Question 1
A 72-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with complaints of increasing shortness of breath over the past two days. Physical examination reveals an expiratory wheeze. What lung sound is most likely being heard?
A) Stridor
B) Crackles
C) Pleural friction rub
D) Wheezes
E) Rhonchi
Rationale: Wheezes are high-pitched, musical sounds heard primarily during expiration and are associated with airway obstruction, as seen in conditions like COPD. Stridor is a high-pitched sound noted on inspiration, indicative of upper airway obstruction. Crackles are discontinuous sounds usually heard on inspiration and are associated with fluid in the airways. Pleural friction rub is a grating sound caused by the movement of inflamed pleural surfaces. Rhonchi are low-pitched sounds that resemble snoring, indicating secretions in large airways.
Question 2
A 55-year-old woman with a history of heart failure is admitted to the hospital. Upon auscultation, fine crackles are heard at the bases of both lungs. This lung sound is indicative of which of the following?
A) Normal lung sounds
B) Airway inflammation
C) Pulmonary edema
D) Airway obstruction
E) Pneumothorax
Rationale: Fine crackles are short, high-pitched sounds heard during inspiration. They are indicative of fluid in the alveoli and are commonly associated with pulmonary edema, especially in patients with heart failure. Normal lung sounds do not include crackles. Airway inflammation and obstruction are typically associated with wheezes or rhonchi. A pneumothorax is associated with absent breath sounds over the affected area.
Question 3
During a routine physical examination, a healthy 29-year-old man is noted to have loud, high-pitched sounds heard over the trachea. This lung sound is best described as which of the following?
A) Bronchial breath sounds
B) Vesicular breath sounds
C) Tracheal breath sounds
D) Stridor
E) Wheezes
Rationale: Tracheal breath sounds are normal breath sounds heard over the trachea. They are loud and high-pitched due to the air moving through a relatively narrow conduit. Bronchial breath sounds are heard over the large airways and have a similar quality but are not the primary sounds over the trachea. Vesicular breath sounds are soft and low-pitched, heard over the majority of the lung fields. Stridor and wheezes are indicative of airway obstruction and are not considered normal lung sounds.
Question 4
A 3-year-old child presents to the pediatric clinic with a barking cough and stridor at rest. The child appears anxious and has a temperature of 38.2°C (100.8°F). Which of the following conditions is most likely associated with these findings?
A) Asthma
B) Croup
C) Bronchitis
D) Pneumonia
E) Foreign body aspiration
Rationale: Croup is characterized by a barking cough, stridor, and hoarseness, often caused by viral infection. Stridor at rest indicates significant airway obstruction, a hallmark of severe croup. Asthma typically presents with wheezing and difficulty breathing but not a barking cough. Bronchitis involves inflammation of the airways and produces a different cough sound without stridor. Pneumonia presents with fever and productive cough, but not typically with stridor. Foreign body aspiration can cause sudden coughing and respiratory distress, but the distinctive barking cough and the presence of fever suggest an infectious cause like croup.
Question 5
A patient with pneumonia has coarse crackles noted on auscultation. Which part of the respiratory cycle are these sounds most likely to be heard?
A) Exclusively during inspiration
B) Exclusively during expiration
C) During both inspiration and expiration
D) At the end of expiration
E) At the beginning of inspiration
Rationale: Coarse crackles are low-pitched, bubbling sounds heard during both inspiration and expiration. They are caused by the opening of small airways and alveoli that have been filled with fluid, pus, or mucus, as is often seen in pneumonia. Unlike wheezes or stridor, which have specific phases of the respiratory cycle where they are most prominent, coarse crackles can be heard throughout the respiratory cycle. Fine crackles are more commonly heard at the end of inspiration, not coarse crackles.
Question 6
A 67-year-old male with a history of smoking presents with a chronic cough and significant weight loss. On examination, you note a high-pitched wheeze localized to one side of the chest. This finding is most suggestive of which of the following?
