Deck 5: Fundamentals of Physical Examination

Question 1

Which of the following patterns of breathing is associated with a loss in lung volume?

A) Slow and deep
B) Rapid and deep
C) Slow and shallow
D) Rapid and shallow

Answer 1

Rapid and shallow

Question 2

What problem is associated with nasal flaring?

A) Hypoxemia
B) Increased lung compliance
C) Increased work of breathing
D) Increased dead space ventilation

Answer 2

Increased work of breathing

Question 3

Which of the following terms is used to describe double vision?

A) Miosis
B) Diplopia
C) Nystagmus
D) Mydriasis

Answer 3

Diplopia

Question 4

Which of the following are associated with dilated and unresponsive pupils?
1) Opiates
2) Atropine
3) Brain death
4) Methamphetamines

A)1 and 2
B)3 and 4
C)1, 2, and 4
D)2, 3, and 4

Question 5

Which of the following terms describes an abnormal lateral curvature of the spine?

A) Kyphosis
B) Scoliosis
C) Anhidrosis
D) Myelosis

Question 6

Which of the following are components of the physical examination?
1) Inspection
2) Auscultation
3) Manipulation
4) Percussion

A)1 and 2
B)3 and 4
C)1, 2, and 4
D)2, 3, and 4

Question 7

Which of the following is the most common cause of jugular venous distention?

A) Auto-positive end-expiratory pressure (auto-PEEP)
B) Pneumonia
C) Pneumothorax
D) Right heart failure

Question 8

A review of the patient's history of present illness prior to a physical examination is helpful in that it:

A) gives insight into the expected findings during the examination.
B) suggests compliance with current medications.
C) helps determine if the patient will be friendly.
D) allows for a quick diagnosis.

Question 9

Which of the following terms is used to describe drooping of the eyelids?

A) Ptosis
B) Miosis
C) Diplopia
D) Chondrosis

Question 10

What problem is associated with cyanosis of the oral mucosa?

A) Low cardiac output
B) Reduced arterial oxygenation
C) Hyperventilation
D) Hypoventilation

Question 11

Which of the following physical examination findings is associated with myasthenia gravis?

A) Ptosis
B) Miosis
C) Mydriasis
D) Hepatomegaly

Question 12

At what point on the posterior chest wall can the inferior border of the lung normally be found?

A) Between T2 and T4
B) Between T4 and T6
C) Between T6 and T8
D) Between T9 and T12

Question 13

What disease is most likely to cause a prolonged expiratory time?

A) Asthma
B) Pneumonia
C) Pneumothorax
D) Pulmonary fibrosis

Question 14

In a patient's chart, the physician has documented finding tender lymph nodes in the neck region during the physical examination. This problem is consistent with:

A) respiratory infection.
B) human immunodeficiency virus (HIV) infection.
C) lymphoma.
D) lung cancer.

Question 15

Which of the following diseases is most likely to cause a prolonged inspiratory time?

A) Chronic obstructive pulmonary disease (COPD)
B) Asthma
C) Epiglottitis
D) Acute bronchitis

Question 16

At what angle should the head of the bed be elevated to assess jugular vein pressure (JVP)?

A) 15 degrees
B) 30 degrees
C) 45 degrees
D) 90 degrees

Question 17

Which of the following terms is used to describe constriction of the pupil of the eye?

A) Lytosis
B) Miosis
C) Mydriasis
D) Nystagmus

Question 18

Which of the following disorders is associated with a barrel chest?

A) Chronic bronchitis
B) Pneumonia
C) Emphysema
D) Chest trauma

Question 19

Which of the following is most likely to cause tracheal deviation?

A) Left upper lobe pneumonia
B) Right upper lobe pneumothorax
C) Left lower lobe pleural effusion
D) Right lower lobe pleural effusion

Question 20

The horizontal fissure that separates the right upper lobe from the right middle lobe begins at what rib in the midsternal line?

