READ ME / 1: Clinical signs

Question 1

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Question 2

The questions are written using the official Dundee lectures, so you might find it useful to have them open in the background in case you get stuck.

Question 3

I write the questions based on what I think the important facts are, but not everything is relevant. Don’t waste your time learning tiny details.

Question 4

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Question 5

There’s a good chance that older decks will be inaccurate (lectures and guidelines change year to year) so I’ll try to update them in the future.

Break a leg 👍

Question 6

The vast majority of information leading to diagnosis will come from a patient’s ___.

Answer 6

history

Question 7

When examining a patient from the end of the bed, what are you looking for?

Answer 7

Respiratory distress

Stridor (high pitched wheezing heard on inspiration)

Cyanosis

State of nutrition

Question 8

What do you look at in a peripheral examination of a patient’s respiratory system?

Answer 8

Mouth

Hands

Skin perfusion

CO₂ flap

Lymph nodes

JVP

Question 9

What is the difference between a symptom and a sign?

Answer 9

Symptom - what the patient feels / tells you; found by taking history

Sign - physical variations from the norm; what you find on examination

Question 10

What is cachexia?

Answer 10

Wasting caused by chronic disease

Question 11

What is obesity?

Answer 11

Accumulation of body fat to the degree that it has negative effects on health

Question 12

What is anaemia?

Answer 12

Decrease in the number of red blood cells

Question 13

What is hypercapnia?

Answer 13

Abnormally elevated levels of CO₂ in the blood

Question 14

What is encephalopathy?

Answer 14

Any disease which affects the brain

Question 15

What causes a CO₂ flap?

i.e CO₂ retention

Answer 15

Hypercapnic encephalopathy

Question 16

What does a CO₂ flap look like?

Answer 16

Flapping of hand when wrist is hyperextended

Question 17

What causes yellowing of fingernails?

Answer 17

Nicotine

Tar

Fungus

Question 18

What kind of disease is eczema?

Answer 18

Atopic disease

atopy - diseases where there is a heightened immune response to ordinary allergens

Question 19

What is erythema nodosum?

Answer 19

Red bumps found on the shins

Question 20

What diseases are associated with erythema nodosum?

Answer 20

Sarcoidosis

TB

Question 21

What is lupus pernio?

Answer 21

Hard purple patches on the face - particularly the cheeks, nose

Question 22

What disease is lupus pernio associated with?

Answer 22

Sarcoidosis

Question 23

What is finger clubbing?

Answer 23

Increased curvature of nails

and

loss of nail bed angle

Question 24

What are some respiratory causes of finger clubbing?

Answer 24

Bronchial carinoma

Fibrosing alveolitis

Lung suppuration (common in bronchiectasis, lung abscesses, empyema)

Question 25

What are some **cardiovascular** causes of finger clubbing?

Answer 25

**Infective endocarditis** **Congenital heart disease**

Question 26

If you examined someone's eyes and found a **small pupil** unilaterally, what syndrome would you suspect? If you later found a tumour on a CXR, what tumour would it be and where exactly is it found?

Answer 26

**Horner's Syndrome** **Pancoast's Tumour**, found at lung apex

Question 27

If a patient had **uveitis** (inflammation of the middle layer of eye), what respiratory diseases may they have?

Answer 27

**Sarcoidosis** **TB**

Question 28

Why may a patient have **dilated retinal veins** in their eyes?

Answer 28

**CO₂ retention**

Question 29

What signs may you see in a patient who has **cor pulmonale**?

Answer 29

Cyanosis **Raised JVP** **Pitting oedema** (sacrum / ankles) **Parasternal heaves** **Loud 2nd heart sound**

Question 30

What are the four steps of chest examination?

Answer 30

**Inspection** **Palpation** **Percussion** **Auscultation**

Question 31

What is **kyphoscoliosis**?

Answer 31

Abnormal curvature of the spine

Question 32

What is **pectus excavatum?**

Answer 32

Abnormal deformity of the anterior thoracic wall - **caved-in chest**

Question 33

What is a **hyperinflated** chest an indicator of?

Answer 33

**Emphysema**

Question 34

What are you looking for on **inspection** of a patient's chest?

Answer 34

**Operation scars** **Expansion** **Respiratory abdominal movement**

Question 35

On palpation, what do you feel in the **suprasternal notch** for?

Answer 35

**Tracheal deviation**

Question 36

The trachea moves: **towards / away -** collapse **towards / away -** consolidation **towards / away** **-** effusion

Question 37

What are some causes of **reduced chest expansion**?

Answer 37

**Unilateral pneumothorax** **Pleural effusion** Bilaterally - restrictive lung disease, hyperinflation from emphysema

Question 38

On percussion, why may a chest sound **hyper-resonant**?

Answer 38

**Emphysema** **Pneumothorax**

Question 39

Why may a chest sound **stony dull** on percussion?

Answer 39

**Pleural effusion**

Question 40

What name is given to **normal breath sounds**?

Answer 40

**Vesicular**

Question 41

Why may breath sounds be **reduced**?

Answer 41

**Effusion**, **collapse**, obstruction, emphysema

Question 42

What are **transmited breath sounds** also known as?

Answer 42

**Bronchial breath sounds**

Question 43

Why may breath sounds be described as **bronchial**?77

Answer 43

Consolidation --\> pneumonia, pulmonary fibrosis

Question 44

What name is given to a musical sound which is made as air passes through narrowed airways?

Answer 44

**Wheeze** (rhonchi)

Question 45

What are **fine crepitations** a sign of?

Answer 45

**Pulmonary fibrosis**

Question 46

What are **moderate/coarse crackles**?

Answer 46

**Pulmonary oedema**, **consolidation**, **bronchiectasis**

Question 47

What is a **pleural rub**?

Answer 47

Leathery, creaking sound made by **inflamed pleural surfaces** rubbing together

Question 48

What are some causes of **pleural rub**?

Answer 48

**Pneumonia, pulmonary embolus**, **pleurisy**

Question 49

In which disease would you hear a **pleural click**?

Answer 49

**Pneumothorax**