Ab Thorax Week 10

What are the most common sites of breast cancer metastasis?

Ribs

Spine

Pelvis

Long bones of arms/legs

When should the breast self-exam be performed?

Monthly, 5-7 days after onset of menses

What age do fibroadenomas usually occur?

15-25 yo

What are the characteristics of fibroadenomas?

Round

Mobile

Nontender

What age do breast cysts usually occur?

25-50 yo

What are the characteristics of breast cysts?

Soft-to-firm

round

mobile

tender

What age do fibrocystic changes occur in?

25-50 yo

What are the characteristics of fibrocystic changes?

Nodular, rope-like densities

What dietary change can eliminate fibrocystic changes?

Cut out coffee

What age does breast cancer usually occur?

Over 50 yo

What are the characteristics of breast cancer?

Irregular

Stellate

firm

adheres to adjacent tissues

Non-tender

What is the gold standard of breast cancer diagnosis?

Biopsy

What are the steps of breast cancer diagnosis?

Clinical breast exam

Mammogram

Breast MRI

Ultrasound

Biopsy

T or F: Men can develop breast cancer

True

The pulse amplitude decreases on quiet inspiration with a/n __________ pulse.

A. Paradoxical

B. Bisferiens

C. Alternans

D. Normal

A. Paradoxical

Which transmitted voice sound is most sensitive to detect consolidation?

A. Bronchophony

B. Egophony

C. Pectoriloquy

C. Pectoriloquy

Which sound is accentuated by the aortic maneuver?

A. S3 and S4 heart sounds

B. Splitting of S2

C. Mitral stenosis

D. Aortic insufficiency

D. Aortic insufficiency

When the patient whispers "99" and it sounds louder, clearer, and more distinct over a section of the lung, which of the following conditions is most likely?

A. Bronchitis

B. Emphysema

C. Pleuritis

D. Pneumonia

D. Pneumonia

Harsh vesicular breath sounds would most likely be heard when auscultating the lungs of which of the following individuals?

A. 5 year-old child

B. 90 year-old adult

C. 30 year-old chiropractor

D. 60 year-old with emphysema

A. 5 year-old child

What is the percussion tone over atelectasis?

Dull

When performing the puddle sign, what finding suggests presence of fluid in the abdomen? The sound of tapping on the abdomen becomes ________ as the stethoscope moves away from the umbilicus.

A. Louder

B. Quieter

A. Louder

For the hooking method of liver palpation, the examiner should face toward which of the following?

A. Head

B. Right knee

C. Left foot

D. Umbilicus

C. Left foot

Bruising around the _________ and __________suggests hemorrhagic pancreatitis

A. Umbilicus; flanks

B. Epigastric region; right scapula

C. Inguinal ligaments; left upper quadrant

D. Right lower quadrant; costovertebral angle

A. Umbilicus; flanks

If an irregularly shaped density is seen on a mammogram, what is the gold standard follow up test to determine if the mass is cancerous?

A. Biopsy

B. MRI

C. Tomosynthesis

D. Ultrasound

A. Biopsy

A blood pressure measurement of 126/78 is classified as ____________.

A. Hypotension

B. Normal

C. Elevated

D. Stage 1 hypertension

C. Elevated

A 21-year old woman feels a firm, round, non-tender, 1 cm mobile mass in her left breast. The mass is most likely a ________.

A. Cyst

B. Fibroadenoma

C. Cancerous tumor

D. Fibrocystic density

B. Fibroadenoma

A 45-year old overweight, sedentary woman presents with right upper quadrant pain that refers to her right scapula. Checking for which of the following would be most appropriate to aid in diagnosing her condition? ________ sign.

Murphy's

A dull percussion tone in the gastric area suggests which of the following?

A. Flatus

B. Distended bladder

C. Gastric air bubble

D. Tumor

D. Tumor

A loud heart murmur accompanied by a thrust or thrill that can be heard with the stethoscope tilted on the chest wall is described as ________.

A. 3/6

B. 4/6

C. 5/6

D. 6/6

C. 5/6

A person with Cushings syndrome may present with a protuberant abdomen accompanied by which abdominal inspection finding?

A. Periumbilical varicose veins

B. Bruising around the flanks

C. Large, violaceous striae

D. A midline ridge from the xiphoid to umbilicus

C. Large, violaceous striae

An individual reports having a productive cough. On examination, bronchial breath sounds and late inspiratory crackles are heard over the right middle lobe. Whispered pectoriloquy is also present over the right middle lobe and tactile fremitus is increased. What would be the most likely percussion tone over the right middle lobe?