A) Rib 2
B) Rib 4
C) Rib 6
D) Rib 8

Question 21

A respiratory therapist is examining a patient in respiratory distress. She observes that the patient has a barrel chest, is using his accessory muscles of inspiration even when sitting at rest, and has a prolonged expiratory phase with pursed-lip breathing. This finding is most consistent with:

A) an upper respiratory infection.
B) an acute exacerbation of asthma.
C) severe COPD.
D) a myocardial infarction.

Question 22

In patients with severe COPD and hyperinflation, the low, flat diaphragm causes inward movement of the lateral chest walls with inspiration. What is this called?

A) Abdominal paradox
B) Biot breathing
C) Hoover sign
D) Respiratory alternans

Question 23

Which of the following clinical disorders will cause decreased resonance to percussion?

A) COPD
B) Asthma
C) Pneumonia
D) Pneumothorax

Question 24

Which of the following clinical conditions is associated with central cyanosis?

A) Hypercarbia
B) Renal failure
C) Poor circulation
D) Respiratory failure

Question 25

Which of the following techniques is most useful for application of the bell portion of the stethoscope?

A) Press it lightly against the chest wall.
B) Press it firmly against the chest wall.
C) Hold it about 1 cm from the chest wall.
D) Slide it gently in a circular motion on the chest wall.

Question 26

The diaphragm portion of the stethoscope is used to listen for:

A) heart murmurs.
B) pleural friction rubs.
C) low-pitched heart sounds.
D) most lung sounds.

Question 27

What clinical disorder will cause a unilateral decrease in thoracic expansion?

A) COPD
B) Lobar pneumonia
C) Acute asthma attack
D) Neuromuscular disease

Question 28

Which of the following will cause a decrease in vocal fremitus upon palpation?

A) Atelectasis
B) Pneumonia
C) Lung tumor
D) Pneumothorax

Question 29

The muscles of inspiration include all which of the following?
1) The diaphragm
2) The sternocleidomastoids
3) The scalene muscles
4) The rectus abdominus muscle

A)1 and 4
B)2 and 3
C)1, 2, and 3
D)2, 3, and 4

Question 30

Which of the following characteristics apply to normal tracheal breath sounds?
1) Loud
2) Low pitched
3) High pitched
4) Fairly equal inspiratory and expiratory components

A)1 and 3
B)2 and 4
C)1, 2, and 4
D)2, 3, and 4

Question 31

Where is the best anatomic place to begin auscultation in most patients?

A) Over the trachea
B) Over the upper lobes
C) In the axillary regions
D) In the dependent regions

Question 32

The bell portion of the stethoscope is best designed to listen to _____-pitched _____ sounds.

A) low; lung
B) low; heart
C) high; lung
D) high; heart

Question 33

Which of the following will cause an increase in vocal fremitus upon palpation?

A) COPD
B) Obesity
C) Pneumonia
D) Pneumothorax

Question 34

Which of the following breathing patterns is most typically associated with fatigue of the diaphragm?

A) Bradypnea
B) Deep and fast breathing
C) Biot breathing
D) Abdominal paradox

Question 35

Which of the following are characteristics of breath sounds that should be evaluated whenever chest auscultation is performed?
1) The respiratory rate
2) The pitch (vibration frequency)
3) The amplitude or intensity (loudness)
4) The duration of inspiration versus expiration

A)1 and 4
B)2 and 3
C)1, 2, and 3
D)2, 3, and 4

Question 36

A respiratory therapist (RT) examining a patient notes that on assessment of chest expansion with palpation, the right lower chest is found to lag behind the left lower chest. With which of the following problems is this finding consistent?

A) COPD
B) Right lower lobe pneumonia
C) Left lower lobe pneumonia
D) Severe asthma

Question 37

Which of the following terms describes the sinking inward of the skin overlying the rib cage with each inspiratory effort?

A) Ataxia
B) Bulging
C) Retractions
D) Mydriasis

Question 38

A therapist examining a patient encounters an area of skin along the right midaxillary line, which, when palpated, produces a crackling sound and sensation. This is an indication of ______________ in this patient.

