NSG Respiratory exam |63 questions and answers

A mother brings her infant to you because of a "rattle" in his chest with breathing. Which of the following would you hear if there were a problem in the upper airway? Inspiratory sounds All of the following produce a chronic cough except: Chronic Bronchitis Allergic Rhinitis Acute viral upper respiratory infection Acute viral upper respiratory infection A 47-year-old receptionist comes to your office, complaining of fever, shortness of breath, and a productive cough with golden sputum. She says she had a cold last week and her symptoms have only gotten worse, despite using over-the-counter cold remedies. She denies any weight gain, weight loss, or cardiac or gastrointestinal symptoms. Her past medical history includes type 2 diabetes for 5 years and high cholesterol. She takes an oral medication for both diseases. She has had no surgeries. She denies tobacco, alcohol, or drug use. Her mother has diabetes and high blood pressure. Her father passed away from colon cancer. On examination you see a middle-aged woman appearing her stated age. She looks ill and her temperature is elevated, at 101. Her blood pressure and pulse are unremarkable. Her head, eyes, ears, nose, and throat examinations are unremarkable except for edema of the nasal turbinates. On auscultation she has decreased air movement, and coarse crackles are heard over the left lower lobe. There is dullness on percussion, increased fremitus during palpation, and egophony and whispered pectoriloquy on auscultation. What disorder of the thorax or lung best describes her symptoms? Spontaneous pneumothorax Chronic obstructive pulmonary disease (COPD) Asthma Pneumonia Pneumonia Which of the following is consistent with good percussion technique? Strike the pleximeter over the distal interphalangeal joint. Which of the following conditions would produce a hyperresonant percussion note? Large Pneumothorax Which of the following is a normal physiological lung sound? Vesicular Stridor Wheezing Rhonchi Vesicular A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these? Heart Failure A 60-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can't do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke and her father died from prostate cancer. She denies any recent upper respiratory illness, and she has had no other symptoms. On examination she is in no acute distress. Her blood pressure is 160/100 and her pulse is 100. She is afebrile and her respiratory rate is 16. With auscultation she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination the S1 and S2 are distant and an S3 is heard over the apex. What disorder of the chest best describes her symptoms? Pneumonia Chronic obstructive pulmonary disease (COPD) Pleural pain Left-sided heart failure Left-sided heart failure A male patient states that he has difficulty breathing when he is lying down but when he sits up, it improves. This is a classic description of: Orthopnea A patient states that the only way he can sleep at night is to use several pillows or to sleep upright in a recliner. This sleep pattern is most consistent with: obstructive lung disease When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology? Bronchitis Which of the following is characteristic of COPD? Asymmetric chest expansion Increased lateral diameter Increased anterior-posterior diameter Pectus excavatum Increased anterior-posterior diameter When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of: Pneumonia Emphysema Pneumothorax Asthma Pneumonia During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with: COPD Pneumothorax A normal finding Pleural effusion A normal finding Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? Computed tomography (CT) scan Chest xray with PA, lateral, and lordotic views Ultrasound Positron emission tomography (PET) scan Computed tomography (CT) scan Alpha-1 antitrypsin deficiency should be considered in patients diagnosed with: Exercise-induced cough Bronciectasis COPD Pericarditis COPD Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to: Pneumothorax Pleural effusion Pneumonia Pulmonary embolism Pneumothorax During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with: Pneumonia Pleuritis Pneumothorax A and B A and B While assessing auscultated spoken sounds, the ausculated sound is heard as "a-a-a" when he is asked to repeat "e-e-e." This is indicative of: Asthma Tumor Pneumonia Pleural effusion Pneumonia A cough is described as chronic if it has been present for: 2 weeks or more 8 weeks or more 3 months or more 6 months or more 8 weeks or more Which of the following medications are commonly associated with the side effect of cough? Beta blocker Diuretic ACE inhibitor Calcium antagonist ACE inhibitor Which of the following details are NOT considered while staging asthma? Nighttime awakenings Long-acting beta agonist usage Frequency of symptoms Spirometry findings Long-acting beta agonist usage When asthma is suspected, which of the following is NOT useful in making a diagnosis? Decreased FEV1/FVC ratio Decreased FEV1 Some reversibility with administration of bronchodilator Peak flow meter reading Peak flow meter reading The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Age over 40 Fever greater than 101 Tachypnea greater than 30 breaths/minute Productive cough Tachypnea greater than 30 breaths/minute The most common etiologic organism for community-acquired pneumonia is: Streptococcus pneumoniae Beta hemolytic streptococcus Mycoplasma Methicillin resistant staphylococcus Streptococcus pneumoniae A 75-year-old patient with community-acquired pneumonia presents with temperature of 102.1, chills, productive cough, BP 90/5062, WBC 12,000, and blood urea nitrogen (BUN) 20 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient: Can be treated as an outpatient Requires hospitalization for treatment Requires a high dose of parenteral antibiotic Can be treated with oral antibiotics Can be treated as an outpatient Your patient with community-acquired pneumonia shows a pleural effusion on chest x-ray, indicating the need for: Immediate endotracheal intubation Broad spectrum intravenous antibiotics Thoracentesis to rule out empyema Gram stain and culture of sputum Thoracentesis to rule out empyema If on physical examination the clinician auscultates rhonchi, the clinician should ask the patient to take a deep breath and cough in order to: Mobilize secretions Diagnose pleural effusion Accurately distinguish lung sounds A & C A & C Which of the following is considered a "red flag" when diagnosing a patient with pneumonia? Fever of 102 Infiltrates on chest x-ray Pleural effusion on chest x-ray Elevated white blood cell count Pleural effusion on chest x-ray