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...
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
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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
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