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Chapter 2: Thorax

A 23-year-old male arrives at the outpatient clinic with complaints of fever, chills, and a "chest cold" of 3 days duration. Crackling is detected during inspiration with the stethoscope over the right triangle of auscultation. At this position on the posterior chest wall, air movement is being heard in which part of the respiratory system?

A. Right inferior lung lobe

B. Right main bronchus

C. Right middle lung lobe

D. Right superior lung lobe

E. Trachea

Answer A. The triangle of auscultation overlies the inferior lobe of both lungs. Most of the thoracic wall is covered by muscle and bone associated with the pectoral girdle. The triangle of auscultation is an area of the posterior thoracic wall that is subcutaneous, providing for better auscultation. The triangle is bounded by the latissimus dorsi, trapezius, and medial border of the scapula. The 6th intercostal space lies in the floor.

A 68-year-old male presents with the primary complaint of shortness of breath during mild exertion. Auscultation of the thoracic wall detects a murmur adjacent to the sternum in the left 2nd intercostal space. This is suggestive of:

A. Aortic valve disease

B. Coronary artery disease

C. Left ventricular failure

D. Pulmonary valve disease

E. Stenosis of the right atrioventricular (tricuspid) valve

Answer D. The best position to hear the sounds produced by the pulmonary valve is parasternal in the left 2nd intercostal space. Only the aortic valve sound can be auscultated on the right side of the thorax.

A 35-year-old male driver was involved in a car accident with air-bag deployment. Radiography reveals costochondral joint separation for both the fourth and fifth ribs on the left. While still in the emergency department, he develops dyspnea (difficulty breathing), hypotension, cyanosis, and neck vein distension. These classic signs of cardiac tamponade result from accumulation of fluid in the:

A. Costomediastinal recess

B. Potential space between fibrous and parietal serous pericardium

C. Potential space between parietal and visceral serous pericardium

D. Potential space between visceral serous pericardium and myocardium

E. Superior mediastinum

Answer C. The pericardial cavity is a potential space between the parietal and ...

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