Questions and Answers
What anatomical landmark corresponds to the tracheal bifurcation in the posterior chest?
During deep inspiration, how much should the thumbs move apart from the midline in normal thoracic expansion?
What describes the correct technique for auscultating lung sounds?
Which muscle's usage is indicative of severe obstruction during breathing?
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What is the anterior landmark for the left dome of the diaphragm?
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Which of the following is not a characteristic used to describe lung sounds?
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Which breath sound is characterized by a high pitch and musical quality?
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In the presence of unilateral bronchial obstruction, what is likely to happen to vocal fremitus?
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What is the normal anatomical position of the diaphragm during inspiration?
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Why is the right hemidiaphragm typically higher than the left hemidiaphragm?
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What breathing pattern is characterized by irregular breathing with long periods of apnea?
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Which adventitious lung sound is associated with the presence of fluid in the alveoli?
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How can capillary refill be assessed?
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What is the correct range of the inferior borders of the lungs?
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In which thoracic condition would you commonly see a barrel chest?
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What is the significance of assessing jugular venous pressure?
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What causes an increase in vocal fremitus during palpation?
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Which lung sound can be described as a continuous high-pitched musical sound emerging during expiration?
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What constitutes a normal finding in the examination of voice sounds?
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Which of the following describes normal lung sounds?
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What does nasal flaring during inspiration typically indicate?
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What does a high jugular venous pressure (JVP) primarily indicate?
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What is the significance of a tracheal shift towards the affected side?
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Which of the following accurately describes cyanosis?
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The position of the trachea can help identify which conditions?
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What does increased blood in the jugular veins when the patient is supine indicate?
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What condition is typically indicated by pursed-lip breathing?
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Which lines are considered imaginary landmarks for lung topography?
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What is indicated by miosis during an eye examination?
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Which of the following does not contribute to jugular venous pressure changes?
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Study Notes
Examination of the Head and Neck
- Evaluate facial expressions for signs of acute distress, pain, alertness, mood, and cognitive capacity.
- Nasal flaring indicates increased work of breathing (WOB) during inspiration.
- Cyanosis presents as bluish discoloration of skin, indicating significant deoxygenated hemoglobin.
- Central cyanosis is more severe, noted in areas like lips, nose, ears, and tongue.
Respiratory Signs
- Pursed-lip breathing: Common in COPD patients; involves puckering lips during exhalation.
- Eye evaluations: Include checks for mydriasis (dilated pupils), miosis (pinpoint pupils), ptosis (drooping eyelid), diplopia (double vision), and nystagmus (involuntary eye movement).
Neck Examination
- Tracheal position and jugular venous pressure (JVP) assessed through inspection and palpation.
- JVP findings:
- Full when supine; at 45º angle, it should be a few cm above the clavicle.
- Elevated JVP common in right heart failure and other conditions like hypervolemia.
Lung Topography
- Key imaginary lines for lung examination: midsternal, midclavicular, midaxillary, midspinal, and midscapular.
- Anatomical landmarks of the thoracic cage include the suprasternal notch and sternal angle.
Lung Borders and Fissures
- Superior lung borders extend 2-4 cm above clavicles; inferior borders to the 6th rib at the midclavicular line.
- Right lung has both oblique and horizontal fissures; left lung has only an oblique fissure.
Diaphragm Position
- Right dome: anteriorly at the 5th rib, posteriorly at T9.
- Left dome: anteriorly at the 6th rib, posteriorly at T10.
Thoracic Configuration and Breathing Patterns
- Normal thorax: Anteroposterior diameter < transverse diameter; notable in emphysema (barrel chest).
- Abnormal thoracic configurations include pectus carinatum, pectus excavatum, kyphosis, scoliosis, and flail chest.
Breathing Mechanics
- Accessory muscle use increases with respiratory demand; sternocleidomastoid muscle indicates severe obstruction.
- Palpation used to assess thoracic expansion, vocal fremitus, and to identify subcutaneous emphysema.
Auscultation Techniques
- Use stethoscope components effectively: bell for light sounds, diaphragm for firm sounds.
- Perform auscultation in a systematic manner to assess lung sounds, considering pitch, amplitude, and duration.
Respiratory Sounds and Terminology
- Lung sounds categorized into normal (tracheal, vesicular) and adventitious (crackles, wheezes, stridor, friction rub).
- Voice sounds (bronchophony, whispered pectoriloquy, egophony) help evaluate underlying lung conditions.
Peripheral Examination
- Pay attention to clubbing and pedal edema during extremity examination as indicators of systemic issues.
- Assess peripheral skin temperature through palpation; poor perfusion presents as cool extremities.
Capillary Refill
- Test used to evaluate blood flow; poor refill indicates possible circulatory issues.
These notes cover essential facts on the examination of the head and neck, signs of respiratory distress, thoracic evaluations, and peripheral signs affecting overall health assessment.
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Description
This quiz focuses on Chapter 5 of the Fundamentals of Physical Examination, which covers the examination of the head and neck. You will learn how to identify various facial expressions indicative of acute distress, pain, and respiratory diseases like nasal flaring and cyanosis.