A) previous scarring due to a burn injury
B) a collection of fluid under the skin
C) lymphadenopathy
D) subcutaneous emphysema

Question 39

Which of the following clinical disorders will cause increased resonance to percussion?

A) Atelectasis
B) Pneumonia
C) Pneumothorax
D) Pleural effusion

Question 40

Retractions and bulging are observed:

A) when the work of breathing is very high.
B) during heavy exercise.
C) only in newborns and children.
D) primarily in patients with pulmonary fibrosis.

Question 41

Which of the following adventitious lung sounds is most likely to be heard in a patient with croup?

A) Stridor
B) Rhonchi
C) Polyphonic wheezes
D) Late-inspiratory crackles

Question 42

Which of the following terms describes the area of the chest wall that overlies the heart?

A) Periosteum
B) Precordium
C) Pericardium
D) Overcardium

Question 43

Which of the following terms applies to an abnormal increase in vocal resonance?

A) Fremitus
B) Egophony
C) Bronchophony
D) Plural friction rub

Question 44

In which area is the point of maximal impulse normally felt during palpation of the chest wall?

A) Midaxillary line at the fifth intercostal space
B) Midclavicular line at the fifth intercostal space
C) Just left of the sternum at the third intercostal space
D) Just right of the sternum at the fourth intercostal space

Question 45

Which of the following adventitious lung sounds is associated most closely with restrictive types of lung diseases?

A) Polyphonic wheezing
B) Monophonic wheezing
C) Late-inspiratory crackles
D) Early-inspiratory crackles

Question 46

Which of the following statements is false about vesicular or normal breath sounds?

A) They have a minimal expiratory sound.
B) They are produced somewhat regionally.
C) They are produced when air enters the alveoli.
D) They are used to help confirm proper placement of an endotracheal tube.

Question 47

What may cause the point of maximal impulse to shift to the anterior axillary region on the left?

A) A tension pneumothorax on the right
B) Right ventricular hypertrophy
C) Cor pulmonale
D) Pericarditis

Question 48

Which of the following abnormalities would be associated with an increase in vocal resonance?

A) Pneumonia
B) Emphysema
C) Pneumothorax
D) Large pleural effusion

Question 49

Which of the following lung conditions is associated with diminished breath sounds because of airflow limitation and poor transmission of sound through the lung?

A) Bronchitis
B) Pneumonia
C) Lung tumor
D) Emphysema

Question 50

Which of the following mechanisms is believed to be responsible for the normal vesicular breath sound?

A) Air entering the alveoli
B) Contraction of the inspiratory muscles
C) Rubbing together of the two layers of the pleurae
D) Filtration of turbulent flow sounds in the larger airways

Question 51

Which of the following terms best describes a louder version of a vesicular sound that can be heard over lung consolidation?

A) Tubular
B) Tracheal
C) Crepitation
D) Harsh or bronchial

Question 52

Which of the following types of wheezing is likely to be heard over the chest of a patient with a tumor that is partially obstructing a single airway?

A) Sibilant wheezing
B) Sonorous wheezing
C) Polyphonic wheezing
D) Monophonic wheezing

Question 53

Which of the following descriptions applies to normal vesicular breath sounds?
1) The sounds should be soft and muffled
2) Heard primarily during inhalation
3) Heard primarily over the lung parenchyma
4) High pitched as compared with tracheal breath sounds

A)1 and 2
B)3 and 4
C)1, 2, and 3
D)2, 3, and 4

Question 54

Which of the following terms is used to describe a continuous type of adventitious lung sound heard loudest over the neck of a patient with upper airway obstruction?

A) Wheezes
B) Stridor
C) Rhonchi
D) Sonorous rales

Question 55

Which of the following terms is used to describe the normal breath sounds heard around the sternum on the anterior chest and between the scapulae on the posterior chest?

A) Tubular
B) Vesicular
C) Bronchial
D) Bronchovesicular

Question 56

Which of the following characteristics of wheezing is least reliable for predicting the degree of airway obstruction?

A) Pitch
B) Duration
C) Intensity
D) Sound frequency

Question 57

Which of the following adventitious lung sounds is related most closely to a life-threatening problem?

