1.

A 4-year-old female is brought in by her parents

due to an increased nightly cough and low
grade temperature. The x-ray shows a Steeple
Sign. Which of the following is your diagnoses?
1. Croup
2. Epiglottitis
3. FB aspiration
4. Peritonsillar Abcsess
1. Croup, also known as laryngotracheobronchitis
- is associated with upper tracheal narrowing and edema, which is visible on an
anteroposterior soft tissue neck x-ray. This is termed the "steeple sign."
Epiglottitis is associated with a thickened epiglottis on a lateral soft-tissue neck x-
ray, termed the "thumb" sign. Foreign body aspiration and tracheal carcinoma
may have x-ray findings based on the location, size, and components present.
Peritonsillitis is best visualized on physical exam. If assessing for a potential
peritonsillar abscess, a contrasted CT is recommended.
2. A 23 yo women presents at your office with new
onset asthma. You start her on albuterol and a
long acting beta agonist. Which of the following
is not one of your goals in treating her asthma?
1. Get her back to her normal activity level.
2. Allow her to sleep w/o S/S.
3. No school/work absences from asthma
4. Eventually get her off the meds
4. Eventually get her off the meds...
Asthma treatment is surpressive therapy - the goal is to restore and maintian the
patient's NORMAL life without interference from S/S of asthma. This means the
asthmatic will prob be on meds for the rest of their lives.
3. A 32 yo white female comes to your office with
complaints of hemoptysis, chest pain and
shortness of breath. On CXR you see potato
nodes. Microscopy of her sputum shows
schaumann bodies and Asteroid bodies. You
have r/o the usual pulmonary suspects. What
might this young, white female have?
Sarcodosis
(Which according to our path test is a hypersentivity to a unknow antigen and we
know as UNKNOWN ETIOLOGY)
Pulmo Ques Packet 2
Study online at quizlet.com/_6ezcr
4. A 67-year-old female presents
for a follow-up visit for chronic
obstruction pulmonary disease
(COPD). Her most recent FEV1
is <80% predicted. Her room
air oxygen saturation is 94%.
She is currently managed on a
short acting beta-agonist as
needed, and has recently been
on a taper-dosed corticosteroid
for an exacerbation. Which of
the following is the most
appropriate next step of
management for this patient?
A. Increase the dosage of the
short acting beta-agonist
B. Add an anticholinergic, such
as tiotropium
C. Begin oral theophylline
D. Begin chronic oxygen
therapyE. Begin daily oral
corticosteroids
B. Add anticholinergic
- Management of COPD patients focuses on improving symptoms and decreasing the severity of
exacerbations. The initial management should focus on smoking cessation in all patients that
smoke. Medications may be utilized to allow bronchodilation, but must be used appropriately, to
avoid side effects and potential harm. Anticholinergic agents have been shown to improve
symptoms, FEV1, and reduce exacerbations, with less side effects than high dose beta-agonists.
Long-acting beta-agonists have been shown to have similar benefits, with caution being needed
when using these agents in certain populations. Corticosteroids, both inhaled and systemic, have
been shown to have a vital role in COPD exacerbations, but benefits regarding mortality or limiting
lung function decline have not been shown, with these agents not being considered a vital part of
long-term COPD management. Oral theophylline, which provides bronchodilation and anti-
inflammatory properties, is a fourth-line COPD agent, based upon its narrow therapeutic index and
potential for adverse side effects. Oxygen therapy has been shown to improve the progression of
COPD in patients with resting hypoxemia, defined by most as a resting O2 saturation <88% or
<90% with other comorbid findings.
5. A 70 year old retired coal miner
comes to your office. He has
trouble expanding his lungs
and taking a deep breath. He
has a chronic cough. CXR
shows some anthracosis. What
does this man have?
Coal miners pneumociosis
6. A drunk stubles into your ER
hacking up a lung. He has been
at a shelter for the last few days
but they kicked him out because
he thought sobriety was
optional. You take a CXR and
Dx him with pneumonia. What
is the most common community
aquired pneumonia in
alcoholics?
Pneumococcus Klebsiella
7. A fat, hypertensive, alcoholic,
smoker walks into your office
with SOB and chest pain. You
diagnose him with a PE. Which
of the following things about
him did not increase his risk
for PE?
