Answer to Question 1
ANS: C
The lung fields should be percussed posteriorly, starting from the superior-most areas and then proceeding inferiorly to the level of the diaphragm. Resonance is the normal sound on percussion. Hyperresonance suggests air trapping, which occurs with COPD or tension pneumothorax. Dullness to percussion is detected over the actual site of consolidated lung or pleural fluid. Dullness is also found with pneumonia, severe atelectasis, or pleural effusion.
Answer to Question 2
ANS: A
Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. Conversely, areas of decreased fremitus raise the suspicion of abnormal fluid- or air-filled spaces, such as occurs with pleural effusion, pneumothorax, or emphysema. In the instance of an extensive bronchial obstruction, no palpable vibration is felt in the related field.
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Example of simplified note for a nonmedical setting.
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