A) Stridor
B) Rhonchi
C) Crackles
D) Wheezing

Question 58

Which of the following terms best describes continuous types of adventitious lung sounds?

A) Rhonchi
B) Stridor
C) Wheezes
D) Sibilant rales

Question 59

Which of the following terms has had a confusing history with regard to its use and has been replaced with the term crackles?

A) Rales
B) Wheezes
C) Rhonchi
D) Crepitations

Question 60

Which of the following factors most closely relates to the pitch of a wheeze?

A) The patient's inspiratory-to-expiratory (I:E) ratio
B) The patient's respiratory rate
C) The length of the involved airway
D) The degree of airway compression

Question 61

What is believed to be responsible for production of the first heart sound?

A) Closure of the atrioventricular (AV) valves
B) Opening of the AV valves
C) Closure of the semilunar valves
D) Opening of the semilunar valves

Question 62

Which of the following terms is used to describe an abnormal collection of fluid in the peritoneal cavity?

A) Ascites
B) Pericarditis
C) Pancreatitis
D) Hepatomegaly

Question 63

Digital clubbing is associated with:
1) COPD
2) Cystic fibrosis
3) Bronchogenic carcinoma
4) Pneumonia

A)1 and 4
B)2 and 3
C)1, 2, and 3
D)2, 3, and 4

Question 64

Which of the following findings is consistent with reduced perfusion?

A) Peripheral cyanosis
B) Hepatomegaly
C) Loud P2 sound
D) Jugular vein distention (JVD)

Question 65

What change in the heart sounds is associated with cor pulmonale?

A) Loud A2
B) Loud M1
C) Loud T2
D) Loud P2

Question 66

At which of the following sites on the chest wall is the pulmonic valve best auscultated?

A) Second left intercostal space near the sternal border
B) Fifth intercostal space on the left near the sternal border
C) Sixth intercostal space on the left at the midaxillary line
D) First intercostal space on the right at the midclavicular line

Question 67

Which of the following clinical conditions may cause diminished heart sounds?

A) Bronchitis
B) Pneumonia
C) Emphysema
D) Pulmonary embolism

Question 68

What is a common cause of hepatomegaly?

A) Chronic right heart failure
B) Pneumothorax
C) Pleural effusion
D) Acute asthma attack

Question 69

Which of the following mechanisms is responsible for production of an abnormal third heart sound?

A) Forceful opening of the aortic valve
B) Forceful closure of the pulmonic valve
C) Rapid filling of the atrium during ventricular systole
D) Rapid filling of the ventricles immediately after systole

Question 70

The length of normal capillary refill is less than _____ s.

A) 1
B) 3
C) 5
D) 10

Question 71

Which of the following can be responsible for the production of murmurs?
1) Stenotic AV valves
2) Incompetent AV valves
3) Incompetent semilunar valves
4) Dextrocardia

A)1 and 4
B)2 and 3
C)1, 2, and 3
D)2, 3, and 4

Question 72

Which of the following clinical disorders is characterized by the point of maximal impulse being felt in the epigastric area?

A) Atelectasis
B) Emphysema
C) Pneumothorax
D) Chronic bronchitis

Question 73

Which of the following clinical problem is associated with a gallop rhythm?
1) Left-to-right shunt
2) Myocardial infarction sequelae
3) Overdistention of the ventricles
4) Pulmonary embolism

A)1 and 4
B)2 and 3
C)1, 2, and 3
D)2, 3, and 4

Question 74

Which of the following types of murmurs is associated with mitral valve stenosis?
1) Systolic
2) Diastolic
3) Pansystolic
4) Semisystolic

A)1 only
B)2 only
C)3 and 4
D)2, 3, and 4

Question 75

What is the normal distance that the liver spans in the right upper quadrant of the abdomen?

A) 6 cm
B) 8 cm
C) 10 cm
D) 14 cm

Question 76

Which of the following clinical conditions is associated with the onset of pedal edema?

A) Liver failure
B) Right heart failure
C) Status asthmaticus
D) Tension pneumothorax