1. fat
2. HTN
3. ETOH
4. Smoking
The fact that he drinks like a fish did not contribute to his risk of a PE. His fat, hypertensive
smoking put him in the HIGH risk category tho... so any blood thinning achieved by drinking a liter
of gin a day was lost.
8. A patient presents with mild dyspnea,
increased cough, and rhinorrhea. On physical
exam, you auscultate low-pitched, sonorous,
and adventitious sounds over the bilateral
upper lung fields, which are suggestive of
secretions. Which of the following terms is
defined by these findings?
1. Rales
2. vesicular
3. Rhonchi
4. Crackles
5. Wheeze
3. Rhonchi
- are defined as low-pitched, often harsh breath sounds, with increased secretions
and inflammation. Rhonchi due to secretions may improve with coughing.
Crackles, also known as rales, are due to an increase of fluid shifting from the
intravascular space into the alveoli, and are often described as brief, nonmusical
sounds with popping. Wheezes, which are high-pitched, musical sounds, are due
to the narrowing of the airway related to mucosal edema, secretions, and
bronchospasm. Vesicular breath sounds are normal lung sounds found over the
periphery.
9. A pt of yours is in the hospital. He has an
indwelling catheter, increased severity in his
underlying illness and is on broad spectrum
antibiotics (don't ask me which ones because
this school refuses to give me a damn class in
antibiotics). All the above factors make your pt
predisposed to get what kind of pneumonia?
Nosocomial - Hospital Aquired pnuemonia
***DO NOT confuse this with community aquired which is pneumonia in people
who have not recently been in the hospital or another health care facility (nursing
home, rehabilitation facility).
10. A pt presents with SOB, a productive cough,
fever and chills. You conduct your physical
exam and notice that there is increased tactile
fremitus over her lower right lobe. What is
your diagnosis?
Lobar Pnuemonia -
Pnuemonia is the only thing that increases tactile fremitus.
11. A pt. presents to the ER with difficulty
breathing. He has COPD from years of
smoking. You draw an ABG and the results
are as follows:
pH: 7.3
PaO2: 57
PaCO2: 54
Ox Sat: 84%
What is his acid-base status?
Respiratory acidosis
In this case the 02 is very low and the CO2 is very high. His body seems to be
having trouble blowing off the CO2. Mike Weber taught us that PCO2 abnormality
is respiratory in nature and he is acidotic because increased CO2 means increased
acid. His Ph has not dropped yet because his kidneys are compensating.
12. A pulmonary function test, like spirometry, is
helpful in diagnosing:
1. Chronic bronchitis
2. Lung Cancer
3. Pneumonia
4. TB
1. Chronic Bronchitis
13. A young kid presents to the ER with marked
Stridor, drooling and dyspnea. You do a CXR
and see a thumb sign - what is your Dx?
Should you look in this kids throat?
1. Acute epiglottitis
2. NO!!! No tongue depressor it could kill him
14. A young kid presents to the ER with marked
Stridor. Where in the respiratory tract is his
issue?
In the Upper Airway (Above the vocal cords)
- Wheezing means the problem is in the lower airway (below the cords)
15. An asthmatic presents with daily symptoms.
She wakes up about 1 night a week. You give
her a lung capactiy test and her PEF is at
about 70% of expected. What stage of asthma
is she in?
Moderate persistant
16. Assuming no contraindications, which of the
following class of medications is considered the
preferred long-term control therapy for persistent
asthma?
A. inhaled corticosteroids
B. leukotriene antagonists
C. long-acting B2 agonists
D. methylxanthines
E. muscarinic antagonists
A. Corticosteriods... they kill eosinophils
Inhaled corticosteroids (eg, beclomethasone, fluticasone, triamcinolone, etc)
are the preferred long-term control therapy for persistent asthma in all
patients because of their potency and consistent effectiveness. Low- to
medium-dose inhaled corticosteroids offer several advantages over other
medications, including the ability to reduce bronchial hyper-responsiveness,
improve overall lung function, and reduce severe exacerbations that often
lead to emergency department visits and hospitalizations.
17. At smoker presents with chest pain and dyspnea. I
wish to god they had anything else wrong with
them but since this is a pulmn test I suppose these
have to be the symptoms... anyway they have SOB,
chest pain, etc etc. You conduct your exam and
note hyperresonance on percussion. What do you
think is going on with them?
