Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

NR 509 APEA 3P EXAM WEEK 4 2024 LATEST QUESTIONS AND GUARANTEED CORRECT ANSWERS WITH RATIO, Exams of Nutrition

NR 509 APEA 3P EXAM WEEK 4 2024 LATEST QUESTIONS AND GUARANTEED CORRECT ANSWERS WITH RATIONALES ALREADY GRADED A+..pdf

Typology: Exams

2024/2025

Available from 07/04/2025

to-highscore
to-highscore 🇺🇸

352 documents

1 / 74

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe
pff
pf12
pf13
pf14
pf15
pf16
pf17
pf18
pf19
pf1a
pf1b
pf1c
pf1d
pf1e
pf1f
pf20
pf21
pf22
pf23
pf24
pf25
pf26
pf27
pf28
pf29
pf2a
pf2b
pf2c
pf2d
pf2e
pf2f
pf30
pf31
pf32
pf33
pf34
pf35
pf36
pf37
pf38
pf39
pf3a
pf3b
pf3c
pf3d
pf3e
pf3f
pf40
pf41
pf42
pf43
pf44
pf45
pf46
pf47
pf48
pf49
pf4a

Partial preview of the text

Download NR 509 APEA 3P EXAM WEEK 4 2024 LATEST QUESTIONS AND GUARANTEED CORRECT ANSWERS WITH RATIO and more Exams Nutrition in PDF only on Docsity!

A. 73 - year-old .retired .salesman .presents .to .the .Emergency .Department .complaining .of chest .pain .that .started .about. 2 .hours .ago. .Electrocardiogram, .cardiac .enzymes, .and chest .x-ray .are .normal. .The .nurse .notes .that .his .blood .pressures .in .the .right .arm .are significantly .lower .than .of .blood .pressures .in .his .left .arm. .Based .on .history .and .physical examination, .which .of .the .following .will .most .likely .explain .his .signs .and .symptoms? .- ANSWER- .a. .Dissecting .aortic .aneurysm Rationale: .Patients .with .dissecting .aortic .aneurysms .typically .present .with .chest .pain, many .times .described .as .a ."tearing" .type .pain. .They .are .usually .elderly, .and, .due .to .the dissection .of .the .aorta, .asymmetric .pulses .in .blood .pressures .in .the .extremities .may .be present. .Coarctation .of .the .aorta .can .also .cause .similar .symptoms; .however, .it .would .be unlikely .due .to .the .patient's .age .as .this .is .a .congenital .defect. .MI, .PE, .and .pericarditis are .also .common .causes .of .concerning .chest .pain; .however, .neither .typically .will .cause asymmetric .blood .pressures .or .pulses .in .the .extremities. A. 19 - year-old .carwash .attendant .sustained .a .laceration .to .the .ulnar .aspect .of .his .mid- forearm .while .at .work .last .week. .He .did .not .have .it .evaluated .at .that .time .and .is .now noticing .purulent .discharge .and .increasing .pain .from .the .wound .along .with .fever .and chills. .Where .would .the .clinician .expect .to .find .the .first .signs .of .lymphadenopathy? .- ANSWER- .a. .Epitrochlear .nodes

NR 509 APEA 3P EXAM WEEK 4 2025 LATEST

QUESTIONS AND GUARANTEED CORRECT

ANSWERS WITH RATIONALES ALREADY

GRADED A+.

