Upon assessment of respiratory excursion, the clinician notes ...

[viki]

Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to:
 
  A. Pneumothorax
  B. Pleural effusion
  C. Pneumonia
  D. Pulmonary embolism

Question 2

Alpha-1 antitrypsin deficiency should be considered in patients diagnosed with:
 
  A. Exercise-induced cough
  B. Bronciectasis
  C. COPD
  D. Pericarditis

[IAPPLET]

Answer to Question 1

ANS: A
The respiratory excursion, or expansion, is determined by placing hands around the patient's posterior rib cage with the thumbs approximately at the level of the 10th rib between the thumbs, and then asking the patient to take a deep breath and observing the movement of the hands. The motion should be symmetrical. Less than anticipated movement occurs with advanced COPD and many restrictive processes, such as interstitial lung disease. Asymmetry of movement occurs with atelectasis, lobar collapse, pneumothorax, and several other conditions.

Answer to Question 2

ANS: C
When younger patients or nonsmokers develop findings consistent with COPD, alpha-1 antitrypsin deficiency should be suspected. Currently, the American Thoracic Society (2003) recommends that all individuals with COPD or asthma with chronic obstructive changes be tested for alpha-1 antitrypsin deficiency. If alpha-1 antitrypsin deficit is suspected, a qualitative serum should be performed as a screen, followed by quantitative study, as indicated.

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TYSM

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Excellent