Which respiratory disease causes a restrictive, parenchymal pattern of illness?

Correct Answer: C

Rationale: The correct answer is C: Sarcoidosis. Sarcoidosis is a respiratory disease characterized by granulomatous inflammation in the lung parenchyma, leading to a restrictive pattern of lung function. This results in decreased lung volume and impaired gas exchange. Myasthenia gravis (A) is a neuromuscular disorder, not a respiratory disease. Asthma (B) is characterized by reversible airway obstruction, not a restrictive pattern. Ankylosing spondylitis (D) primarily affects the spine and joints, not the lungs. Therefore, the correct choice is C based on the specific pathological and clinical features of sarcoidosis.

Correct Answer: A

Rationale: The correct answer is A: It is a splenic rub. The rough grating noise heard on examination is characteristic of a splenic rub, which occurs when the peritoneum overlying the spleen rubs against the spleen itself. This is often associated with conditions like splenic infarction or abscess. In Cody's case, with his history of leukemia and an enlarged spleen, this finding is concerning and warrants further investigation. Summary of other choices: B: It is not a variant of bowel noise as bowel noises are typically more high-pitched and gurgling in nature. C: It is not borborygmi, which refers to the normal sounds produced by the movement of gas and fluid in the intestines. D: It is not a vascular noise as those are usually associated with blood flow abnormalities and are not typically heard in the left upper quadrant.

Correct Answer: D

Rationale: The correct answer is D because in children, the sound produced by percussing over the lungs can sometimes be louder, longer, and lower in pitch compared to adults due to their thinner chest walls. This finding is considered normal for a child of this age and should not raise concerns. Palpating for pain or tenderness (Choice A) is not necessary as the loud tones are not indicative of pathology. Asking the child to take shallow breaths (Choice B) would not change the percussion findings. Referring the child immediately (Choice C) is unwarranted as the findings are within the expected range for a 4-year-old.

Correct Answer: B

Rationale: The correct answer is B because low-pitched sounds like heart murmurs are best detected using the bell of the stethoscope. The bell is designed to pick up low-frequency sounds with more clarity and resonance due to its shape and size. Heart murmurs typically fall into the category of low-pitched sounds, making the bell ideal for their detection. Choice A is incorrect because high-pitched sounds like breath sounds are better detected using the diaphragm of the stethoscope, not the bell. Choice C is incorrect as sounds over a large surface area would be better detected using the diaphragm as well. Choice D is incorrect because the amplitude of the sound does not determine whether the bell or diaphragm is used; it is more about the frequency or pitch of the sound.

Correct Answer: D

Rationale: The correct answer is D: Use of accessory muscles during breathing. This finding indicates respiratory distress and requires immediate attention as it suggests the patient is having difficulty breathing effectively. Accessory muscle use signifies increased work of breathing and potential respiratory compromise. A: A respiratory rate of 16 breaths per minute is within the normal range. B: An SpO2 of 92% on room air is slightly below the normal range but may not require immediate intervention. C: Bilateral lung sounds clear to auscultation indicate normal breath sounds and do not suggest imminent respiratory distress.