3. Resp examination

Question 1

general inspection respiratory exam

Answer 1

patient (colour, breathing, comfort, position, purse-lipped
breathing in COPD, nutritional state (obesity may suggest obstructive sleep apnoea,
Pickwickianism))

Question 2

hand signs resp exam

Answer 2

Clubbing
Tar staining
Wasting of the intrinsic muscles (T1 nerve invasion by an apical lung cancer)
Tremor (flapping asterixis in respiratory failure, fine with beta-agonists e.g.
salbutamol)

Question 3

pulse CO2 retention

Answer 3

bounding pulse

Question 4

what does a raised JVP indicate resp exam

Answer 4

cor pulmonale

A raised non-pulsatile JVP may be
seen in superior vena cava (SVC) obstruction due to a lung cancer, in which case there
will be oedema of the face and neck.

Question 5

face respiratory signs

Answer 5

Horner’s syndrome
● Chemosis (conjunctival oedema may be seen with hypercapnia 2° to COPD)
● Look for respiratory disease in the face and mouth:
● Facial swelling is seen in SVC obstruction
● Dental caries (may cause lung abscess by inhalation of debris)
● Central cyanosis

Question 6

inspection of the chest resp exam

Answer 6

Shape
● Barrel chest (hyper inflated in emphysema)
● Severe kyphoscoliosis
● Severe pectus excavatum (funnel chest)
● Pectus carinatum (pigeon chest) +/- Harrison’s sulci

Symmetry
● Scars
● Muscle wasting
● Chest versus abdominal (diaphragmatic) breathing
● Use of accessory muscles
● Recession (more common in children, but can be seen in adults with partial
laryngeal/tracheal obstruction)

Question 7

what does tactile vocal fremitus test for

Answer 7

Transmission of vibrations is
increased in consolidation as sound travels quicker through solid than air.

Transmission is decreased with an effusion or pneumothorax as the lung tissue becomes separated from the chest wall

Question 8

tracheal deviation causes? which way would it go?

Answer 8

The trachea deviates away from tension pneumothorax and large pleural effusions.

The trachea deviates towards lobar collapse and pneumonectomy.

Question 9

cause of symmetrical reduction in chest expansion

Answer 9

pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion.

Question 10

causes of asymmetrical reduction in chest expansion

Answer 10

pneumothorax, pneumonia and pleural effusion can all cause ipsilateral reduced chest expansion.

Question 11

cause stony dullness

Answer 11

typically caused by an underlying pleural effusion.

Question 12

cause dullness to percussion

Answer 12

suggests increased tissue density (e.g. cardiac dullness, consolidation, tumour, lobar collapse).

Stony dullness: typically caused by an underlying pleural effusion.

Question 13

what is bronchial breathing

Answer 13

harsh-sounding (similar to auscultating over the trachea), inspiration and expiration are equal and there is a pause between. This type of breath sound is associated with consolidation.

Question 14

what is wheeze? causes?

Answer 14

a high-pitched, musical, adventitious lung sound produced by airflow through an abnormally narrowed or compressed airway(s)
Wheezing can be either expiratory, inspiratory, or both. Expiratory wheezing is more common and may mean that a person has a mild blockage causing the wheezing.

asthma, COPD and bronchiectasis.

Question 15

what are coarse crackles?

Answer 15

discontinuous, brief, popping lung sounds typically associated with fluid/secretions

pneumonia, bronchiectasis and pulmonary oedema.

Question 16

what are fine crackles? causes?

Answer 16

sounding similar to the noise generated when separating velcro. Fine end-inspiratory crackles are associated with pulmonary fibrosis.

Question 17

what are reduced breath sounds? causes?

Answer 17

diminished or absent breath sounds

• pleural effusion
• pneumothorax

Question 18

what are crackles? general definition

Answer 18

Crackles are high-pitched discontinuous sounds during inspiration not cleared by a cough and further defined as fine and coarse

Question 19

what is pleural friction rub? causes?

Answer 19

Pleural friction rub occurs during inhalation and exhalation, may be continuous or broken and creaking or grating. Pleural friction rubs are the squeaking or grating sounds of the pleural linings rubbing together[1] and can be described as the sound made by treading on fresh snow.

• pleurisy
• pneumonia
• PE

Question 20

what does vocal resonance help you distinguish between

Answer 20

This technique allows discrimination between dullness to percussion from pleural effusion and that from consolidation. Voice sounds, which are created in the larynx,
are transmitted more effectively across an area of consolidation. Transmission is reduced across a pleural effusion or pneumothorax.)

Question 21

if you suspect consolidation, what other test should you do resp

Answer 21

If you suspect an area of consolidation, perform whispering pectoriloquy (whisper “two-two-two”). (Whispers are transmitted more loudly across an area of consolidation.)

Question 22

to complete resp exam

Answer 22

Check sputum pot (volume, consistency, colour, odour, any haemoptysis)

Assess peak flow (state that you would do this in the OSCE)

Question 23

presenting resp exam

Answer 23

I completed a respiratory examination on xyz.

On inspection there was xyz (run through from bed area then top to toe) / no signs of respiratory disease. the pulse rate was x with a normal rhythm. The respiratory rate was x.

On examination of the chest my positive findings were…/there were no positive findings on palpation/percussion or auscultation.