A. Tympanic

B. Hyper-resonant

C. Dull

D. Resonant

C. Dull

Brain damage at the medullary level causes which of the following types of breathing that has no predictable pattern?

A. Ataxic

B. Kussmaul

C. Tachypnea

D. Cheyne-Stokes

A. Ataxic

A 27-year old woman who drinks 3 cups of coffee per day feels a mobile, nodular, rope-like density in her left breast. She is most likely developing ___________.

A. A cyst

B. A fibroadenoma

C. Breast cancer

D. Fibrocystic changes

D. Fibrocystic changes

Early systolic ejection sounds, heard shortly after ___, are ____________ findings.

A. S1, benign

B. S1, pathological

C. S2, benign

D. S2, pathological

B. S1, pathological

For the capture method of kidney palpation, the examiner asks the patient to take a full _________, then the examiner squeezes their hands together just below the inferior edge of the patient's ribcage.

inhale

Hearing an S3 heart sound would be most likely pathological in which of the following individuals?

A. 4-year old

B. 23-year old

C. 76-year old

D. Woman due to give birth

C. 76-year old

If the apical impulse is normal, where would it would be visualized and palpated? The left ____ intercostal space, _______________.

A. 2nd; sternal border

B. 2nd; midclavicular line

C. 5th; sternal border

D. 5th; midclavicular line

D. 5th; midclavicular line

If an individual presents with acute, intense abdominal tenderness and palpation of the abdomen reveals board-like rigidity, on auscultation the bowel sounds will most likely be __________.

A. Increased

B. Normal

C. Absent

C. Absent

Normal lymph nodes in the _________ area are commonly palpable and relatively larger than other lymph nodes.

A. Axillary

B. Cervical

C. Infraclavicular

D. Inguinal

D. Inguinal

Observing a patchy reddish-brown discoloration on a patient's shins suggests __________ occlusion.

Venous

Over an area of consolidation, tactile fremitus would be __________.

A. Normal

B. Increased

C. Decreased

D. Not detectable

B. Increased

Pain felt deep in the calf when the ankle is rapidly dorsiflexed suggests which of the following?

A. Arterial occlusion

B. Lymphatic obstruction

C. Thrombophlebitis

D. Venous anomaly

C. Thrombophlebitis

Pulsus alternans, where the pulse _______ alternates beat to beat, is associated with what condition?

A. Amplitude; hyperthyroidism

B. Amplitude; left ventricular failure

C. Rhythm; hypovolemia

D. Rhythm; pericardial tamponade

B. Amplitude; left ventricular failure

Retraction of the intercostal spaces during inspiration would suggest which of the following?

A. Pleural effusion

B. Normal respiration

C. Airway obstruction

D. Patent bronchioles

C. Airway obstruction

The _________ maneuver is used to accentuate low-pitched heart murmurs.

A. Aortic

B. Mitral

B. Mitral

The posterior tibial artery is palpated adjacent to which landmark?

A. Popliteal fossa

B. Inguinal ligament

C. Medial malleolus

D. Extensor hallucis tendon

C. Medial malleolus

The S1 heart sound is heard best in which of the following areas?

A. Apex and left lower sternal border

B. Base and right lower sternal border

C. Left 2nd and 3rd intercostal spaces

D. Right and left 2nd intercostal spaces

A. Apex and left lower sternal border

What abdominal inspection finding suggests portal hypertension?

Caput Medusa

To palpate the spleen, the doctor stands on the patient's __________ side, facing toward the patient's ______________.

A. Right, umbilicus

B. Right, head

C. Left, umbilicus

D. Left, head

A. Right, umbilicus

What is the most common cause of elevated jugular venous pressure?

Right ventricular pressure

What is a common cause of a paradoxical pulse?

A. COPD

B. Fever

C. Hypovolemia

D. Aortic stenosis

A. COPD

When is a physiological split S2 heart sound heard?

A. Throughout respiration

B. During expiration only

C. During inspiration only

D. When the person holds their breath

C. During inspiration only

Which part of the stethoscope is used during the mitral maneuver?

Bell

Which of the transmitted voice sounds is most useful in determining the size of a pleural effusion?

A. Bronchophony

B. Pectoriloquy

C. Egophony

C. Egophony

Which of the following would decrease tactile fremitus?

A. Carcinoma

B. Consolidation

C. Pneumonia

D. Pneumothorax

D. Pneumothorax