Bates Ch 15 Thorax & Lungs Verified Solutions

Bates Ch 15 Thorax & Lungs Verified Solutions A patient reports chest pain/discomfort and uses a clenched fist over their sternum to indicate this; what does this suggest is the underlying cause? Angina pectoris A patient reports chest pain/discomfort and uses a finger to point to a tender spot on the chest wall; what does this suggest is the underlying cause? Musculoskeletal pain Brainpower Read More A patient reports chest pain/discomfort and uses a hand moving from the neck to the epigastrium; what does this suggest is the underlying cause? Heartburn Sources of chest pain w/ related causes: What is the "triangle of safety"? Anatomical region in the midaxillary line formed by the lateral border of the pectoralis major muscle anteriorly, lateral border of the latissimus dorsi posteriorly, and nipple line (4th or 5th intercostal space) inferiorly. This triangle represents a "safe position" for chest tube insertion. Aspiration pneumonia is more common in which lung? Why? More common in the right middle and lower (RML & RLL) lobes because the right main bronchus is more vertical. for this same reason, if an ETT is advanced too far during intubation, it will more likely enter the right main-stem bronchus visceral pleura covers the outer surface of the lungs lacks sensory nerves parietal pleura Lines the pleural cavity along the inner rib cage and the upper surface of the diaphragm. richly innervated by the intercostal and phrenic nerves Pleural space the area between the parietal and visceral pleurae; a potential space 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 chest 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? A. Anxiety B. Asthma C. Pneumonia D. Aspiration of a foreign body E. Left-sided heart failure A. Anxiety Tingling around the lips can be a symptom of anxiety. The start of a new school year can be anxiety provoking for children. The normal lung examination is consistent with anxiety. Aspiration of a foreign body is incorrect. She does not have a cough. Putting a foreign body in her mouth and aspirating it would be unusual at her age. Asthma is incorrect. Asthma is a possible cause of shortness of breath but is less likely in this girl because of the tingling around her lips and lack of cough or chest tightness, in addition to the lack of wheezing on examination. Left-sided heart failure is incorrect. Left-sided heart failure is uncommon in children. She also has no other symptoms of heart failure, such as orthopnea or paroxysmal nocturnal dyspnea. She has no history of heart disease, high blood pressure, or other conditions that could put at an increased risk of heart disease. She also has no crackles on lung auscultation, which can be heard in left-sided heart failure. Pneumonia is incorrect. Pneumonia is less likely than anxiety because of the lack of other characteristic symptoms of pneumonia (fever, cough, sputum production, and chest pain) and the normal lung examination. Reference: Bickley, Lynn S.Bates’Guide to Physical Examination and History Taking,13th ed., Philadelphia: Wolters Kluwer, Chapter 15: The Thorax and Lungs. 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 asthma? A. Stridor B. Wheezes C. Mediastinal crunch D. Rhonchi E. Pleural rub B. Wheezes Wheezes are suggestive of narrowed airways, as in asthma, chronic obstructive pulmonary disease, or bronchitis. Mediastinal crunch is incorrect. A mediastinal crunch is suggestive of pneumomediastinum, not asthma. Pleural rub is incorrect. A pleural rub can be suggestive of a pleural effusion or a pneumothorax, not asthma. Rhonchi are incorrect. Rhonchi are suggestive of secretions in larger airways, not asthma. Stridor is incorrect. Stridor is suggestive of partial obstruction of the larynx or trachea, not asthma. Reference: Bickley, Lynn S.Bates’Guide to Physical Examination and History Taking,13th ed., Philadelphia: Wolters Kluwer, Chapter 15: Thorax and Lungs. After examining a patient who is in the hospital for shortness of breath, the clinician records the following for lung examination: "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 transmitted voice sounds." Which of the following is the most likely diagnosis? A. Left-sided heart failure B. Atelectasis C. Pneumothorax D. Chronic obstructive pulmonary disease (COPD) E. Pneumonia B. Ateletasis All of the physical examination findings are characteristic of atelectasis. They ca