Question 1

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

Accepted Answer

The bell is to be placed lightly against the chest wall. If it is placed firmly against the chest wall, it will cause the underlying skin to act as a diaphragm and filter out certain sounds.

Question 2

All of the following are characteristics of breath sounds that should be evaluated whenever chest auscultation is performed except:

Accepted Answer

Normally, the breath rate is counted while one observes the patient, often in conjunction with determining the heart rate. In addition to the pitch, amplitude, and duration of inspiration versus expiration, the characteristics of the breath sounds should be noted.

Question 3

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?

Accepted Answer

Inward movement of the lateral chest wall with inspiration in patients with COPD is known as the Hoover sign.

Question 4

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

Accepted Answer

Central cyanosis is a sign of severe hypoxemia and respiratory failure.

Question 5

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

Accepted Answer

Starting auscultation in the lower lobes can be useful for identifying late-inspiratory crackles that would clear with several deep breaths. If the clinician started at the top of the lung and worked downward, the late-inspiratory crackles would be gone by the time the lower lobes were reached.

Question 6

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

Accepted Answer

The diaphragm is most useful for listening to high-pitched sounds. Most lung sounds are relatively high pitched compared with heart sounds.

Question 7

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

Accepted Answer

Unilateral refers to only one side. Lobar pneumonia reduces expansion of the lung on the affected side.

Question 8

The muscles of inspiration include all of the following except:

Accepted Answer

The rectus abdominus muscle is an accessory muscle of expiration.

Question 9

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

Accepted Answer

Air in the pleural space will cause an increase in the resonance to percussion.

Question 10

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

Accepted Answer

When the diaphragm is fatigued and can no longer assist with breathing, it needs a rest. As a result, the accessory muscles take over, and when they cause negative intrathoracic pressure to occur with inspiration, the abdominal contents tend to be pulled inward and upward. This is known as abdominal paradox because the abdomen is moving in the opposite direction from normal with breathing.

Question 11

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

Accepted Answer

Pneumothorax puts more air between the outer chest wall and the source of the vocal fremitus and reduces the ability of vibrations to be felt at the surface.

Question 12

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

Accepted Answer

Consolidation of the lung will cause a decrease in resonance to percussion.

Question 13

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

Accepted Answer

The bell portion of the stethoscope is designed to capture low-pitched heart sounds.

Question 14

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.

Accepted Answer

The sensation and sound of crackling just under the skin is an indication of air trapped in pockets in the subcutaneous tissue, which is known as subcutaneous emphysema.

Question 15

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

Accepted Answer

Pneumonia causes an increase in lung tissue density. This causes vocal fremitus to increase.

Question 16

Which of the following characteristics does not apply to normal tracheal breath sounds?

Accepted Answer

Tracheal breath sounds are high pitched.

Question 17

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

Accepted Answer

When intrathoracic pressures become extremely negative with inspiration, the skin overlying the chest wall may sink inward between the ribs. This is known as retractions, and it indicates a severe increase in the work of breathing.

Question 18

Retractions and bulging are observed:

Accepted Answer

Retractions and bulging are signs of dramatically increased work of breathing.

Question 19

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?

Accepted Answer

Pneumonia reduces the ability of the lung to expand normally.

Question 20

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:

Accepted Answer

Patients with COPD tend to use their accessory muscles to breathe when the work of breathing increases and the diaphragm becomes less effective.

Quiz 5: Fundamentals of Physical Examination