1. pneumonia
2. Pleural effusion
3. Lung tumor
4. Emphysema
4. Emphysema - there is extra air trapped in the lungs so you get
hyperresonance.
The other 3 will sound dull upon percussion
18. At what time of day is a cough from postnasal drip
most prevalent?
Night time bitches!! And that is what it is... Bed time for me...
19. Bob, a 69 yo, has COPD. Her O2 sat is less than
89%. He is going to start oxygen therapy to relieve
her symptoms. Her penis also hurt but as you are a
pulmonologist you can't help him with his ovary
problem. Ok - seriously - this COPD'r needs O2
therapy at home. How many hours a day will he
need to be on it to have it be effective?
18 hours a day NO LESS. If he doesn't do it for 18 hrs then its essentially the
same as not using it.
20. Chronic cough in kids is frequently caused by
everything BUT:
1. Sinusitis
2. Allergic rhinitis
3. cystic fibrosis
4. enlarged adenoids
3. Cystic Fibrosis - this cough takes years to develop. It is very rare in
children.
21. How would you treat Streptococcus Pneumoniae? Penicillin
22. I occur in healthy, young people with no pre-
existing lung disease. I prefer men who are tall and
thin. I am an accumulation of air in the normally
airless pleural space. I can be caused by a popped
bleb (a common side effect of smoking the ganja).
What am I?
Spontaneous pneumothorax
PS - I do NOT happen in Marfan's
23. If the trachea is deviated to the UNAFFECTED side what 2
things could be the problem?
1. Plueral effusion
2. massive normal pnuemonthorax
24. In order for you to Dx a person with asthma the pt must do all
of the following EXCEPT:
1. demonstrate episodic S/S of airflow obstruction
2. Show airflow obstruction is @least partially
reversible.
3. R/O other diseases in ur DDX
4. Improve 3% after a trial of Proventil.
4. Improve 3% after a trial of Proventil.
Proventil is a bronchodilator and the asthma pt MUST show an
improvement but it has to be @least a 12% improvement
25. In which condition would you assess vesicular breath sounds,
moderate vocal resonance and localized crackles with sibiliant
(hissing) wheezing?
1. Bronchiectasis
2. Acute Bronchitis
3. Emphysema
4 Asthma
2. Acute Bronchitis
1. Bronchiectasis has very coarse crackles
3. Emphysema has NO crackles
4. Asthma is wheezing with NO crackles
26. Increased rigidity of the lung tissue, Increased airway
resistance or enhanced ventilation during exercise can all be a
cause of:
Dyspnea
27. Inner city kids with asthma have to worry about what bug? Roaches (EWEWEWEWEWE)
28. Intermittent episodes of airway obstruction caused by
bronchospasm, excessive bronchial secretions and edema of
the bronchial mucosa are characteristic of:
1. Atelectasis
2. Acute Bronchitis
3. Asthma
4. Emphysema
3. Asthma - The bronchospasm is caused by the hyerreactivity
of the bronchus to allergens, the muscous secretion and edema
are part of the inflammatory response.
***remember - asthma is eosinophil mediated response
29. Lung Volumes
30. Marge, age 36, blue gal from Springfield presents to your ER looking for Dr.
Hibbert but she finds you. She complains of acute onset of dyspnea. Her
pertinent positives are chest pain, faintness, tachypnea, peripheral cyanosis,
hypotension, crackles and a slight wheeze. She has been on OCP for the last 15
years and smokes an occasional cigarette. Whatcha thinkin Marge has? And
how will Homie survive without her?
Marge has got herself a little Pulmonary
Emboli, but you give her some TPA and it
clears right up. She's home in time to give
Homer his nightly Duff.
31. Marvin is a 34 yo asthmatic. He uses his short acting beta agonist several
times a day. His attacks have severely impacted his daily activities. He is
frequently woken up at night by his asthma.
1. Which Category of Asthma is he in?
2. How would you Tx it?
1. Severe Persistant
2. SABA, LABA, High Dose Inhaled Steroids
and maybe a Leukotriene receptor agonist (-
lukast)
32. Meg, a 45 yo asthmatic has been diagnosed with step 1 (intermittent mild)
asthma. What long term control therapy are you going to prescribe her?
NONE SON! Intermittent mild people get an
albuterol rescue inhaler and nothing else.
