the older adult is due to a combination of factors including:

skeletal changes of aging.

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The patient tells you that she uses herbal and other alternative therapies to maintain health. This information will be recorded in the:

social history.

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A patient describes shortness of breath that gets worse when he sits up. To document this, you will use which term?

Platypnea

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Bradypnea may accompany:

an excellent level of cardiovascular fitness.

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A 34-year-old man is being seen for complaints of dull pain between the shoulder blades that is more intense with deep breathing and coughing. Upon auscultation of the chest you suspect that you will hear:

rhonchi.

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In barrel chest, the ratio of anteroposterior diameter to transverse (lateral) diameter is:

1.0.

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a pt is c/o pain near the spine. While palpating the spinous process at T7, and medially to the inferior border of the right scapula, the patient feels more intense pain. When viewing the cxray, you will carefully look at which rib?

Right eighth rib

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In which patient situation would you expect to assess tachypnea?

Patient with metabolic acidosis

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Which site of chest wall retractions indicates a more severe obstruction in the asthmatic patient?

Above the clavicles

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Which type of apnea requires immediate action?

Secondary apnea

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Breath odors may clue the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify:

uremia.

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You would expect to document the presence of a pleural friction rub for the patient being treated for:

pleurisy.

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Tactile fremitus is best felt:

parasternally at the second intercostal space.

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The examiner percusses for diaphragmatic excursion along the:

scapular line.

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When there is consolidation in the lung tissue, the breath sounds are louder and easier to hear while healthy lung tissue produces softer sounds. This is because:

air-filled lung tissue is an insulator of sound.

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an older pt is being seen today as a f/u for a 2-day history of pneumonia. The patient continues to have a productive cough, shortness of breath, and lethargy and has been spending most of the day lying in bed. You should begin the chest examination by:

auscultating the lung bases.

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To distinguish crackles from rhonchi, you should auscultate the lungs:

before and after the patient coughs.

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Which of following is considered an expected finding in newborns and when found in adults is a concern?

Nasal flaring

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The pregnant woman is expected to develop:

deep breathing but not more frequent breathing.

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Which condition requires immediate emergency intervention?

Patient with pleuritic pain without dyspnea

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