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

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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