A) Asthma
B) Lung cancer
C) Pulmonary edema
D) COPD
E) Pneumothorax
Rationale: A unilateral, localized high-pitched wheeze can indicate an obstruction in a major airway, often caused by a mass such as lung cancer, especially in a patient with a history of smoking and significant weight loss. Asthma typically presents with bilateral wheezes and is reversible with bronchodilators. Pulmonary edema is characterized by crackles, not wheezes. COPD presents with diffuse wheezing due to widespread airway obstruction. Pneumothorax is typically associated with absent breath sounds on the affected side, not wheezing.
Question 7
An 80-year-old woman with a history of hypertension and diabetes presents to the clinic with complaints of difficulty breathing and a dry cough. On auscultation, you hear a low-pitched, rubbing sound over the lower lateral aspects of both lung fields. This lung sound is most consistent with which of the following?
A) Pleural friction rub
B) Vesicular breath sounds
C) Bronchial breath sounds
D) Rhonchi
E) Stridor
Rationale: A pleural friction rub is a low-pitched, rubbing or grating sound caused by the movement of inflamed pleural surfaces against one another. It is most commonly heard in conditions that cause pleural inflammation, such as pleurisy, pulmonary embolism, or pleural effusion. Vesicular breath sounds are normal sounds heard over most lung fields. Bronchial breath sounds are heard over areas where lung tissue is solidified or compressed, not typically described as rubbing. Rhonchi are low-pitched, snore-like sounds caused by airway obstruction. Stridor is a high-pitched, wheezing sound associated with upper airway obstruction.
Question 8
A patient is admitted to the hospital with a diagnosis of congestive heart failure. During the assessment, you note bilateral fine crackles starting at the lung bases and extending halfway up the posterior lung fields. This finding is indicative of which of the following?
A) Normal aging lung
B) Acute asthma exacerbation
C) Early pulmonary edema
D) Advanced COPD
E) Pneumonia
Rationale: Bilateral fine crackles that start at the lung bases and extend upward are characteristic of early pulmonary edema, where fluid begins to accumulate at the lowest parts of the lungs due to congestive heart failure. This pattern of fluid accumulation and the associated lung sounds are not indicative of normal aging, which might show decreased lung sounds due to changes in lung structure but not crackles. Acute asthma exacerbation is more likely to present with wheezing. Advanced COPD presents with decreased breath sounds, wheezing, and sometimes rhonchi but not typically crackles. Pneumonia might cause localized crackles in the affected lung segment, not the pattern described.
Question 9
A 25-year-old man presents to the emergency room after a motorcycle accident. He is alert but anxious, and complains of sharp chest pain that worsens with deep breaths. On examination, you notice diminished breath sounds on the left side of the chest. This finding is most consistent with which of the following?
A) Hemothorax
B) Bronchitis
C) Asthma attack
D) Pulmonary embolism
E) Pleural effusion
Rationale: Diminished or absent breath sounds on one side of the chest, especially when associated with trauma and sharp, pleuritic chest pain, are highly suggestive of a hemothorax, where blood accumulates in the pleural space compressing the lung. Bronchitis typically presents with cough and possibly wheezes or rhonchi but not unilateral diminished breath sounds. Asthma attacks are characterized by bilateral wheezing and difficulty breathing. Pulmonary embolism may cause shortness of breath and pleuritic chest pain but not typically unilateral diminished breath sounds without other findings. Pleural effusion can cause diminished breath sounds but is less likely to present acutely after trauma unless it is a result of the trauma.
Question 10
An 82-year-old man with a history of chronic heart failure is admitted to the hospital with worsening dyspnea. Upon auscultation, you hear high-pitched, discontinuous sounds at the end of inspiration. These sounds are best described as:
A) Rhonchi
B) Wheezes
C) Fine crackles
D) Coarse crackles
E) Pleural friction rub
Rationale: Fine crackles are high-pitched, discontinuous sounds heard primarily at the end of inspiration and are indicative of fluid in the alveoli or interstitial tissues. In patients with chronic heart failure, fine crackles may suggest acute exacerbation with pulmonary edema. Rhonchi are low-pitched sounds caused by obstructions in the larger airways and are more continuous. Wheezes are musical and high-pitched, usually heard during expiration and associated with airway narrowing. Coarse crackles are louder, lower-pitched, and also suggest fluid but in larger airways. Pleural friction rub is a grating sound caused by pleural surfaces rubbing together, not typically associated with heart failure.