Pt. Assessment
Pt. Assessment
Radiography
Radiography
Pt. Assessment
Pt. Assessment
100
Pt is dyspneic with bilateral wheezes. What's wrong?
A patient with asthma would suffer from dyspnea caused by the airway obstruction. Usually a patient with asthma will complain of chest tightness and difficulty to take a breath. Bilateral wheezing and a loose, productive cough are also signs of an asthma attack.
100
What artery is most often used to assess arterial blood pressure?
When the cuff is applied to the upper arm and pressurized to exceed systolic blood pressure, the brachial artery blood flow stops.
100
Which of the following may cause the trachea to shift to the right?
Right upper lobe atelectasis. The trachea shifts away from areas with increased air, fluid, or tissue (e.g., in tension pneumothorax or large pleural effusion) and toward atelectasis. In general, abnormalities in the lung bases do not shift the trachea.
100
What problem exists when interpreting an overexposed chest film?
An overpenetrated x-ray overexposes the film, leaving the lung parenchyma black and no ability to visualize the peripheral blood vessels. This overpenetration will make evaluation of the lung parenchyma far more difficult.
100
What is the most common cause of jugular venous distention (JVD)?
The most common cause of JVD is the failure of the right side of the heart.
100
What is the normal range for diastolic blood pressure in the adult patient?
Diastolic pressure is the force in the major arteries remaining after relaxation of the ventricles; it is normally 60 to 90 mm Hg.
200
What disease is associated with a barrel chest?
This abnormal increase in anteroposterior diameter is called barrel chest and is associated with emphysema.
200
What does the presence of stridor indicate?
Another continuous type of adventitious lung sounds heard in certain situations, primarily over the larynx and trachea during inhalation, is stridor. Stridor is a loud, high-pitched sound, which sometimes can be heard without a stethoscope. Most common in infants and small children, stridor is a sign of obstruction in the trachea or larynx. Stridor is most often heard during inspiration.
200
Blunting of the costophrenic angles on CXR indicates what?
If the point of the costophrenic angle is rounded rather than sharp, it usually indicates a hydrothorax is present.
200
Which of the following is a major limitation of magnetic resonance imaging (MRI) of the chest?
Cannot be used in patients with pacemakers. It is critically important to avoid taking conventional metal objects near the MRI machine, because the powerful magnet will pull the metallic object into the magnet with great force, exposing patients and health care providers in its path to life-threatening risk.
200
What is the most common cause of hypothermia?
The most common cause of hypothermia is prolonged exposure to cold.
200
What structure in the body is responsible for regulating the body temperature?
The hypothalamus plays an important role in regulating heat loss.
300
increase in vocal resonance because of enhanced transmission of sound?
Bronchophony
300
An air-fluid level in the pleural space typically indicates
An air-fluid level in the pleural space indicates a hydropneumothorax.
300
What is the best imaging technique for examining mediastinal masses?
CT is the best type of imaging for assessing most mediastinal masses.
300
What is the most common cause of cephalization as seen on the upright chest film?
Cephalization of the pulmonary blood flow is often caused by left heart failure.
300
What is the most common cause of lobar atelectasis?
Bronchial obstruction. Volume loss involving a whole lobe is usually caused by central airway obstruction.
300
What term is used to describe difficult breathing in the reclining position?
Dyspnea may be present only when the patient assumes the reclining position, in which case it is referred to as orthopnea.
400
What is indicated by retractions?
Increased work of breathing also can result in retractions.
400
What is indicated by the breathing pattern known as abdominal paradox?
Diaphragm fatigue. This is recognized by inward movement of the anterior abdominal wall during inspiratory efforts and is seen best with the patient in the supine position. This sign is called abdominal paradox.
400
What abnormality may appear on a CXR but is due to abnormal rotation of the patient?
The patient's rotation will make the mediastinum appear unusually wide.
400
What is the area of the anterior chest wall overlying the heart called?
Precordium. The techniques for physical examination of the chest wall overlying the heart (precordium) include inspection, palpation, and auscultation.
400
What is indicated by the presence of central cyanosis?
Respiratory failure. When respiratory disease reduces arterial oxygen content, cyanosis (a bluish discoloration of the tissues) may be detected, especially around the lips and in the oral mucosa of the mouth (central cyanosis).
