Health Assessment Exam 2
1. A 62-year-old construction worker presents to your office complaining of chronic cough
and occasional shortness of breath. Although he has had worsening of symptoms
occasionally with a cold, his symptoms have stayed about the same. The cough has
occasional mucous drainage but has never any blood. His past medical history is
significant for high blood pressure and arthritis. He has smoked two packs a day for the
past 45 years. He drinks occasionally but denies any illegal drug use. He is married and
has two children, he denies foreign travel. His father died of a heart attack and his
mother died of Alzheimer's disease. On examination you see a man looking slightly older
than his stated age. His blood pressure is 130/80 and his pulse is 88. He is breathing
comfortably with respirations of 12. His head, eyes, ears, nose, and throat examinations
are unremarkable. His cardiac examination is normal. On examination of his chest, the
diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi
are heard all over lung fields. There is no area of dullness and no increased or decreased
tactile fremitus. What thorax or lung disorder is most likely causing his symptoms?
a. Spontaneous pneumothorax
b. Chronic obstructive pulmonary disease (COPD)
c. Asthma
d. Pneumonia
2. A 68-year-old male retired postal worker presents to your office complaining of dull,
intermittent left-sided chest pain over the last few weeks. The pain occurs after he
mows the lawn or chops wood. He says that the pain radiates to the left side of his jaw
but nowhere else. He has felt light-headed and nauseated with the pain but has had no
other symptoms. He states when he sits down for several minutes the pain goes away.
Ibuprofen, Tylenol, and antacids have not improved the symptoms. He reports no recent
weight gain, weight loss, fever, or night sweats. He has a past medical history of high
blood pressure and arthritis. He quit smoking 10 years ago after smoking one pack a day
for 40 years. He denies any recent alcohol use and reports no drug use. He is married
and has two healthy children. His mother died of breast cancer and his father died of a
stroke. His younger brother has had bypass surgery. On examination you find him
healthy-appearing and breathing comfortably. His blood pressure is 140/90 and he has a
pulse of 80. His head, eyes, ears, nose, and throat examinations are unremarkable. His
lungs have normal breath sounds and there are no abnormalities with percussion and
palpation of the chest. His heart has a normal S1 and S2 and no S or S4. Further workup
is pending. Which disorder of the chest best describes these symptoms?
a. Angina pectoris
b. Pericarditis
c. Dissecting aortic aneurysm
, d. Pleural pain
3. A 75-year-old female retired teacher presents to your office complaining of chest pain
radiating to her back. She describes it as if someone is "ripping out her heart." It began
less than an hour ago. She states she is feeling very nauseated and may pass out. She
denies any trauma or recent illnesses. She states that she has never had pain like this
before. Nothing seems to make the pain better or worse. Her medical history consists of
difficult-to-control hypertension and coronary artery disease requiring two stents in the
past. She is a widow. She denies any alcohol, tobacco, or illegal drug use. Her mother
died of a stroke and her father of a heart attack. she has one younger brother who has
had bypass surgery. On examination you see an elderly female in a great deal of distress.
She is lying on the table, curled up, holding her left and right arms against her chest and
is restless, trying to find a comfortable position. Her blood pressure is 180/110 in the
right arm and 130/60 in the left arm and her pulse is 120. Her right carotid pulse is
bounding, but the left carotid pulse is weak. She is afebrile but her respirations are 24
times a minute. On auscultation her lungs are clear, and her cardiac examination is
unremarkable. You call EMS and have her taken to the hospital's ED (ER) for further
evaluation. What disorder of the chest best describes her symptoms?
a. Angina pectoris
b. Pericarditis
c. Dissecting aortic aneurysm
d. Pleural pain
4. A grandmother brings her 13-year-old grandson to you for evaluation. She noticed last
week when he took off his shirt that his breastbone seemed collapsed. He seems
embarrassed and tells you that is has been that way for quite a while. He states that he
has no symptoms from it and he just tries not to take his shirt off in front of anyone. He
denies shortness of breath, chest pain, or lightheadedness on exertion. His past medical
history is unremarkable. he is in the sixth grade and just moved in with his grandmother
after his father was deployed to the Middle East. His mother died several years ago in a
car accident. He states that he does not smoke and has never touched alcohol or drugs.
On examination you see a teenage boy appearing his stated age. On visual examination
of his chest, you see that the lower portion of the sternum is depressed. Auscultation of
the lungs and heart are unremarkable. What disorder of the thorax best describes your
findings?
a. Barrel chest
b. Pectus excavatum (funnel chest)
c. Pectus carinatum (pigeon chest)
d. Thoracic kyphoscoliosis
, 5. A 55-year-old smoker complains of chest pain and gestures with a closed fist over her
sternum to describe it. Which of the following diagnoses should you consider because of
her gesture?
a. Bronchitis
b. Costochondritis
c. Pericarditis
d. Angina pectoris
6. Upon auscultation in a patient with COPD, you would expect to hear:
a. Stridor
b. Delayed expiratory phase
c. Late inspiratory crackles
d. Pleural rub
7. Which of the following percussion notes would you obtain over the gastric air bubble
rather than the lung field?
a. Resonance
b. Tympany
c. Hyperreasonance
d. Flatness
8. Which of the following conditions would produce a hyper resonant percussion note?
a. Large pneumothorax
b. Lobar pneumonia
c. Pleural effusion
d. Empyema
9. A patient complains of shortness of breath for the past few days. On exam, 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?
a. Asthma
b. COPD
c. Bronchiectasis
d. Heart failure
10. When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely
etiology?
