Exam 2 Study Guide
Lungs and Thorax
1. A 21-year-old college senior presents to your clinic, complaining of shortness of breath
and a nonproductive nocturnal cough. She states she used to feel this way only with
extreme exercise, but lately she has felt this way continuously. She denies any other
upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract
symptoms. Her past medical history is significant only for seasonal allergies, for which
she takes a nasal steroid spray but is otherwise on no other medication. She has had no
surgeries. Her mother has allergies and eczema, and her father has high blood pressure.
She is an only child. She denies smoking and illegal drug use but drinks three to four
alcoholic beverages per weekend. She is a junior in finance at a local university and she
has recently started a job as a bartender in town. On examination she is in no acute
distress and her temperature is 98.6. Her blood pressure is 120/80, her pulse is 80, and her
respirations are 20. Her head, eyes, ears, nose, and throat examinations are essentially
normal. Inspection of her anterior and posterior chest shows no abnormalities. On
auscultation of her chest, there is decreased air movement and a high-pitched whistling
on expiration in all lobes. Percussion reveals resonant lungs.
a. Which disorder of the thorax or lung does this best describe?
Asthma
2. 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.
a. What disorder of the thorax or lung best describes her symptoms?
Pneumonia
3. A 17-year-old high school senior presents to your clinic in acute
respiratory distress. Between shallow breaths he states he was at
home finishing his homework when he suddenly began having right-
sided chest pain and severe shortness of breath. He denies any recent