Rationale: .The .epitrochlear .nodes .are .the .first .nodes .in .the .drainage .region .from .the ulnar .surface .of .the .forearm .and .hand, .little .and .ring .fingers, .and .adjacent .surface .of .the middle .finger. .Axillary .nodes, .infraclavicular .nodes, .and .cervical .chain .nodes .are .all distal .to .this .area .and .may .show .evidence .of .lymphadenopathy .as .well; .however, .that would .be .secondary .after .the .epitrochlear .nodes. When .assessing .for .the .femoral .pulse, .where .should .the .clinician .begin .deeply palpating? .- .ANSWER- .C. .Below .the .inguinal .ligament, .midway .between .the .anterior superior .iliac .spine .and .symphysis .pubis Rationale: .The .clinician .would .begin .deeply .palpating .below .the .inguinal .ligament, midway .between .the .anterior .superior .iliac .spine .in .the .symphysis .pubis. .The .external iliac .artery .transitions .into .the .femoral .artery .at .the .level .of .the .inguinal .ligament. Therefore, .palpating .above .the .inguinal .ligament .would .be .assessing .the .external .iliac artery. .The .femoral .artery .is .typically .located .midway .between .the .anterior .superior .iliac spine .in .the .symphysis .pubis .in .most .patients. The .clinician .is .palpating .pulses .in .the .foot .of .a .diabetic .patient .while .in .the .clinic. .A strong .pulse .is .felt .located .on .the .dorsum .of .the .foot, .just .lateral .to .the .extensor .tendon of .the .big .toe. .Which .artery .is .being .assessed? .- .ANSWER- .C. .Dorsalis .pedis Rationale: .The .dorsalis .pedis .artery .is .usually .palpable .on .the .dorsum .of .the .foot .just lateral .to .the .extensor .tendon .of .the .big .toe. .The .arterial .arch .of .the .foot .is .more .distal and .runs .transversely .and .is .not .usually .palpable. .The .posterior .tibial .artery .is .found

A. 61 - year-old .retired .librarian .was .recently .diagnosed .with .ovarian .cancer. .She .was otherwise .healthy .until .her .recent .cancer .diagnosis. .She .has .not .been .feeling .well .lately and .has .had .a .cough .and .some .mild .shortness .of .breath .for .the .past .couple .of .days. She .now .presents .to .the .clinic .complaining .of .pain .and .swelling .in .her .right .groin .and leg, .which .she .says .is .been .there .for .about .a .week .but .is .worsening. .On .physical examination, .2+ .edema .of .the .right .leg .up .to .the .thigh; .1+ .femoral, .popliteal, .dorsalis pedis, .and .posterior .tibial .pulses; .and .no .significant .erythema .are .noted. .What .is .the chief .concern .with .this .patient? .- .ANSWER- .d. .Pulmonary .embolism .(PE) Rationale: .Cancer .patients .are .at .high .risk .of .deep .venous .thrombosis .(DVT), .and, .with the .presenting .symptoms .of .swelling .and .pain .in .her .groin, .along .with .recent .history .of cough .and .shortness .of .breath, .this .patient's .presentation .is .suspicious .for .PE. .Patients with .DVT .in .the .proximal .leg .veins .are .at .high .risk .of .thromboembolism. .Acute .arterial occlusion .should .not .cause .significant .edema, .and .pulses .would .likely .be .absent. .The constellation .of .symptoms .and .history .in .this .patient .also .does .not .suggest .an .acute arterial .occlusion. .Superficial .thrombophlebitis .typically .only .causes .mild .local .swelling, redness, .and .warmth .along .with .a .subcutaneous .cord. .Acute .lymphangitis .typically presents .with .red .streaks .from .an .infection .passing .through .lymph .channels. A. 32 - year-old .cabdriver .complains .of .pain .in .his .left .leg. .He .has .a .history .of .type. 2 diabetes, .is .a .smoker, .and .recently .was .diagnosed .with .hypertension. .He .does .not remember .injuring .his .leg; .however, .he .notes .that .there .is .a .small .wound .on .the .lateral

