Macleod's II

Question 1

Irritation of the parietal pleura of the top few ribs causes localised pain. How many ribs does this refer to?

Answer 1

Irritation of the parietal pleura of the upper six ribs causes localised pain.

Question 2

What type of pain is felt from irritation of the parietal pleura overlying the central diaphragm?

Answer 2

Pain that is referred to the neck or shoulder tip

Question 3

Describe mediastinal pain.

Answer 3

Mediastinal pain is central, retrosternal and unrelated to respiration or cough.

Question 4

What is Cheyne-Stokes respiration?

Answer 4

Periodic breathing that is cyclical with increasing rate and depth of breathing, followed by diminishing respiratory effort and rate, ending in a period of apnoea or hypopnoea.

Question 5

Define Tachypnoea and Bradypnoea

Answer 5

Tachypnoea is >25 breaths/min.

Bradypnoea is <10 breaths/min.

Question 6

What are the lung conditions that coal miners are at risk of?

Answer 6

COPD and pulmonary fibrosis

Question 7

What is the cause of Farmer’s lungs?

Answer 7

Fungal spores of thermophilic actinomycetes or Micropolyspora faeni

Question 8

What is the cause of Malt worker’s lungs?

Answer 8

Aspergillus clavatus

Question 9

What is the cause of Bird Fancier’s lungs?

Answer 9

Bloom on birds’ feathers or excreta

Question 10

What are the accessory muscles of respiration?

Answer 10

Sternocleidomastoid, platysma and trapezius muscles.

Question 11

How to examine for stridor?

Answer 11

Ask patient to cough and then breathe deeply in and out with the mouth wide open. Listen for high pitch breathing sounds resulting from turbulent airflow in the larynx or lower in the bronchial tree.

Question 12

What does central cyanosis reflects?

What does peripheral cyanosis reflects?

Answer 12

Central cyanosis reflects arterial hypoxaemia.

Peripheral cyanosis is usually due to circulatory disorders or cold, but can arise with severe central cyanosis.

Question 13

What does clubbing suggest?

Answer 13

Thoracic disease such as lung cancer, bronchiectasis, interstitial lung disease.
It can also suggest gastrointestinal disorders.

Question 14

What is asterixis?

Answer 14

Asterixis is flapping tremor of the hands, seen in CO2 retention and severe ventilatory failure.

Question 15

What does unilateral asterixis indicative of?

Answer 15

A structural abnormality in the contralateral cerebral hemisphere.

Question 16

What are the findings in superior vena cava obstruction?

Answer 16

JVP is raised and non-pulsatile. Abdominjugular reflex is also absent.

Question 17

Who will have a barrel-shaped chest? How do you define a barrel shaped chest?

Answer 17

Patients with severe COPD.

When the anteroposterior diameter is greater than the lateral diameter.

Question 18

How do you determine the position of the mediastinum?

Answer 18

Shift of the upper mediastinum causes tracheal deviation.

Displacement of the apex beat indicates lower mediastinum shift.

Question 19

What is a common cause of displacement of the cardiac impulse without tracheal deviation?

Answer 19

Left ventricular hypertrophy.

Question 20

In tension pneumothorax, does the trachea deviate away or towards the side of the lung lesion?

Answer 20

Away from side of lung lesion.

Question 21

What does paradoxical inward movement of the chest during normal tidal breathing indicate?

Answer 21

Bilateral reduction of expansion on side indicates diaphragmatic paralysis, or more commonly, severe COPD.

Question 22

What are the possible diagnosis of dullness in percussion of chest?

Answer 22

Pulmonary consolidation, pulmonary collapse, severe pulmonary fibrosis

Question 23

What are the possible diagnosis of stony dull percussion note from the chest?

Answer 23

Pleural effusion, haemothorax

Question 24

Resonance below which rib indicates hyperinflation?

Answer 24

Below the 5th rib

Question 25

Describe the sound of bronchial breathing.

Answer 25

High-pitched breath sounds with a hollow or blowing quality. Breath sounds are of similar length and intensity in inspiration and expiration, with a characteristic pause between the 2 phases.