MJ Phys Di - Exam 1 TQs

In which lung is asphyxiation more common?

Right lung

Which lung has 2 lobes and a lingula?

Left lobe

An anterior approach to auscultation is most likely to miss what lobe?

Anterior lobe

A posterior approach is most likely to miss what lobe?

Middle lobe

Where does the tracheobronchial tree divide into the right/left main bronchi?

T4/5 below manubriosternal joint - Angle of Louis

When does the diaphragm contract?

During inspiration

What is NOT contained in the mediastinum?

Lungs (note - DOES contain all thoracic viscera)

Which opening closes within minutes after birth due to a decrease in pulmonary pressure?

Foramen ovale

What opening closes due to increased oxygen tension in arterial blood?

Ductus arteriosus

What condition is likely to be found in pregnant women?

Dyspnea

What part of the stethoscope is used for low-pitched sounds?

Bell

What part of the stethoscope is used for high-pitched sounds?

Diaphragm

What rhythm of breathing involves rapid, deep, and labored respiration?

Kussmaul

What are the three abnormal patterns of breathing?

Cheyne-Stokes, Biot, and Ataxic

What pattern of breathing involves increased depth with apnea?

Cheyne-Stokes

What pattern of breathing involves interspersed apnea in a disorganized sequence?

Biot

What pattern of breathing involves disorganization with irregular depth?

Ataxic

T/F: With paradoxical breathing, a person uses their chest/postural muscles to breath, NOT the diaphragm.

True

What is felt via palpation to indicate air underneath the skin?

Crepitus - AKA subcutaneous emphysema

When is friction rub more common - inspriation or expiration?

Inspiration

What is a crackly or crinkly sensation noticed during palpation?

Crepitus

What can a tympanic sound indicate during percussion?

Stomach air bubble

What a dull sound on percussion indicate?

Lung tumor, pneumonia, fluid, or solid

What is the inhale to exhale ratio of vesicular sounds?

3:1

What sound should predominate when auscultating healthy lung tissue?

Vesicular sounds

What breath sound is low pitched and low-intensity?

Vesicular sounds

What breath sound is common in infants?

Bronchovesicular

What breath sound is the highest pitch and highest intensity?

Bronchial

What breath sound is MC heard in a large/stiff cavity or tension pneumothorax with bronchopleural fisula?

Amphoric

What breath sound is MC heard in a pulmonary cavity with a rigid wall?

Cavernous

What condition is most likely if crackles/rales are heard?

Pneumonia - breathing through thin fluid

What condition is MC if rhonchi (sonorous wheezes) are heard?

Pneumonia - breathing through thick fluid

T/F: coughing can clear rhonchi.

True

In what position is mediastinal crunch heard best?

Lying on side

In what conditions are wheezes (sibilant wheeze) commonly heard?

Asthma or bronchitis - constriction of airway

What infant breathing compensation is heard high in the respiratory tree?

Stridor

T/F: Bronchovesicular sounds may dominate in children.

True

What is heard in auscultation of asthma?

Rhonchi or wheezing

T/F: In asthma, there is NO change in tactile fremitus or percussion.

True

What are the exam findings of atelectasis?

Increased tactile fremitus

Greater resonance on percussion

Decreased breath sounds

What is inflammation/infection of the LARGE airways?

Bronchitis

What are the exam findings in bronchitis?

No change in tactile fremitus

no change in percussion

Rhonchi, wheezing, occasional crackles

What condition has a friction rub heard on auscultation?

Pleurisy

What are the MC causes of pleural effusion?

left-sided heart failure

renal insufficiency

infection

What are the exam findings of pleural effusion?

Chest pain, dyspnea, cough

decreased tactile fremitus

dull percussion

Decreased breath sounds

What are the exam findings of empyema?

Fever, cough, tachypnea

Absent tactile fremitus

Dull percussion

Decreased breath sounds

What is a well-circumscribed fluid-containing cavity?

Lung abscess

What is the hallmark finding of a lung abscess?

