Midterm Exam: NR 5 09 / NR5 09 (Latest 2023/ 2024 Update ) Advanced Physical Assessment Exam Review | Weeks 5 -8 Covered| Questions and Verified Answers QUESTION A 39 -year-old architect comes to the clinic for a 2 -day history of fever, chills, cough productive of green sputum, and dyspnea. He has no history of serious illness. His temperature is 101.2ºF. His other vital signs are within normal limits. Late inspi ratory crackles are heard on auscultation over the left lower lung posteriorly. When the clinician listens over that area and instructs the patient to say "ee," it sounds like "A." Which of the following would most likely be found on percussion of his lung s? Answer: a. Flatness b. Hyperresonance c. Stridor d. Tympany e. Dullness QUESTION A student is practicing the performance of a lung examination on a classmate. Which of the following is the correct order for performing the components of the lung examination ? Answer: a. Auscultation, inspection, palpation, and percussion b. Auscultation, percussion, palpation, and inspection c. Inspection, palpation, percussion, and auscultation d. Auscultation, inspection, palpation, and percussion e. Inspection, auscultati on, percussion, and palpation f. Palpation, inspection, auscultation, and percussion QUESTION A 14 -year-old high school student comes to the clinic for a 3 -month history of periodic dyspnea when playing basketball. It resolves shortly after resting. He has not had fever, chills, cough, sputum production, or chest pain. He has no history of serious illness. Based on the boy's history, asthma is suspected. Which of the following sounds heard on expiration during lung auscultation would be most suggestive of as thma? Answer: a. Mediastinal crunch b. Pleural rub c. Rhonchi d. Wheezes e. Stridor QUESTION A clinician is percussing the lungs of a patient with chronic obstructive pulmonary disease to see if they sound hyperresonant. Which of the following is an example of good technique for percussion? Answer: a. Strike using the tip of the third finger. b. The proximal interphalangeal joint is the joint that is struck. c. Put the third and fourth fingers next to each other on the chest. d. Strike using the finger pad of the fourth finger. e. The wrist is kept still during percussion. Submit QUESTION A 29 -year-old waiter comes to the clinic for a 2 -month history of a cough. When he lowers his gown so the clinician can listen to his lungs, the clinician notices a depression of the lower part of his sternum. Which of the following best describes the appearance of his chest? Answer: a. Barrel chest b. Flail chest c. Pectus excavatum d. Pigeon chest e. Thoracic kyphoscoliosis QUESTION A 13 -year-old girl is brought by her mother to the clinic one day before the start of eighth grade because of a 3 -day history of episodes of shortness of breath. When she gets the shortness of breath, she also notices tingling around her lips. She has no fever, cough, sputum production, or ch est pain. She has no history of serious illness and takes no medications. Vital signs are within normal limits. Cardiac, lung, and extremity examinations show no abnormalities. Which of the following is the most likely diagnosis? Answer: a. Aspiration of a foreign body b. Anxiety c. Asthma d. Left -sided heart failure e. Pneumonia QUESTION A 70 -year-old patient has suspected chronic obstructive pulmonary dis - ease. The clinician instructs the patient to take a deep breath in, and then with his mouth open, breat he out as fast and completely as he can. For what is the clinician checking? Answer: a. Bronchophony b. Egophony c. Tactile fremitus d. Forced expiratory time e. Whispered pectoriloquy QUESTION After examining a patient who is in the hospital for shortness of breath, the clinician records the following for lung examination Answer: "There is dullness to percussion over the right lung base. Breath sounds are absent at the right lung base. There are no crackles, wheezes, or rhonchi. There are no tran s- mitted voice sounds." Which of the following is the most likely diagnosis? Answer: a. Atelectasis b. Left -sided heart failure c. Pneumonia d. Pneumothorax e. Chronic obstructive pulmonary disease (COPD) QUESTION A 16 -year-old boy is brought to the Emergency Department (ED) after a motor vehicle accident for shortness of breath for 1 hour. A chest x -ray shows a rib fracture and a pneumothorax on the right side. The ED physician decides that a chest tube needs to be placed in the fourth intercostal space. How does he determine where the fourth intercostal space is? Answer: a. He finds the suprasternal notch and then moves his finger laterally to the third rib. The fourth intercostal space is just below the third rib. b. He finds the angle of Louis and then moves laterally to the first rib. He walks down from there to the fourth intercostal space. c. He finds the sternal angle and then moves his finger laterally to the second rib. He then walks down to the second intercostal space, third rib, third inte rcostal space, fourth rib and then the fourth intercostal space. d. He finds the clavicle. The second intercostal space is just below the clavicle. He then walks down to third rib, third intercostal space, fourth rib, and then the fourth intercostal space. e. He finds the angle of Louis and then moves his finger laterally to the third rib. The fourth intercostal space is just below the third rib. QUESTION An elderly patient with a history of smoking two packs of cigarettes a day for 50 years complains to her p hysician of progressive shortness of breath. On cardiac examination, the physician feels the most prominent palpable impulse to be in the xiphoid area. This is most likely a result of what condition? Answer: a. Aortic stenosis b. Hypertrophic cardiomyopat hy c. Hypertension d. Pulmonary hypertension e. Mitral regurgitation QUESTION A newborn baby has an embryologic defect affecting the aortic valve. What other cardiac valve is most likely to be affected? Answer: a. Tricuspid valve b. Pulmonic valve c. Mitral valve d. Pyloric valve e. Eustachian valve QUESTION A 77 -year-old man is experiencing progressive shortness of breath and dizziness. The patient undergoes cardiac catheterization, and the systolic blood pressure measured in the left ventricle is 180 m m Hg, while the systolic blood pressure measured in the aorta is 140 mm Hg. The patient is most likely experiencing symptoms related to what valvular condition? Answer: a. Aortic insufficiency b. Mitral stenosis c. Aortic stenosis d. Mitral regurgitation e. Pulmonic stenosis
