Fundamentals of Physical Examination Chapter 5

Questions and Answers

What anatomical landmark corresponds to the anterior chest location of the right dome of the diaphragm?

6th rib

5th rib (correct)

4th rib

7th rib

Which condition is commonly associated with a barrel chest?

Pulmonary embolism

Pneumonia

Chronic obstructive pulmonary disease (COPD) (correct)

Asthma

During what respiratory phase is the tracheal bifurcation (carina) located at T4?

At rest

End-exhalation (correct)

End-inhalation

Inhalation

Which abnormal respiratory pattern is characterized by irregular breathing with long periods of apnea?

Biot Signup and view all the answers

What is the term for vibrations created by the vocal cords during phonation?

Vocal fremitus Signup and view all the answers

What does decreased vocal fremitus indicate in a patient?

Bronchial obstruction Signup and view all the answers

Which rib marks the superior borders of the lungs?

1st rib Signup and view all the answers

In what configuration does the diaphragm rise to a higher position during normal breathing?

Exhalation phase Signup and view all the answers

What clinical sign suggests an increased work of breathing (WOB)?

Nasal flaring Signup and view all the answers

What type of breathing pattern is characterized by deep and fast breathing?

Kussmaul Signup and view all the answers

What physical examination technique is used to assess underlying lung structure through touch?

Palpation Signup and view all the answers

Which condition is characterized by bluish discoloration of the skin when significant deoxygenated hemoglobin is present?

Central cyanosis Signup and view all the answers

What does the presence of ptosis in a patient typically indicate?

Drooping of the upper lid Signup and view all the answers

During the physical examination of the neck, tracheal shift can indicate which of the following?

Pleural effusion Signup and view all the answers

What is the primary sign of mydriasis?

Dilated and fixed pupils Signup and view all the answers

What does a prominent jugular venous pressure (JVP) most commonly indicate?

Right heart failure Signup and view all the answers

What does pursed-lip breathing signify in patients?

Chronic Obstructive Pulmonary Disease (COPD) Signup and view all the answers

In the examination of the neck, which position of the trachea indicates tension pneumothorax?

Shift to the unaffected side Signup and view all the answers

Which of the following conditions is associated with the presence of diplopia?

Double vision Signup and view all the answers

What aspect of the thoracic cage assists in determining the lung's topography?

Angle of Louis Signup and view all the answers

What characteristic is NOT a component of lung sounds?

Color Signup and view all the answers

Which breath sound is characterized as a continuous sound?

Wheezes Signup and view all the answers

What should be ensured to avoid interference while auscultating?

Tubing should not touch anything Signup and view all the answers

Breath sounds in normal air filled lungs are affected by which of the following?

Voice sounds intensity and clarity Signup and view all the answers

What is a characteristic of late inspiratory crackles?

Typically occurs at the end of inspiration Signup and view all the answers

Which type of lung sound is associated with partial obstruction of the airways?

Stridor Signup and view all the answers

Which of the following methods assesses poor peripheral perfusion?

Capillary refill time Signup and view all the answers

What does a pleural friction rub indicate?

Inflammation of the pleural surfaces Signup and view all the answers

Which of the following terms describes sounds that are not normal breathing sounds?

Adventitious sounds Signup and view all the answers

What is NOT typically assessed with palpation of a patient’s extremities?

Respiratory rate Signup and view all the answers

Study Notes

Examination of the Head and Neck

Assess facial expression for signs of distress, pain, alertness, mood, and mental capacity.
Nasal flaring during inspiration indicates increased work of breathing.
Cyanosis presents as bluish skin discoloration, indicating significant deoxygenated hemoglobin.

Types of Cyanosis

Central cyanosis affects lips, nose, ears, neck, and tongue; harder to detect in darker skin.
Acrocyanosis is less severe, typically affecting extremities.

Breathing Patterns

Pursed-lip breathing is common in patients with COPD; helps regulate airflow during exhalation.
Mydriasis (dilated pupils) and miosis (pinpoint pupils) are examined in the neurologic assessment.
Ptosis (drooping eyelid), diplopia (double vision), and nystagmus (involuntary eye movement) are also noted.

Neck Examination

Inspection and palpation assess tracheal position, JVP (jugular venous pressure), and accessory muscle usage.
Trachea shifts away from tension pneumothorax or pleural effusion; shifts towards atelectasis or lung resection.

Jugular Venous Pressure (JVP)

Evaluated by the level of blood in jugular veins; right heart failure often leads to increased JVP.
In supine position, jugular veins appear full; at 45º angle, the blood level measures just above the clavicle.

Lung Topography and Landmarks

Thoracic examination includes anterior and posterior imaginary lines for anatomical reference.
Major landmarks include suprasternal notch, sternal angle (angle of Louis), and rib positions.
Diaphragm domes are located at varying rib levels (right: 5th rib anteriorly, T9 posteriorly; left: 6th rib anteriorly, T10 posteriorly).

Chest Examination

Normal AP diameter should be less than transverse diameter; barrel chest seen in emphysema.
Abnormal thoracic configurations include pectus carinatum, pectus excavatum, kyphosis, scoliosis, and kyphoscoliosis.
Retractions indicate severe obstruction or respiratory effort.

Breathing Patterns Analysis

Accessory muscles activate when ventilatory demands are high; sternocleidomastoid activation indicates severe distress.
Abnormal breathing patterns include apnea, Biot's breathing, Cheyne-Stokes respiration, Kussmaul breathing, and apneustic patterns.

Palpation of the Chest

Vocal fremitus indicates vibrations from vocal cords; tactical fremitus assessed by patient repeating "99."
Increased thickness of lung tissue leads to higher fremitus, while conditions like pneumothorax or pleural effusion can decrease it.

Auscultation of the Lungs

Proper technique involves sitting upright, relaxed, and breathing deeper through the mouth.
Four primary characteristics of lung sounds: pitch, amplitude, distinctive features, and duration.
Normal lung sounds are tracheal, bronchial, and vesicular; variations noted include crackles, wheezes, and pleural friction rubs.

Voice Sounds

Normal air-filled lungs filter voice sounds; conditions affecting this include bronchophony and egophony.
Abnormal voice sounds indicate lung pathology.

Extremity Examination

Clubbing of fingers indicates potential respiratory or cardiac issues.
Pedal edema assessed for fluid retention; compares extremity temperature to determine perfusion.
Poor peripheral perfusion presents as cool extremities, while capillary refill time is an important perfusion indicator.

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Description

This quiz focuses on Chapter 5 of the Fundamentals of Physical Examination, covering the examination of the head and neck. It includes identifying facial expressions and signs of respiratory disease, such as nasal flaring and cyanosis. Test your knowledge on these critical assessment skills.