Rosh Internal Medicine Boost Practice Exam

In a patient with a long history of cigar smoking, which physical examination finding is most likely?

1. Barrel chest

2. Clubbed fingers

3. Wheezing

4. Accessory muscle use

The correct answer is: Barrel chest

In a patient with a long history of cigar smoking, a barrel chest is a physical examination finding that is particularly indicative of chronic lung disease, such as emphysema, which is often associated with smoking. A barrel chest develops as a result of permanent enlargement of the air spaces beyond the terminal bronchioles, leading to an increase in the anteroposterior diameter of the thorax. This change in shape occurs because of the loss of elastic recoil in the lungs, causing air to become trapped and leading to hyperinflation. This physical change is commonly observed in patients with chronic obstructive pulmonary disease (COPD), especially those with a significant smoking history. The other options, while they could be associated with respiratory issues, are less specific to the particular scenario of chronic cigar smoking. For instance, clubbed fingers are more characteristic of diseases like lung cancer or interstitial lung disease. Wheezing can occur in various conditions, including asthma and other types of airway obstruction, but it is not exclusively tied to chronic smoking. Accessory muscle use indicates respiratory distress but does not specifically point to the long-term effects of smoking. Therefore, the presence of a barrel chest is the most strongly correlated finding with prolonged cigar smoking and associated lung damage.