Have you not been reading the words I've
been spewing?? :)
33. Name the horizontal groove in the rib cage at the level of the diaphragm,
extending from the sternum to the midaxillary line, that is mostly seen in kids,
esp those with rickets?
Harrison's Groove -
- Prominence of this area is a sign of
respiratory distress
- In a pt that is tachypneic it means
IMPENDING FAILURE
34. Of the 50 or so million idiots that smoke each year, about 34% try to quit. How
many of that 34% actually manage to kick the habit for good?
2.5%
35. Old people have trouble coughing. They are old and feeble. Which of the
following changes in their geriatric lungs account for this:
1. Decrease in VC
2. Less elasticity
3. Increase in RV
4. All of the above (and don't pick me because you think - oh it must be all of
the above... think about your answer!)
Ok so it was all of the above.
- Old people have less elastic lungs and have
a much harder tine getting air in and out.
36. One of your asthma pt. has symptoms more than 2 times a week but never
more than once a day. They also wake up about 2 nights a month with
symptoms. Their FEV1 is 80% of expected. What is the severity of their
asthma?
Mild persistant
37. Some dumb teenager heard they could hallucinate if they took a bottle of
aspirin, and rather than googling it he decided just to give it a shot. So he
takes like 250 aspirin and presents to your ER. Now assuming he is still alive,
what early acid-base disturbance might you notice?
Respiratory Alkalosis
Why? Well Because phase 1 of the toxicity is
characterized by hyperventilation resulting
from direct respiratory center stimulation,
leading to respiratory alkalosis and
compensatory alkaluria. Potassium and
sodium bicarbonate are excreted in the urine.
38. that volume of air moved into or out of the lungs during quiet breathing Tidal Volume (500cc)
39. The amount of gas left in the lung after
exhaling all that is physically possible is
called:
Residual Volume (1500cc)
40. the determination of the vital capacity from
a maximally forced expiratory effort
Forced vital capacity (FVC)
41. The inspiratory rate equals the expiratory
rate in what normal breath sound?
1. Bronchial
2. Bronchiovesicular
3. Vesicular
4. Tracheal
1. Bronchial
42. the maximal volume that can be inhaled
from the end-inspiratory level
Inspiratory reserve volume (1500 cc)
43. The sum of vital capacity and Residual
volume is:
Total Lung Capacity (5L)
44. the volume equal to TLC Reserve volume Vital capacity
45. The volume that can be maximally exhaled
after a passive exhalation
Expiratory reserve volume (1500 cc)
46. Unexplained nocturnal cough in an OLD
person can be explained by:
1. allergies
2. CHF
3. virus
4. post nasal drip
2. CHF causes unexplained nocturnal cough in the elderly because when they lie
down the venous return to the heart is increased so it gets more congested.
GERD is a close second... so you have old person coughing at night think CHF or
GERD!
47. Unexplained nocturnal cough in an YOUNG
person can be explained by:
1. allergies
2. CHF
3. virus
4. post nasal drip
4. Post nasal drip!
48. Volume that has been exhaled at the end of
the first second of forced expiration
FEV1
49. What are Bronchial Breath Sounds?
bronchial breath sounds over the trachea has a higher pitch, louder, inspiration and
expiration are equal and there is a pause between inspiration and expiration.
50. What are some alternatives to cigarettes you can offer your pt's in order to get
them off their nicotine addiction?
1. The patch (they will have crazy dreams)
2. The gum (not so yummy)
3. Nasal spray - really good for quick fix
(think snorting cigs)
4. A tomacco fruit
51. What are the 3 most common causes of SOB? 1. MI (with Chest Pain)
2. PE (with dyspnea)
3. Aortic dissection
52. What are the Main Differences between Asthma and COPD?
ASTHMA:
1. Reversible
2. Eosinophil driven
3. Allergic reaction/hypersensitivity
4. Bronchodialtors/Steroids make it better
- Roids kill the eosinophils
COPD:
1. Irreversible
2. Neutrophil driven
3. Reaction to noxious particle you put in
your lungs (smoke)
4. No cure, slow progressing
53. What are the NORMAL ABG values for:
1. pH
2. PCO2
3. PO2
4. HCO3
5. Base Excess
6. SaO2
1. 7.4
2. 40 mmHg
3. 90 mmHg
4. 24 mmol/L
5. -2 through +2
6. >95%
54. What are the
Vesicular Breathe
Sounds?
is heard over the thorax, lower pitched and softer than bronchial breathing. Expiration is shorter and
there is no pause between inspiration and expiration. The intensity of breath sound is higher in bases
in erect position and dependent lung in decubitus position.