Rationale: .The .epitrochlear .nodes .are .the .first .nodes .in .the .drainage .region .from .the ulnar .surface .of .the .forearm .and .hand, .little .and .ring .fingers, .and .adjacent .surface .of .the middle .finger. .Axillary .nodes, .infraclavicular .nodes, .and .cervical .chain .nodes .are .all distal .to .this .area .and .may .show .evidence .of .lymphadenopathy .as .well; .however, .that would .be .secondary .after .the .epitrochlear .nodes. When .assessing .for .the .femoral .pulse, .where .should .the .clinician .begin .deeply palpating? .- .ANSWER- .C. .Below .the .inguinal .ligament, .midway .between .the .anterior superior .iliac .spine .and .symphysis .pubis Rationale: .The .clinician .would .begin .deeply .palpating .below .the .inguinal .ligament, midway .between .the .anterior .superior .iliac .spine .in .the .symphysis .pubis. .The .external iliac .artery .transitions .into .the .femoral .artery .at .the .level .of .the .inguinal .ligament. Therefore, .palpating .above .the .inguinal .ligament .would .be .assessing .the .external .iliac artery. .The .femoral .artery .is .typically .located .midway .between .the .anterior .superior .iliac spine .in .the .symphysis .pubis .in .most .patients. The .clinician .is .palpating .pulses .in .the .foot .of .a .diabetic .patient .while .in .the .clinic. .A strong .pulse .is .felt .located .on .the .dorsum .of .the .foot, .just .lateral .to .the .extensor .tendon of .the .big .toe. .Which .artery .is .being .assessed? .- .ANSWER- .C. .Dorsalis .pedis Rationale: .The .dorsalis .pedis .artery .is .usually .palpable .on .the .dorsum .of .the .foot .just lateral .to .the .extensor .tendon .of .the .big .toe. .The .arterial .arch .of .the .foot .is .more .distal and .runs .transversely .and .is .not .usually .palpable. .The .posterior .tibial .artery .is .found

A. 61 - year-old .retired .librarian .was .recently .diagnosed .with .ovarian .cancer. .She .was otherwise .healthy .until .her .recent .cancer .diagnosis. .She .has .not .been .feeling .well .lately and .has .had .a .cough .and .some .mild .shortness .of .breath .for .the .past .couple .of .days. She .now .presents .to .the .clinic .complaining .of .pain .and .swelling .in .her .right .groin .and leg, .which .she .says .is .been .there .for .about .a .week .but .is .worsening. .On .physical examination, .2+ .edema .of .the .right .leg .up .to .the .thigh; .1+ .femoral, .popliteal, .dorsalis pedis, .and .posterior .tibial .pulses; .and .no .significant .erythema .are .noted. .What .is .the chief .concern .with .this .patient? .- .ANSWER- .d. .Pulmonary .embolism .(PE) Rationale: .Cancer .patients .are .at .high .risk .of .deep .venous .thrombosis .(DVT), .and, .with the .presenting .symptoms .of .swelling .and .pain .in .her .groin, .along .with .recent .history .of cough .and .shortness .of .breath, .this .patient's .presentation .is .suspicious .for .PE. .Patients with .DVT .in .the .proximal .leg .veins .are .at .high .risk .of .thromboembolism. .Acute .arterial occlusion .should .not .cause .significant .edema, .and .pulses .would .likely .be .absent. .The constellation .of .symptoms .and .history .in .this .patient .also .does .not .suggest .an .acute arterial .occlusion. .Superficial .thrombophlebitis .typically .only .causes .mild .local .swelling, redness, .and .warmth .along .with .a .subcutaneous .cord. .Acute .lymphangitis .typically presents .with .red .streaks .from .an .infection .passing .through .lymph .channels. A. 32 - year-old .cabdriver .complains .of .pain .in .his .left .leg. .He .has .a .history .of .type. 2 diabetes, .is .a .smoker, .and .recently .was .diagnosed .with .hypertension. .He .does .not remember .injuring .his .leg; .however, .he .notes .that .there .is .a .small .wound .on .the .lateral

