Bates’ Guide to Physical Examination and History Taking, 11th Edition
Chapter 8: The Thorax and Lungs
Multiple Choice
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 medications. 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.
Which disorder of the thorax or lung does this best describe?
A) Spontaneous pneumothorax
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pneumonia
Ans: C
Chapter: 08
Page and Header: 296, Techniques of Examination
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often associated with a
history of allergies and can be made worse by exercise or irritants such as smoke in a bar. On
auscultation there can be normal to decreased air movement. Wheezing is heard on expiration
and sometimes inspiration. The duration of wheezing in expiration usually correlates with
severity of illness, so it is important to document this length (e.g., wheezes heard halfway
through exhalation). Realize that in severe asthma, wheezes may not be heard because of the
lack of air movement. Paradoxically, these patients may have more wheezes after treatment,
which actually indicates an improvement in condition. Peak flow measurements help to discern
this.
, 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.
What disorder of the thorax or lung best describes her symptoms?
A) Spontaneous pneumothorax
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pneumonia
Ans: D
Chapter: 08
Page and Header: 318, Table 8–5
Feedback: Pneumonia is usually associated with dyspnea, cough, and fever. On auscultation
there can be coarse or fine crackles heard over the affected lobe. Percussion over the affected
area is dull and there is often an increase in fremitus. Egophony and pectoriloquy are heard
because of increased transmission of high-pitched components of sounds. These higher
frequencies are usually filtered out by the multiple air-filled chambers of the alveoli.
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 traumas or
illnesses. His past medical history is unremarkable. He doesn't smoke but drinks several beers on
the weekend. He has tried marijuana several times but denies any other illegal drugs. He is an
honors student and is on the basketball team. His parents are both in good health. He denies any
recent weight gain, weight loss, fever, or night sweats. On examination you see a tall, thin young
man in obvious distress. He is diaphoretic and is breathing at a rate of 35 breaths per minute. On
auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion
he is hyperresonant over the right upper lobe. With palpation he has absent fremitus over the
right upper lobe.
What disorder of the thorax or lung best describes his symptoms?
Chapter 8: The Thorax and Lungs
Multiple Choice
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 medications. 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.
Which disorder of the thorax or lung does this best describe?
A) Spontaneous pneumothorax
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pneumonia
Ans: C
Chapter: 08
Page and Header: 296, Techniques of Examination
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often associated with a
history of allergies and can be made worse by exercise or irritants such as smoke in a bar. On
auscultation there can be normal to decreased air movement. Wheezing is heard on expiration
and sometimes inspiration. The duration of wheezing in expiration usually correlates with
severity of illness, so it is important to document this length (e.g., wheezes heard halfway
through exhalation). Realize that in severe asthma, wheezes may not be heard because of the
lack of air movement. Paradoxically, these patients may have more wheezes after treatment,
which actually indicates an improvement in condition. Peak flow measurements help to discern
this.
, 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.
What disorder of the thorax or lung best describes her symptoms?
A) Spontaneous pneumothorax
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pneumonia
Ans: D
Chapter: 08
Page and Header: 318, Table 8–5
Feedback: Pneumonia is usually associated with dyspnea, cough, and fever. On auscultation
there can be coarse or fine crackles heard over the affected lobe. Percussion over the affected
area is dull and there is often an increase in fremitus. Egophony and pectoriloquy are heard
because of increased transmission of high-pitched components of sounds. These higher
frequencies are usually filtered out by the multiple air-filled chambers of the alveoli.
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 traumas or
illnesses. His past medical history is unremarkable. He doesn't smoke but drinks several beers on
the weekend. He has tried marijuana several times but denies any other illegal drugs. He is an
honors student and is on the basketball team. His parents are both in good health. He denies any
recent weight gain, weight loss, fever, or night sweats. On examination you see a tall, thin young
man in obvious distress. He is diaphoretic and is breathing at a rate of 35 breaths per minute. On
auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion
he is hyperresonant over the right upper lobe. With palpation he has absent fremitus over the
right upper lobe.
What disorder of the thorax or lung best describes his symptoms?