55. What bacteria is the
M/C cause of
exacerbation in
chronic bronchitis?
Strep. Pnuemoniae (who else?)
56. What is a
bronchovesicular
breath sound?
are heard in the posterior chest between the scapulae and in the center part of the anterior chest.
Bronchovesicular sounds are softer than bronchial sounds, but have a tubular quality. Bronchovesicular
sounds are about equal during inspiration and expiration; differences in pitch and intensity are often
more easily detected during expiration.
57. What is a tracheal
breath sound?
heard over the trachea. These sounds are harsh and sound like air is being blown through a pipe.
58. What is
Bronchoscopy?
an examination by means of a bronchoscope.
59. What is Extensive
stage SCLC?
Defined as tumor that has spread beyond one lung, the mediastinum and ipsilateral and/or contralateral
supraclavicular lymoh nodes. Common distant sites of mets are adrenal glands, bone, liver, marrow and brain.
60. What is the
difference btwn a
primary and
secondary
Pneumothorax?
1. Primary is usu in a young, healthy person with no underlying lung disease
2. Secondary is usu due to an underlying disease
61. What is the limited stage of Small Cell Lung
Cancer?
Defined as tumor involvement of one lung, the mediastinum and ipsilateral
and/or contralateral supraclavicular lymoh nodes. OR disease that can be
encompassed in a single radiotherapy port.
62. What is the most common cause of chronic
cough in kids?
Postinfection cough
(Surprisingly not postnasal drip or asthma)
63. What is the most common community aquired
bacterial pnuemonia?
Streptococcus Pneumoniae
64. What is the Tx for Extensive stage SCLC? - Chemo
- Pallative radiation
65. What is the Tx for Limited stage small cell lung
cancer?
- Chemo
- concomitant contamination
- Prophylactic cranial irradiation
66. What percent of pack a day (or more) smokers
have a cough?
40-60%
(I hate percents!)
67. What should be your first thought with an adult
that presents with asthma for the first time?
It's probably work related
68. What's one of the main differences between the
patch and either the gum or the spray?
The patch provides continuous nicotine where the gum/spray only provides it
for a limited time.
69. When teaching your pt about the nicotine gum
what instructions should you give (and "read
the damn directions" is apparently NOT a
choice):
1. Chew it like regular gum
2. Spit it out after 30 mins of chewing
3. Drink coffee with the foul tasting gum cause
it'll
help the nicotine get absorbed
4. Chew 6-9 pieces daily to prevent withdrawal
2. Spit it out after 30 mins -its not regular gum fool!
1. Chew it like regular gum - Its not regular gum fool!
3. Drink coffee with the foul tasting gum cause it'll
help the nicotine get absorbed - um really?
4. Chew 6-9 pieces daily to prevent withdrawal - the package
says you should chew AT LEAST 9 pieces a day in the first
5-7 weeks to avoid withdrawal.
70. Which is NOT a principle trigger for an asthma
attack:
1. allergens
2. weather changes
3. infection
4. psychological factors
Weather Changes are not a principle trigger 0 they can contribute but they are
not "front line" triggers.
71. Which of the following about Smoking and
weight is true?
1. Smokers weigh 10-20 lbs less than
nonsmokers
2. Upon quitting 85% of smokers gain weight.
3. Smokers gain weight after they smoke cause
the
eat a ton more in order to ignore the fact that
they want a butt.
4. Men gain more than women when they quit.
3. Smokers gain weight after they smoke cause the
eat a ton more in order to ignore the fact that
they want a butt.
Now the NOT TRUE stuff:
1. Smokers weigh 10-20 lbs less than nonsmokers - they
actually weigh 5-7 lbs less
2. Upon quitting 85% of smokers gain weight. - Only about
50% of ex-smokers gain weight.
4. WOMEN gain more because that is just the way life always is... men get to
eat and eat and stay skinny but us girls, we eat and get fat, have babies and get
fat and apparently do something good for ourselves like stop smoking and get
fat!
72. Which of the following are
indications for you to
bronchoscope someone?
1. Evaluation of indeterminant
lung lesions
2. Staging of cancer
3. Widen a stenosed trachea
4. Determine inhalation
injuries
3. Widen a stenosed trachea - this is a surgical correction
Bronchoscopy is used to look not fix.