aspect .of .his .mid-shin. .Upon .examination, .some .mild .erythema .surrounding .the .wound and .flat, .nonpalpable .red .streaks .progressing .up .his .leg .are .noted. .What .do .these streaks .likely .represent? .- .ANSWER- .d. .Draining .lymphatic .channels Rationale: .Acute .lymphangitis .is .typically .caused .from .an .acute .bacterial .infection .of .the skin .that .causes .red .streaks .from .distal .drainage .through .the .lymphatic .system. .The streaks .are .typically .flat, .not .palpable .cords .as .found .in .thrombus .formation .in .a superficial .vein. .Dilated .veins .also .are .not .flat. .Occluded .arterial .vessels .are .not superficial .or .visible. .Dilated .arterioles .are .still .too .small .to .be .visible .at .the .skin .surface. A .clinician, .evaluating .a .patient .for .valvular .competency .in .the .communicating .veins .of the .saphenous .system, .starts .with .the .patient .supine, .then .elevates .one .leg .to .about .90° to .empty .it .of .venous .blood. .Next, .the .great .saphenous .vein .in .the .upper .part .of .the thigh .is .occluded .with .manual .compression, .and .the .patient .stands. .The .clinician .keeps the .vein .occluded .while .watching .for .venous .filling .in .the .leg. .Which .test .is .being performed? .- .ANSWER- .e. .Trendelenburg Rationale: .The .Trendelenburg, .or .retrograde .filling .test, .is .used .to .evaluate .the competency .of .venous .valves .in .the .lower .extremities. .The .Allen .test .is .used .to .evaluate adequate .perfusion .of .the .hand .from .the .ulnar .and .radial .arteries. .The .straight-leg .raise test .is .used .to .evaluate .for .radiculopathy .from .the .lumbosacral .regions. .Romberg .is .a test .for .position .sense. A. 44 - year-old .retail .salesperson .has .noticed .an .increasing .dilatation .of .the .veins .in .her legs. .Upon .inspection, .it .is .noted .that .she .has .significant .varicosities .on .the .posterior

Rationale: .The .pulmonic .and .aortic .valves .are .semilunar .valves .and .have .similar embryologic .origin. .The .tricuspid .and .mitral .valves .are .atrioventricular .valves. .The pyloric .valve .is .located .between .the .stomach .and .small .intestine. .The .Eustachian .valve lies .at .the .junction .of .the .inferior .vena .cava .and .right .atrium. A. 77 - year-old .man .is .experiencing .progressive .shortness .of .breath .and .dizziness. .The patient .undergoes .cardiac .catheterization, .and .the .systolic .blood .pressure .measured .in the .left .ventricle .is. 180 .mm .Hg, .while .the .systolic .blood .pressure .measured .in .the .aorta is. 140 .mm .Hg. .The .patient .is .most .likely .experiencing .symptoms .related .to .what valvular .condition? .- .ANSWER- .c. .Aortic .stenosis Rationale: .Patients .with .aortic .stenosis .often .experience .dyspnea .with .exertion, .chest pain, .or .dizziness. .The .calcification .of .the .aortic .valve .and .narrowing .of .the .valve .area effectively .decreases .the .blood .flow .from .the .left .ventricle .to .the .aorta. .Given .the obstruction .created .from .the .narrowing .of .the .aortic .valve, .the .pressure .within .the .left ventricle .is .often .higher .than .that .seen .in .the .aorta. .Aortic .insufficiency .is .associated with .blood .flow .from .the .aorta .to .the .left .ventricle .during .diastole .and .is .often .not associated .with .differences .in .systolic .blood .pressure. .Mitral .stenosis .involves narrowing .of .the .valve .between .the .left .atrium .and .left .ventricle .while .mitral .regurgitation involves .the .flow .of .blood .from .the .left .ventricle .to .the .left .atrium .during .systole .when .the mitral .valve .is .normally .closed. .Pulmonic .stenosis .involves .valvular .obstruction .between the .right .ventricle .and .pulmonary .artery.