a. Bronchitis
1. A 62-year-old construction worker presents to your office complaining of chronic cough
and occasional shortness of breath. Although he has had worsening of symptoms
occasionally with a cold, his symptoms have stayed about the same. The cough has
occasional mucous drainage but has never any blood. His past medical history is
significant for high blood pressure and arthritis. He has smoked two packs a day for the
past 45 years. He drinks occasionally but denies any illegal drug use. He is married and
has two children, he denies foreign travel. His father died of a heart attack and his
mother died of Alzheimer's disease. On examination you see a man looking slightly older
than his stated age. His blood pressure is 130/80 and his pulse is 88. He is breathing
comfortably with respirations of 12. His head, eyes, ears, nose, and throat examinations
are unremarkable. His cardiac examination is normal. On examination of his chest, the
diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi
are heard all over lung fields. There is no area of dullness and no increased or decreased
tactile fremitus. What thorax or lung disorder is most likely causing his symptoms?
a. Spontaneous pneumothorax
b. Chronic obstructive pulmonary disease (COPD)
c. Asthma
d. Pneumonia
2. A 68-year-old male retired postal worker presents to your office complaining of dull,
intermittent left-sided chest pain over the last few weeks. The pain occurs after he
mows the lawn or chops wood. He says that the pain radiates to the left side of his jaw
but nowhere else. He has felt light-headed and nauseated with the pain but has had no
other symptoms. He states when he sits down for several minutes the pain goes away.
Ibuprofen, Tylenol, and antacids have not improved the symptoms. He reports no recent
weight gain, weight loss, fever, or night sweats. He has a past medical history of high
blood pressure and arthritis. He quit smoking 10 years ago after smoking one pack a day
for 40 years. He denies any recent alcohol use and reports no drug use. He is married
and has two healthy children. His mother died of breast cancer and his father died of a
stroke. His younger brother has had bypass surgery. On examination you find him
healthy-appearing and breathing comfortably. His blood pressure is 140/90 and he has a
pulse of 80. His head, eyes, ears, nose, and throat examinations are unremarkable. His
lungs have normal breath sounds and there are no abnormalities with percussion and
palpation of the chest. His heart has a normal S1 and S2 and no S or S4. Further workup
is pending. Which disorder of the chest best describes these symptoms?
a. Angina pectoris
b. Pericarditis
c. Dissecting aortic aneurysm
, d. Pleural pain
3. A 75-year-old female retired teacher presents to your office complaining of chest pain
radiating to her back. She describes it as if someone is "ripping out her heart." It began
less than an hour ago. She states she is feeling very nauseated and may pass out. She
denies any trauma or recent illnesses. She states that she has never had pain like this
before. Nothing seems to make the pain better or worse. Her medical history consists of
difficult-to-control hypertension and coronary artery disease requiring two stents in the
past. She is a widow. She denies any alcohol, tobacco, or illegal drug use. Her mother
died of a stroke and her father of a heart attack. she has one younger brother who has
had bypass surgery. On examination you see an elderly female in a great deal of distress.
She is lying on the table, curled up, holding her left and right arms against her chest and
is restless, trying to find a comfortable position. Her blood pressure is 180/110 in the
right arm and 130/60 in the left arm and her pulse is 120. Her right carotid pulse is
bounding, but the left carotid pulse is weak. She is afebrile but her respirations are 24
times a minute. On auscultation her lungs are clear, and her cardiac examination is
unremarkable. You call EMS and have her taken to the hospital's ED (ER) for further
evaluation. What disorder of the chest best describes her symptoms?
a. Angina pectoris
b. Pericarditis
c. Dissecting aortic aneurysm
d. Pleural pain
4. A grandmother brings her 13-year-old grandson to you for evaluation. She noticed last
week when he took off his shirt that his breastbone seemed collapsed. He seems
embarrassed and tells you that is has been that way for quite a while. He states that he
has no symptoms from it and he just tries not to take his shirt off in front of anyone. He
denies shortness of breath, chest pain, or lightheadedness on exertion. His past medical
history is unremarkable. he is in the sixth grade and just moved in with his grandmother
after his father was deployed to the Middle East. His mother died several years ago in a
car accident. He states that he does not smoke and has never touched alcohol or drugs.
On examination you see a teenage boy appearing his stated age. On visual examination
of his chest, you see that the lower portion of the sternum is depressed. Auscultation of
the lungs and heart are unremarkable. What disorder of the thorax best describes your
findings?
a. Barrel chest
b. Pectus excavatum (funnel chest)
c. Pectus carinatum (pigeon chest)
d. Thoracic kyphoscoliosis
, 5. A 55-year-old smoker complains of chest pain and gestures with a closed fist over her
sternum to describe it. Which of the following diagnoses should you consider because of
her gesture?
a. Bronchitis
b. Costochondritis
c. Pericarditis
d. Angina pectoris
6. Upon auscultation in a patient with COPD, you would expect to hear:
a. Stridor
b. Delayed expiratory phase
c. Late inspiratory crackles
d. Pleural rub
7. Which of the following percussion notes would you obtain over the gastric air bubble
rather than the lung field?
a. Resonance
b. Tympany
c. Hyperreasonance
d. Flatness
8. Which of the following conditions would produce a hyper resonant percussion note?
a. Large pneumothorax
b. Lobar pneumonia
c. Pleural effusion
d. Empyema
9. A patient complains of shortness of breath for the past few days. On exam, 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?
a. Asthma
b. COPD
c. Bronchiectasis
d. Heart failure
10. When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely
etiology?
a. Bronchitis