73. Which of the following diseases
will NOT cause a 2ndary
pneumothorax?
1. COPD
2. Lung Abscess
3. Marfans
4. Cystic Fibrosis
3. Marfan's will not cause a pneumothorax.
74. Which of the following is a
tumor of bronchial origin that
is known to grow rapidly and
have diffuse metastases at the
time of diagnosis?
A. Adenocarcinoma
B. Carcinoid
C. Large cell
D. Small cell
E. Squamous cell
D. Small Cell
-Small cell lung cancer is a fast-growing, rapidly spreading form of lung cancer. Although the cells
are small, they grow very quickly, metastasize to many parts of the body, and form large tumors. At
the time of diagnosis, tumor spread is presumed. The growth and spread is considered much faster
than that of non-small cell lung cancers. Staging is also different, utilizing a two-stage system
based on the extent of spread.
75. Which of the following is not a
risk factor for lung cancer?
1. Exposure to asbestos or
uranium
2. smoking
3. chronic pneumonia
4. Exposure to radon gas
3. Chronic pneumonia
76. Which of the following
organisms will NOT cause an
infectious exacerbation of
COPD?
1. Strep.Pneumonia
2. Hib
3. Branhamella catarrhalis
4. Pneumococcus coli
4. Pneumococcus coli - this bug attacks in the abdomen
1. Strep.Pneumonia - causes pneumonia DUH!
2. Hib - causes pneumonia
3. Branhamella catarrhalis - Aka MORAXELLA -nonmotile, Gram-negative, aerobic, oxidase-
positive diplococcus that can cause infections of the respiratory system, middle ear, eye, central
nervous system and joints of humans - so yeah its gonna annoy the crap out of COPD.
77. Which of the following statements are true regarding lung TB?
1. Manifestations are usu confined to the lungs.
2. Dyspnea is usu present in early stages
3. Crackles and bronchial breath sounds are usu
present in ALL phases of the disease.
4. Night sweats are often noted as a manifestation of
the fever.
4. Night sweats are often noted as a
manifestation of
the fever. - Big S/S for secondary TB
1. Manifestations are usu confined to the
lungs. - TB is a
systemic disease so manifestations in
many places.
2. Dyspnea is usu present in early stages -
Nope this doesn't
happen til later.
3. Crackles and bronchial breath sounds
are usu
present in ALL phases of the disease. -
These don't appear
til your pretty much dead.
78. Which of the following upper respiratory tract infections occurs most often in
kids 2-5?
1. Epiglottis
2. Peritonsillar abscess
3. Croup (laryngotracheobronchitis)
4. Bacterial tracheitis
1. Epiglottitis
(Personally I would have said croup but
apparently that is not the answer so
DON"T pick that one)
79. Which organism is the most common cause of nosocomial pneumonia? Pseudomonas aeruginosa
- this little bastard will NOT leave
80. Would you hear stridor in atelectasis? NOPE - that is a lower airway problem -
stridor is an upper airway problem
81. You are an asthmatic. Yup, can't breathe. And a female... boys you now have
boobs... Oops you didn't listen to Malka's contraception lecture and now you are
preggo! Congrats btw. How is the pregnancy going to affect your asthma?
Symptoms in 1/3 of preggos improve
Symptoms in 1/3 remain unchanged
Symptoms in 1/4 get worse....
This is a stupid question!
82. You are examining a pt in your office. While auscultating the chest you ask the
pt. to say "99". It comes through the stethescope as a much louder "99". What is
this technique called? When does the change in sound mean?
1. Bronchophony
2. The area where the 99 was louder is an
area of consolidation.
83. You are examining a pt in your office. While auscultating the chest you ask the
pt. to say "eeee". It comes through the stethescope as "aaa". What is this
technique called? When does the change in sound mean?
1. Egophony
2. You use it to determine if the lungs have
pnuemonia. If the "eee" changes to "aaa"
as in this case the pt may have pnuemonia.
84. You are examining a pt in your office. While auscultating the chest you ask the pt. to whisper "123". You
know you should not hear anything through the stethescope but in the lower R lobe you hear "123". What
is this technique called? When does the change in sound mean?
1. Whispered
Pectoriloquy
2. The lower
R lobe has
consolidation