On .routine .physical .examination, .a. 40 - year-old .teacher .is .found .to .have .a .single .second heart .sound. .The .most .likely .explanation .for .this .finding .is .what? .- .ANSWER- .c. Auscultation .occurred .during .expiration. Rationale: .During .expiration, .the .components .of .S2, .A2, .and .P2 .fuse .into .a .single sound. .During .inspiration, .the .right .heart .filling .time .is .increased .thereby .delaying closure .of .the .pulmonic .valve .and .splitting .S2 .into .two .audible .components. .Pulmonic stenosis .and .a .right .bundle .branch .block .delay .the .P2 .component .and .cause .fixed splitting .of .S2. .A .left .bundle .branch .block .delays .the .A2 .component .and .causes paradoxical .splitting. A .first-year .medical .student .is .examining .a .standardized .patient .with .a .structurally normal .heart. .The .student .is .having .difficulty .auscultating .the .splitting .of .the .second heart .sound. .At .what .area .on .the .patient's .chest .would .the .student .have .the .best opportunity .of .hearing .this .sound? .- .ANSWER- .c. .Left .second .and .third .interspace Rationale: .The .pulmonic .area .is .the .left .second .and .third .interspace .close .to .the sternum. .The .mitral .area .is .at .the .apex. .The .right .second .interspace .overlies .the .aortic valve. .The .tricuspid .space .is .the .lower .left .sternal .border. .The .midsternum .does .not correspond .to .the .anatomic .location .of .any .of .the .four .cardiac .valves; .however, .it .is important .to .remember .that .murmurs .radiate .and .must .be .interpreted .in .the .setting .of the .clinical .scenario. A. 20 - year-old .college .student .is .experiencing .dyspnea .on .exertion .and .palpitations. .On cardiac .auscultation, .the .second .heart .sound .is .split .and .fixed .on .both .inspiration .and

not .high .enough .to .cause .this .degree .of .symptomatology. .A .ventricular .septal .defect .is a .holosystolic .murmur .heard .within .the .left .third .to .fifth .interspaces, .but .is .often associated .with .a .thrill. A. 55 - year-old .actress .sustains .a .heart .attack .and .the .follow-up .electrocardiogram demonstrates .a .left .bundle .branch .block. .What .would .be .the .likely .duration .of .the .QRS complex? .- .ANSWER- .e.. 125 .milliseconds Rationale: .The .QRS .complex .is .the .duration .of .ventricular .depolarization .and .is normally .less .than. 100 .milliseconds. .Therefore, .a .left .bundle .branch .block .would .extend ventricular .depolarization .and .cause .lengthening .of .the .QRS .complex .and .its .duration. A. 55 - year-old .truck .driver .with .obstructive .sleep .apnea .has .diastolic .heart .failure. .An echocardiogram .demonstrates .significant .biatrial .enlargement. .What .portion .of .his electrocardiogram .would .likely .be .abnormal? .- .ANSWER- .d. .P .wave Rationale: .The .P .wave .is .the .result .of .atrial .depolarization .and .would .therefore .have changes .associated .with .atrial .enlargement. .The .QRS .complex, .R .wave, .and .S .wave are .a .result .of .ventricular .depolarization, .whereas .the .T .wave .is .a .result .of .ventricular repolarization. A. 45 - year-old .physician .is .placed .on .a .β-blocker .for .hypertension. .Prior .to .medication administration, .the .patient's .heart .rate .is. 75 .beats .per .minute .with .a .cardiac .output .of. 5 liters .per .minute. .Following .initiation .of .the .medication, .the .heart .rate .decreases .to. 60