Purulent, foul-smelling sputum (also friction rub)

What is the name for an infection of pulmonary parenchyma?

Pneumonia

What sounds are heard via auscultation of pneumonia?

Crackles, rhonchi, and bronchovesicular sounds (alveoli filled with fluid)

What sounds are heard in auscultation of influenza?

Crackles, wheezes, rhonchi

What lobes are primarily affected by tuberculosis?

Upper lobes

What are the hallmark features of TB?

Coughing up blood and night sweats

What are the common causes of pneumothorax?

Trauma or bleb rupture

What population is affected more by pneumothorax?

Tall, thin males

What is the hallmark feature of pneumothorax?

Tracheal deviation

What is the MC cause of hemothorax?

Rib fracture

What is the MC malignant lung cancer?

Bronchogenic carcinoma

What is the MC overall lung cancer in NON-smokers?

Lung adenocarcinoma

What is the MC lung cancer in smokers?

Squamous cell carcinoma?

What are the tests used for identifying TB?

PPD

Quantiferon gold

What are the exam findings of a pulmonary embolism?

Pleuritic chest pain, fever, hypoxia, tachycardia

What tests are used for a pulmonary embolism?

Wells PE prediction rule

D-Dimer test for clots

What score indicates a high risk of pulmonary embolism and should be referred to the ER?

>6

What condition is commonly associated with right-sided heart failure?

Cor pulmonale

What is the MC underlying disease causing pulmonary edema?

Heart failure

What unique finding is discovered with auscultation of pulmonary edema?

Bilateral crackles over lower lungs

What is a unique symptom of pulmonary edema?

History of coughing when lying down

How can you differentiate between friction rub and rhonchi?

Coughing - rhonchi will clear, friction rub will persist

T/F: The trachea also deviates toward the affected side EXCEPT for a tension pneumothorax, where it will deviate away.

True

What is the hallmark finding of epiglottitis?

Drooling

What is the hallmark finding of croup (laryngotracheal bronchitis)?

Seal-bark cough (also retractions)

What is a hallmark finding of cystic fibrosis?

Salty skin/sweat

What is heard on auscultation of cystic fibrosis?

Rhonchi and wheezing

What breathing compensations are found with tracheomalacia?

Stridor or wheezing

What condition involves inflammation of small airways, leading to hyperinflation?

Bronchiolitis

What demographic is MC affected by bronchiolitis, and what pathogen is MC?

< 6 months

RSV infection

What is the MC cause of smoking?

COPD

What are the exam findings of emphysema?

Barrel chest, dyspnea

Decreased tactile fremitus

Hyper-resonant percussion

Crackles and wheezes

What is the MC cause of bronchiectasis?

Cystic fibrosis

What is the term for chronic dilation of bronchi or bronchioles?

Bronchiectasis

What is the term for loss of volume or a total collapse of part/all of a lung?

Atelectasis

What do the following imaging signs indicate: triangular, homogenous shadow aligning with base toward pleura and apex toward hilum. Could see mediastinal shift or shift of diaphragm.

Atelectasis

What imaging modality is best to identify the cause of atelectasis?

CT

What is often found in the past medical history of those with asthma?

Atopy, allergic rhinitis, sinusitis

Atopic dermatitis

GERD

Nasal polyps

What are Light’s criteria to differentiate pleural effusion types?

Transudative - distortion of body fluid mechanics, heart failure/nephrotic syndrome

Exudative - localized inflammatory/malignant processes

What is the MC cause of transudative pleural effusion?

Heart failure

What are the MC causes of exudative pleural effusion?

Bacterial pneumonia

Pulmonary embolism

Malignancy

Viral disease

Post-cardiac surgery

What is the first imaging used for pleural effusion?

Chest x-ray

What is used if the x-ray is inconclusive in pleural effusion?

Ultrasound or CT scan

When is aspiration of pleural fluid indicatd?

Thoracentesis

What is the most specific way to diagnose pleural effusion?

Pleural friction rub

2nd is dullness to percussion

What is a common sign of atelectasis?

Tachypnea