400
What term is used to describe the chest pain associated with blockage of the coronary arteries?
A common cause of nonpleuritic chest pain is angina, which classically is a pressure sensation with exertion or stress and results from coronary artery occlusion.
500
In patients with chronic respiratory disease, what does pedal edema indicate?
Right ventricular failure
500
What change in the patient's respiratory breathing pattern is commonly seen with significant fever?
The increased need for oxygen intake and carbon dioxide removal may cause tachypnea.
500
CT angiography is most often used to evaluate what?
Pulmonary emboli
500
Which of the following is false regarding the visualization of air bronchograms on the chest film?
They are caused by air-filled airways surrounded by consolidation. These shadows or opacities often have lucent tubular visible structures running through them that represent air bronchograms. Normally, patent airways are not visible in the outer two-thirds of the lung on the chest radiograph. There is no contrast between air in the airway and air in the lung. However, the increased contrast produced by filling of the surrounding alveoli with fluid makes the airways more visible and causes the air bronchogram sign. Air bronchograms are the hallmark of infiltrates that fill alveoli (the so-called airspace disease).
500
Which of the following conditions is most likely to cause a dry, nonproductive cough?
Pulmonary fibrosis. For example, a dry, nonproductive cough is typical for restrictive lung diseases such as congestive heart failure or pulmonary fibrosis.
500
Which of the following is a common cause of pulsus paradoxus?
Pulsus paradoxus can be quantified with a blood pressure cuff and is common in patients with acute obstructive pulmonary disease, especially those suffering from an asthma attack.
600
What breathing pattern is associated with severe atelectasis?
A significant reduction in lung volume, such as that which occurs with atelectasis, usually results in rapid, shallow breathing.
600
COPD pt. is SOB. Bilateral coarse crackles, pedal edema, "bat's wing" CXR? What condition?
The term "bat's wing" appearance is applied to the predominance of edema in the hilar regions of both lungs with progressively less edema in the more peripheral areas of the lungs. Left heart failure and CHF will cause congestion of the pulmonary vessels leading to pulmonary edema throughout the lung fields.
600
Radiographically, into how many compartments is the mediastinum divided?
The mediastinum is divided into three compartments: anterior, middle, and posterior mediastinum.
600
What is the earliest sign of a left-sided pleural effusion on an upright chest radiograph?
The earliest sign of a left-sided pleural effusion on an upright chest radiograph is an increased distance between the inferior margin of the left lung and the stomach gas bubble.
600
Which of the following terms is used to describe coughing up blood-streaked sputum?
Coughing up blood or blood-streaked sputum from the lungs is referred to as hemoptysis.
600
Which of the following is least likely to cause tachycardia?
Common causes of tachycardia are exercise, fear, anxiety, low blood pressure, anemia, fever, reduced arterial blood oxygen levels, and certain medications.
700
What are the two most common reasons for placing a chest tube?
The most common indications for a chest tube are pneumothorax (air in the pleural space) and empyema (pus in the pleural space), although chest tubes may also be used to drain blood (hemothorax) or fluid (hydrothorax) or to install a sealant (e.g., the antibiotic doxycycline) to achieve closure of the pleural space, thereby preventing recurrent pneumothorax or hydrothorax.
700
Inspiratory crackles in patients without excess secretions are associated with?
Crackles also may be heard in patients without excess secretions. These crackles occur when collapsed airways pop open during inspiration. Airway collapse or closure can occur in peripheral bronchioles or in larger, more proximal bronchi.
700
The right heart shadow is not visible on your patient's chest radiograph. Which of the following pathologies may explain this?
The structures visible on a chest radiograph are seen only when tissue of one density is next to tissue of another density. For example, the heart is visible as a soft tissue density in the middle of the chest because the lungs, which are primarily air density, normally surround it. If the chest on either side of the heart was filled with water (pulmonary consolidation or pleural effusion), the normal heart shadow would not be visible on the radiograph.
700
Which of the following structures will result in the most radiopaque shadow on the chest radiograph?
Bone absorbs a large amount of the x-ray beam and is seen as a nearly white (radiopaque) shadow.
700
What is the advantage of COPD patients breathing through pursed lips during exhalation?