beats .per .minute .without .a .change .in .stroke .volume. .What .would .be .the .expected .new cardiac .output? .- .ANSWER- .b.. 4 .liters .per .minute Rationale: .Cardiac .output .is .the .product .of .heart .rate .and .stroke .volume. .Therefore, .if the .heart .rate .decreases .by .20%, .the .cardiac .output .would .decrease .by .20% .if .the stroke .volume .did .not .change. A. 39 - year-old .architect .comes .to .the .clinic .for .a. 2 - day .history .of .fever, .chills, .cough productive .of .green .sputum, .and .dyspnea. .He .has .no .history .of .serious .illness. .His temperature .is .101.2ºF. .His .other .vital .signs .are .within .normal .limits. .Late .inspiratory crackles .are .heard .on .auscultation .over .the .left .lower .lung .posteriorly. .When .the clinician .listens .over .that .area .and .instructs .the .patient .to .say ."ee," .it .sounds .like ."A." Which .of .the .following .would .most .likely .be .found .on .percussion .of .his .lungs? .- ANSWER- .e. .Dullness Rationale: .This .patient .has .symptoms .and .signs .of .pneumonia. .With .pneumonia, .a .type of .consolidation, .dullness .can .be .noted .on .percussion .over .the .area .of .the .pneumonia. Flatness .is .incorrect. .Flatness .is .not .noted .on .percussion .over .an .area .of .pneumonia. Flatness .is .noted .on .percussion .over .muscles. .Hyperresonance .is .incorrect. Hyperresonance .is .not .noted .on .percussion .over .an .area .of .pneumonia. .Stridor .is incorrect. .Stridor .is .a .type .of .adventitial .(added) .lung .sound, .rather .than .a .sound .noted on .percussion. .Stridor .is .also .not .an .adventitial .lung .sound .heard .in .a .patient .with pneumonia. .Tympany .is .incorrect. .Tympany .is .not .noted .on .percussion .over .an .area .of pneumonia. .Tympany .is .noted .over .percussion .of .the .gastric .air .bubble.

which .lung .examination .is .performed. .With .that .order, .the .clues .gathered .from percussion .to .guide .in .auscultation .would .be .missed 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? .- ANSWER- .d. .Wheezes Rationale: .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. A .clinician .is .percussing .the .lungs .of .a .patient .with .chronic .obstructive .pulmonary disease .to .see .if .they .sound .hyperresonant. .Which .of .the .following .is .an .example .of good .technique .for .percussion? .- .ANSWER- .a. .Strike .using .the .tip .of .the .third .finger. Rationale: .Strike .using .the .tip .of .the .third .finger .is .a .part .of .good .technique .for percussing .the .lungs .and .some .other .structures .in .the .body. .The .proximal interphalangeal .joint .is .the .joint .that .is .struck .is .incorrect. .It .is .the .distal .interphalangeal

joint .that .is .struck .in .good .percussion .technique. .Press .the .third .and .fourth .fingers .next to .each .other .on .the .chest .is .incorrect. .Only .the .third .finger .is .pressed .against .the .chest in .good .percussion .technique. .Strike .using .the .finger .pad .of .the .fourth .finger .is .incorrect. It .is .the .tip .of .the .third .finger .that .is .used .in .good .percussion .technique. .The .wrist .is .kept still .during .percussion .is .incorrect. .A .direct .brisk .yet .relaxed .wrist .movement .is .used .in good .percussion .technique. A. 29 - year-old .waiter .comes .to .the .clinic .for .a. 2 - month .history .of .a .cough. .When .he lowers .his .gown .so .the .clinician .can .listen .to .his .lungs, .the .clinician .notices .a depression .of .the .lower .part .of .his .sternum. .Which .of .the .following .best .describes .the appearance .of .his .chest? .- .ANSWER- .c. .Pectus .excavatum Rationale: .Pectus .excavatum .is .a .congenital .abnormality .in .which .the .inferior .part .of .the sternum .is .displaced .inward. .Barrel .chest .is .incorrect. .In .a .barrel .chest .there .is .an increased .anteroposterior .diameter. .A .barrel .chest .often .accompanies .chronic obstructive .pulmonary .disease. .Flail .chest .is .incorrect. .The .injured .area .of .a .flail .chest moves .inward .with .inspiration .and .moves .outward .with .expiration. .Pigeon .chest .is incorrect. .Pigeon .chest, .also .known .as .pectus .carinatum, .is .a .congenital .abnormality .in which .the .sternum .is .displaced .anteriorly. .Thoracic .kyphoscoliosis .is .incorrect. .Thoracic kyphoscoliosis .is .characterized .by .abnormal .spinal .curvatures .and .vertebral .rotation, which .are .visible .posteriorly .(rather .than .anteriorly). 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

