Respiratory - Respiratory Exam

Question 1

What angle should the bed be at?

Answer 1

45 degrees

Question 2

What clinical signs should you be looking for when inspecting the patient?

Answer 2

Age
Cyanosis
Shortness of breath
Cough
Wheeze
Stridor
Pallor
Oedema
Cachexia

Question 3

What does cyanosis suggest?

Answer 3

Poor circulation (peripheral vasoconstriction secondary to hypovolaemia)

Inadequate oxygenation of blood

Question 4

What signs can indicate shortness of breath?

Answer 4

Nasal flaring
Pursed lips
Accessory muscle use
Tripod position
Inability to speak in full sentences

Question 5

What pathologies can a cough suggest?

Answer 5

Pneumonia
Bronchiectasis
COPD
CF

Dry cough- asthma or interstitial lung disease

Question 6

What is a wheeze associated with?

Answer 6

Asthma
COPD
Bronchiectasis

Question 7

What causes stridor?

Answer 7

High pitched sound from turbulent flow through narrowed upper airways

Foreign body inhalation
Subglottic stenosis

Question 8

What is cachexia?

Answer 8

Ongoing muscle loss not entirely reversed with nutritional supplementation

Associated with lung cancer and COPD

Question 9

What objects may be around the bed?

Answer 9

Oxygen delivery devices
Sputum pot
Medical equipment
Cigarettes or vape
Mobility aids
Vital signs
Fluid balance
Prescriptions

Question 10

What should you be looking for when examining the hands?

Answer 10

Colour
Tar staining
Skin changes- bruising and thinning of the skin, associated with long-term steroid use (asthma, COPD, interstitial lung disease)
Joint swelling or deformity (RA- can affect respiratory system, pleural effusions, pulmonary fibrosis)

Question 11

What causes finger clubbing?

Answer 11

Lung cancer
Interstitial lung disease
Cystic fibrosis
Bronchiectasis

Question 12

What does a fine tremor suggest?

Answer 12

Associated with beta-2-agonist e.g. salbutamol

Question 13

What is asterixis?

Answer 13

Flapping tremor
Due to CO2 retention in conditions that cause type 2 respiratory failure e.g. COPD
Can be caused by uraemia and hepatic encephalopathy

Liver stuff L-shape with hands

Question 14

What can excessively warm and sweaty hands be associated with?

Answer 14

CO2 retention

Question 15

When measuring the pulse what should you do if it’s irregular?

Answer 15

Measure for the full 60 seconds

Question 16

What is a bounding pulse associated with?

Answer 16

Underlying CO2 retention (type 2 respiratory failure)

Question 17

How should you assess the respiratory rate?

Answer 17

While palpating the radial pulse (no longer counting it) assess patient’s respiratory rate to avoid making patient aware you are observing their breathing

Full 60 seconds

Question 18

What respiratory causes are there for a raised JVP?

Answer 18

Pulmonary hypertension- right-sided heart failure after COPD

Question 19

What does a plethoric complexion mean?

Answer 19

Red-faced appearance

Polycythaemia
CO2 retention
COPD

Question 20

What are the signs of Horner’s syndrome and why is it relevant?

Answer 20

Ptosis
Miosis
Enophthalmos

Pancoast tumour

Question 21

What does central cyanosis and oral candidiasis suggest?

Answer 21

Central cyanosis
Hypoxaemia

Oral candidiasis
Fungal infection due to steroid inhaler (local immunosuppression)

Question 22

What chest scars might you see and what do they mean?

Answer 22

Median sternotomy scar
CABG

Axillary thoracotomy scar
Chest drain insertion

Posterolateral thoracotomy scar
Lobectomy
Pneumonectomy
Oesophageal surgery

Infraclavicular scar
Pacemaker

Radiotherapy-associated skin changes- dry skin, thickened skin, depigmentation, telangiectasia

Question 23

What chest wall deformities may you see and what do they mean?

Answer 23

Asymmetry
Associated with pneumonectomy and thoracoplasty

Pectus excavatum
Sunken appearance

Pectus carinatum
Protrusion of sternum and ribs

Barrel chest
COPD

Question 24

What causes tracheal deviation?

Answer 24

Away
Tension PTX
Large pleural effusions

Towards
Lobal collapse
Pneumonectomy

Question 25

What can cause a displaced apex beat?

Answer 25

RV hypertrophy (secondary to pulmonary hypertension, COPD, interstitial lung disease)

Large pleural effusion

Tension pneumothorax

Question 26

What does reduced chest expansion mean?

Answer 26

Symmetrical
Pulmonary fibrosis

Asymmetrical
Pneumothorax
Pneumonia
Pleural effusion

Question 27

What are the different types of percussion note and what they indicate?

Answer 27

Resonant
Normal

Dullness
Increased tissue density
(Consolidation, tumour, lobar collapse)

Stony dullness
Pleural effusion

Hyper-resonance
Pneumothorax

Question 28

How is tactile vocal fremitus assessed?

Answer 28

Palpating over different areas while patient repeats 99

Increased vibration
Increased tissue density
(consolidation, tumour, lobar collapse)

Decreased vibration
Fluid or air outside of lung (pleural effusion or PTX)

Question 29

What are the different quality of breath sounds?

Answer 29

Vesicular
Normal

Bronchial
Harsh-sounding
Pause between inspiration and expiration

Consolidation

Question 30

What do different volumes of breath sounds suggest?

Answer 30

Quiet
- Reduced air entry
- Due to pleural effusion or PTX

Reduced breath sounds^

Question 31

What added sounds when auscultating may you hear?

Answer 31

Wheeze
Asthma
COPD
Bronchiectasis

Stridor
High-pitched
Foreign body inhalation
Subglottic stenosis

Coarse-crackles
Pneumonia
Bronchiectasis
Pulmonary oedema

Fine end-inspiratory crackles
Pulmonary fibrosis