Advanced Patient Assessment Practice Exam

Which clinical chest x-ray finding is consistent with hyperinflation caused by obstructive lung disease?

1. Prolonged inspiratory phase

2. Large retrosternal space

3. Decreased functional residual capacity (FRC)

4. Decreased resonance to percussion

The correct answer is: Large retrosternal space

The finding that indicates hyperinflation caused by obstructive lung disease on a chest x-ray is the presence of a large retrosternal space. In individuals with conditions such as asthma or chronic obstructive pulmonary disease (COPD), the lungs can become overinflated due to trapped air, leading to an increase in lung volume. This results in a noticeable expansion of the retrosternal space – the area in front of the heart and behind the sternum – which becomes enlarged on the x-ray. In obstructive lung disease, the difficulty in expiration leads to the retention of air within the lungs, causing them to appear hyperinflated. The large retrosternal space is a radiographic manifestation of this hyperinflation as it reflects the increased volume of air present in the thoracic cavity. This characteristic appearance helps clinicians assess the presence of obstructive pathology. The other findings do not correlate with hyperinflation in the same way. For example, a prolonged inspiratory phase can be seen in various respiratory conditions but does not specifically indicate hyperinflation. Decreased functional residual capacity (FRC) would suggest a reduction in the amount of air left in the lungs after normal expiration, which contradicts the concept of hyperinflation. Likewise, decreased