breathe .out .as .fast .and .completely .as .he .can. .For .what .is .the .clinician .checking? .- ANSWER- .d. .Forced .expiratory .time Rationale: .Forced .expiratory .time .is .assessed .by .asking .the .patient .to .take .a .deep breath .in .and .then .breathing .out .as .fast .and .fully .as .he .can .with .his .mouth .open. Bronchophony .is .incorrect. .Testing .for .bronchophony .is .done .by .listening .with .a stethoscope .while .the .patient .says ."ninety-nine." .Egophony .is .incorrect. .Testing .for egophony .is .done .by .listening .with .the .stethoscope .while .the .patient .says ."ee." .Tactile fremitus .is .incorrect. .Testing .for .tactile .fremitus .is .done .by .feeling .for .palpable .vibrations on .the .chest .wall .while .the .patient .says ."ninety-nine." .Whispered .pectoriloquy .is incorrect. .Testing .for .whispered .pectoriloquy .is .done .by .listening .with .the .stethoscope while .the .patient .whispers ."nine-nine." 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? .- .ANSWER- .a. .Atelectasis Rationale: .All .of .the .physical .examination .findings .are .characteristic .of .atelectasis. .They can .also .be .seen .with .a .pleural .effusion, .but .that .was .not .one .of .the .answer .options .for this .question. .Left-sided .heart .failure .is .incorrect. .It .characteristically .has .different findings .for .all .the .physical .examination .parameters .mentioned .and .particularly .late inspiratory .crackles .in .the .dependent .portions .of .the .lungs. .Pneumonia .is .incorrect. Dullness .to .percussion .can .be .seen .with .both .atelectasis .and .pneumonia, .but .with

pneumonia .typically .late .inspiratory .crackles .are .heard .over .the .involved .area .and bronchophony, .egophony, .and .whispered .pectoriloquy .can .also .be .heard .over .the involved .area. .Pneumothorax .is .incorrect. .Hyperresonance .is .characteristic .of .the percussion .note .with .a .pneumothorax, .rather .than .dullness, .which .is .characteristic .of the .percussion .note .with .atelectasis. .COPD .is .incorrect. .Hyperresonance .is characteristic .of .the .percussion .note .with .chronic .obstructive .pulmonary .disease, .rather than .dullness, .which .is .characteristic .of .the .percussion .note .with .atelectasis. .Notice .that the .words ."characteristic" .and ."typical" .are .used .in .the .explanation .rather .than ."always." A. 16 - year-old .boy .is .brought .to .the .Emergency .Department .(ED) .after .a .motor .vehicle accident .for .shortness .of .breath .for. 1 .hour. .A .chest .x-ray .shows .a .rib .fracture .and .a pneumothorax .on .the .right .side. .The .ED .physician .decides .that .a .chest .tube .needs .to be .placed .in .the .fourth .intercostal .space. .How .does .he .determine .where .the .fourth intercostal .space .is? .- .ANSWER- .c. .He .finds .the .sternal .angle .and .then .moves .his finger .laterally .to .the .second .rib. .He .then .walks .down .to .the .second .intercostal .space, third .rib, .third .intercostal .space, .fourth .rib .and .then .the .fourth .intercostal .space. Rationale: .He .finds .the .sternal .angle .and .then .moves .his .finger .laterally .to .the .second rib. .He .then .walks .down .to .the .two .intercostal .space, .third .rib, .third .intercostal .space, fourth .rib, .and .then .the .fourth .intercostal .space. .Conventionally, .the .sternal .angle .is used .as .the .starting .point .for .determining .where .the .second .rib .is .and .then .one .walks down .from .there .to .find .the .intercostal .spaces .and .other .ribs. .He .finds .the .suprasternal notch .and .then .moves .his .finger .laterally .to .the .third .rib. .The .fourth .intercostal .space .is just .below .the .third .rib .is .incorrect. .The .suprasternal .notch .is .not .the .starting .point .and