Question 1

In auscultating the precordium of a patient, you hear a high-pitched "whooshing" noise occurring simultaneously with S₁. This finding is most consistent with which of the following?

Accepted Answer

Systolic murmurs are produced by an incompetent atrioventricular (AV) valve or a stenotic semilunar valve. An incompetent AV valve allows a backflow of blood into the atrium, usually producing a high-pitched "whooshing" noise simultaneously with S₁.

Question 2

In palpating a patient's feet and hands, you note extreme coolness to the touch. This finding is most consistent with which of the following?

Accepted Answer

When perfusion is poor (as in heart failure or shock), the compensatory vasoconstriction in the extremities helps shunt blood to the vital organs. This reduction in peripheral perfusion causes the extremities to become cool to the touch. The extent to which the coolness to touch extends toward the body is an indication of the degree of circulatory failure.

Question 3

In which of the following disorders is digital clubbing a common physical sign?
1) Congenital heart disease
2) Lung cancer
3) Chronic obstructive pulmonary disease
4) Pancreatic cancer

Accepted Answer

Digital clubbing is a common physical sign in conditions that involve chronic hypoxia or inflammation, such as congenital heart disease (1), lung cancer (2), and chronic obstructive pulmonary disease (COPD) (3). Pancreatic cancer (4) is less commonly associated with digital clubbing unless it leads to secondary conditions that cause hypoxia.

Question 4

Which of the following is true of peripheral cyanosis?

Accepted Answer

Cyanosis of the digits is referred to as peripheral cyanosis and is mainly the result of poor blood flow, especially in the extremities.

Question 5

Which of the following abnormalities should the practitioner be on the lookout for during inspection of the extremities?
1) Digital clubbing
2) Peripheral cyanosis
3) Ascites
4) Impaired capillary refill

Accepted Answer

Digital clubbing and peripheral cyanosis are abnormalities that can be observed during inspection of the extremities, and impaired capillary refill is also important to assess. Ascites, on the other hand, is not related to the inspection of the extremities but rather involves the abdominal examination.

Question 6

The second heart sound (S₂) is created primarily by which of the following?

Accepted Answer

When systole ends, the ventricles relax, and the pulmonic and aortic (semilunar) valves close, creating the second heart sound (S₂).

Question 7

An emergency room patient is lying on his bed with his head elevated at a 45-degree angle. An RT, who is coming to examine the patient, notices that the patient's jugular vein extends approximately 7 cm above his sternal angle. What can the RT assume about this patient's condition?

Accepted Answer

When lying in a supine position, a healthy individual has neck veins that are full. When the head of the bed is elevated gradually to a 45-degree angle, the level of the blood column descends to a point no more than a few centimeters above the clavicle. With elevated venous pressure, the neck veins may be distended as high as the angle of the jaw, even when the patient is sitting upright. Jugular venous distention (JVD) is present when the jugular vein is enlarged and it can be seen more than 3 to 4 cm above the sternal angle. The most common cause of JVD is heart failure (cor pulmonale). Heart failure frequently occurs with advanced COPD because of hypoxemia. This causes chronic pulmonary vasoconstriction and hypertension which leads to right heart failure from the excessive workload. Other conditions associated with JVD include left heart failure, cardiac tamponade, tension pneumothoraces, and mediastinal tumors.

Question 8

Which of the following are potential causes of cardiac murmurs?
1) Backflow of blood through an incompetent valve
2) Forward flow through a stenotic valve
3) Rapid flow through a normal valve

Accepted Answer

Cardiac murmurs can be caused by backflow of blood through an incompetent valve, forward flow through a stenotic valve, and rapid flow through a normal valve, making all the given options correct causes of cardiac murmurs.

Question 9

A clinician unsuccessfully tried to take the pulse of a patient who is suffering from an asthma attack in the ER. The patient's breath sounds are diminished to absent bilaterally with a BP of 110 mm Hg systolic and 90 mm Hg diastolic. What can be concluded about this patient's condition?
1) Abdominal paradox is present.
2) Lung hyperinflation is present.
3) Pulsus paradoxus is present.
4) Pulse pressure is greater than 30 mm Hg.

Accepted Answer

The patient's condition indicates lung hyperinflation, which is common in severe asthma attacks due to air trapping and difficulty in exhalation. The inability to take the pulse during the attack suggests pulsus paradoxus, a condition where there's a greater than normal drop in blood pressure during inhalation, making the pulse difficult to detect.

Question 10

Which of the following pulmonary disorders is most likely to result in hepatomegaly?

Accepted Answer

An enlarged liver is called hepatomegaly and may be caused by right-sided heart failure from chronic hypoxemia (cor pulmonale), although many other causes exist.

Question 11

Diastolic murmurs are generally associated with which of the following?
1) Stenotic semilunar valve
2) Incompetent atrioventricular (AV) valve
3) Incompetent semilunar valve
4) Stenotic atrioventricular valve

Accepted Answer

Diastolic murmurs occur when the heart is in the relaxation phase. They are typically associated with stenotic atrioventricular valves (like mitral stenosis) and incompetent semilunar valves (like aortic regurgitation).

