Examination of the respiratory system

Question 1

what angle should the patient be at?

Answer 1

45 degrees

Question 2

key elements of the general inspection?

Answer 2

bed side-oxygen/nebuliser/sputum cup

patient- accessory muscles/ distressed/LOC

noises- wheeze/hoarse voice/stridor

Question 3

what does a wheeze indicate?

Answer 3

COPD

asthma

Question 4

what does stridor indicate (rasping noise on inspiration)

Answer 4

obstruction of airways

Question 5

normal angle between nail and cuticle ?

Answer 5

140 degrees

Question 6

common causes of finger clubbing

Answer 6

intrathoracic disease eg fibrosis, empyema. bronchiectasis,lung cancer

Question 7

what to observe for in the hands?

Answer 7

nicotine staining
peripheral cyanposis
finger clubbing
small muscle wasting
tremor
co2 retention flap
pulse 
resp rate

Question 8

what may cause muscle wasting?

Answer 8

compression of the brachial plexus by peripheral lung tumours

Question 9

what does a fine tremor indicate

Answer 9

beta 2 adrenoceptor agonist

eg salbutamol inhaler

Question 10

extending wrists with eyes closed tests for what

Answer 10

checks for co2 retention flap

Question 11

what does increased pulse volume indicate?

Answer 11

co2 retention

Question 12

what does tachycardia indicate?

Answer 12

severe asthma

Question 13

normal respiratory rate

Answer 13

12-20 per minute

Question 14

inspection of face and neck

Answer 14

central cyanosis
anaemia in conjuctiva
JVP -elevated? pulsatile?

Question 15

pale conjunctiva indicates what?

Answer 15

anaemia

Question 16

patient with general cyanosis and warm extremities. what is the likley cause?

Answer 16

venous/arterial shunts

Question 17

what can cause central cyanosis

Answer 17

lung disease

Question 18

what would cause a non pulsatile JVP

Answer 18

obstruction in SVC due to tumour in mediastinum

Question 19

what to look for in chest inspection

Answer 19

pectus excavatum 
pectus carinatum
scoliosis 
over expanded
scars

Question 20

what is palpated ?

Answer 20

trachea
apex beat
chest expansion

Question 21

what could cause tracheal deviation

Answer 21

towards lesion- fibrosis, pneumonetomy

away from lesion- massive plural effusion, pneumothorax

Question 22

what does reduced expansion on one side of the chest indicate

Answer 22

lesion on that side

Question 23

where should chest expansion be checked

Answer 23

2x front

1x back

Question 24

where should percussion be done ?

Answer 24

middle phalanx of middle finger using other middle finger

Question 25

what position should the patient be in when percussing the back?

Answer 25

arms forward

Question 26

normal chest percussion sound

Answer 26

resonant

Question 27

what does a dull percussion indicate?

Answer 27

consolidated lung

Question 28

what does a stony dull percussion note indicate?

Answer 28

fluid filled area eg pleural effusion

Question 29

what does a hyper resonant percussion sound indicate?

Answer 29

percussion over a hollow structure eg.pneumothorax

Question 30

what should the patient do during auscultation

Answer 30

breathe in and out through an open mouth every time stethoscope moved

Question 31

what side of the stethoscope should be used

Answer 31

diaphragm

Question 32

how are normal breath sounds described

Answer 32

vesicular

Question 33

what sound is described as vesicular?

Answer 33

breath sound increase in intensity in inspiration and fading in expiration

Question 34

what due bronchial breath sounds indicate?

Answer 34

consolidation /fibrosis

Question 35

what are the three ways the intensity of breath sounds can be described

Answer 35

normal reduced abscent

Question 36

locally abscent breath sounds can indicate

Answer 36

pneumothorax | pleural effusion

Question 37

what 3 sounds may be audible as added sounds?

Answer 37

wheeze crepitations pleural rub