Promotes more complete emptying of the lungs. Breathing through pursed lips during exhalation creates resistance to flow. The increased resistance causes development of a slight backpressure in the small airways during exhalation, which prevents their premature collapse and allows more complete emptying of the lung.
700
What is the normal range for pulse pressure?
A normal pulse pressure is 30 to 40 mm Hg.
800
You hear coarse crackles throughout both inspiration and expiration. These sound clear when the patient coughs. What is this
Excessive mucus in the airways causes crackles that are usually coarse (low pitched) and heard during inspiration and expiration. These crackles often clear when the patient coughs or when the upper airway is suctioned.
800
palpating the neck region of a patient on a mechanical ventilator, you notice a crackling sound and sensation. What is this?
Subcutaneous emphysema is caused by air trapped in the subcutaneous tissues and is usually due to an air leak from the lung.
800
How many solitary pulmonary nodules (SPNs) would be encountered for every 1000 routine chest radiographs?
One or two SPNs are encountered in every 1000 chest radiographs.
800
What term is used to describe the shadows seen on the chest film when the alveoli fill with pus, fluid, or blood?
Both pneumonia and a bleeding lung can cause identical-appearing patchy increased density shadows of that tend to coalesce over time on the chest radiograph. These shadows are often referred to as infiltrates.
800
You observe a patient's breathing pattern as very irregular and interspersed with long periods of apnea. Which of the following is the most likely cause of this problem?
Increased intracranial pressure
800
What is the most common cause of pulmonary fibrosis?
Unknown. The two most common interstitial lung diseases, sarcoidosis and idiopathic pulmonary fibrosis, have no known cause.
900
What breathing pattern is associated with diabetic ketoacidosis?
Patients with diabetic ketoacidosis often breathe with a deep and rapid pattern, which is called Kussmaul breathing.
900
You press firmly for a brief period on a fingernail. You observe that it takes approximately 5 sec for the color to return to the nail bed. What is happening?
Reduction in cardiac output or poor peripheral perfusion
900
In what pulmonary condition does the chest radiograph often "lag behind" the clinical status of the patient?
The chest radiograph often lags behind the clinical condition of the patient. This is common in pneumonia where the patient may come in with high fever and cough typical for pneumonia but an infiltrate on the chest film may not appear for 12 to 24 hr.
900
What lung problem can a ventilation/perfusion (
) scan be used to detect?
Ventilation/perfusion scanning (also known as 
scanning) is often used in evaluating for pulmonary embolism.
900
What is indicated by the presence of gas bubbles within the pleural fluid without prior surgery or needle insertion?
The presence of gas bubbles within the fluid without prior surgery or needle insertion (which can introduce air) establishes the diagnosis of empyema.
900
Your patient has an abnormal sensorium. Which of the following is most likely true?
This often is called evaluating the sensorium. The alert patient who is well oriented to time, place, person, and situation is said to be "oriented 
4," and sensorium is considered normal.
1000
In which of the following patient categories would the intensity of the point of maximal impulse (PMI) be most difficult to palpate?
In patients with chronic pulmonary hyperinflation (emphysema), the PMI may be difficult to locate. Because of the increase in anteroposterior diameter and the changes in lung tissue, systolic vibrations are not well transmitted to the chest wall.
1000
Right ventricular hypertrophy often produces a systolic thrust that can be felt and seen near which of the following?
Lower left border of the sternum
1000
In PA chest film, the heart shadow should be less than what proportion of the chest width?
50%
1000
What imaging technique would be most useful to determine which patients with emphysema may benefit from lung volume reduction surgery?
HRCT is far more sensitive and may show evidence of emphysema even when pulmonary function test results are normal. For example, Figure 21-24 demonstrates a case of upper lobe paraseptal emphysema, characterized by cysts on the pleural surface. Chest CT may prove useful to define which patients may benefit from treatments such as lung volume reduction surgery.
1000
Which of the following is an example of a leading question?
Asking the patient, "Is your breathing better now?" leads the patient toward a desired response and may elicit false information.
1000
Which of the following is the least likely cause of lymphadenopathy in the neck?
Congestive heart failure. Lymphadenopathy occurs with a variety of medical disorders including infection, malignancy, and sarcoidosis. Tender lymph nodes in the neck are suggestive of a nearby infection. The lymph nodes are not tender when malignancy is the cause.