Question 12

A 55-year-old patient has been smoking a pack and a half of cigarettes (30 cigarettes) per day for 30 years. What is the patient's smoking history?

Accepted Answer

If a patient describes his or her smoking in terms of the number of cigarettes, or fractions of a pack, the calculation is as follows: there are 20 cigarettes per pack. If a patient states he or she has smoked a pack and a half of cigarettes per day for 30 years, then the smoking history is calculated as follows: 30 cigarettes/20 cigarettes-per-pack = 1.5 packs F1F1F1S1F1F1F10 30 years = 45 pack-year smoking history.

Question 13

In auscultating the heart sounds of a patient with chronic hypoxemia, you notice a marked increase in the intensity of the second heart sound (S₂) and no splitting during inhalation. This finding is most consistent with which of the following?

Accepted Answer

Pulmonary hypertension produces an increased intensity of S₂. This sound is referred to as a loud P₂ and is a result of more forceful closure of the pulmonic valve.

Question 14

Splitting of the second heart sound (S₂) is normally most pronounced during which of the following?

Accepted Answer

The normal splitting of S₂ is increased during inhalation because of the decrease in intrathoracic pressure, which improves venous return to the right side of the heart and further delays pulmonic valve closure.

Question 15

An RT is examining a patient suspected to have a left-sided tension pneumothorax. During inspection and palpation, the RT notices the patient's trachea has shifted to the left. Is the patient's diagnosis correct?

Accepted Answer

The trachea shifts away from areas with increased air, fluid, or tissue (e.g., in tension pneumothorax or large pleural effusion) and toward atelectasis. In general, abnormalities in the lung bases do not shift the trachea.

Question 16

In which of the following conditions might the intensity of the heart sounds be reduced?
1) Heart failure
2) Severe cachexia
3) Pneumothorax
4) Pleural effusion

Accepted Answer

Heart failure, pneumothorax, and pleural effusion can all reduce the intensity of heart sounds. Severe cachexia, on the other hand, can increase the intensity of heart sounds.

Question 17

In patients with chronic respiratory disease, what does pedal edema indicate?

Accepted Answer

Pedal edema most often results from heart failure, which causes an increase in the hydrostatic pressure of the venous system and leaking of fluid from the vessels into the surrounding tissues.

Question 18

A 23-year-old patient enters the emergency room complaining of dyspnea. The RT places the patient on oxygen as per hospital protocol and begins to interview the patient about her symptoms. She states that she is having difficulty taking a breath with chest tightness. Patient has a respiratory rate of 28 breaths/min with a loose productive cough. During auscultation, the RT hears bilateral wheezing in the lungs. What is the most likely cause of the patient's symptoms?

Accepted Answer

A patient with asthma would suffer from dyspnea caused by the airway obstruction. Usually a patient with asthma will complain of chest tightness and difficulty to take a breath. Bilateral wheezing and a loose, productive cough are also signs of an asthma attack.

Question 19

During examination of a patient's extremities, you press firmly for a brief period on a fingernail. You observe that it takes approximately 5 sec for the color to return to the nail bed. This finding is most consistent with which of the following?

Accepted Answer

When cardiac output is reduced and digital perfusion is poor, capillary refill is slow, taking several seconds to complete. In healthy individuals with good cardiac output and digital perfusion, capillary refill time is less than 3 sec.

Question 20

What term is used to describe the absence of breathing?

Accepted Answer

Apnea is the term used to describe no breathing and is typically caused by cardiac arrest, narcotic overdose, and severe brain trauma.

Quiz 16: Bedside Assessment of the Patient

In auscultating the precordium of a patient, you hear a high-pitched "whooshing" noise occurring simultaneously with S1. This finding is most consistent with which of the following?

In palpating a patient's feet and hands, you note extreme coolness to the touch. This finding is most consistent with which of the following?

In which of the following disorders is digital clubbing a common physical sign? 1) Congenital heart disease 2) Lung cancer 3) Chronic obstructive pulmonary disease 4) Pancreatic cancer

Which of the following is true of peripheral cyanosis?

Which of the following abnormalities should the practitioner be on the lookout for during inspection of the extremities? 1) Digital clubbing 2) Peripheral cyanosis 3) Ascites 4) Impaired capillary refill

The second heart sound (S2) is created primarily by which of the following?

An emergency room patient is lying on his bed with his head elevated at a 45-degree angle. An RT, who is coming to examine the patient, notices that the patient's jugular vein extends approximately 7 cm above his sternal angle. What can the RT assume about this patient's condition?

Which of the following are potential causes of cardiac murmurs? 1) Backflow of blood through an incompetent valve 2) Forward flow through a stenotic valve 3) Rapid flow through a normal valve