Resp Exam

Question 1

Peripheral cyanosis

Answer 1

Hypoxaemia (O2 says <85%)

Question 2

Clubbing

Answer 2

Lung cancer 
Pulmonary fibrosis
Bronchiectasis
Cystic fibrosis
Tuberculosis
Abscess
Empyema

Question 3

Tar staining on fingers

Answer 3

Smoking

Question 4

Temperature

Answer 4

Cold- poor peripheral perfusion

Warm with dilated veins- CO2 retention

Question 5

Flapping tremor (asterisks)

Answer 5

Ask patient to hold hands in front of them extended at the wrist for 30s
CO2 retention

Question 6

Fine tremor

Answer 6

Overuse of beta agonists (salbutamol)

Question 7

Tachycardia ‘bounding’ pulse

Answer 7

CO2 retention

Question 8

Pulses paradoxus

Answer 8

Pulse wave volume decreases significantly during inspiration

Severe acute asthma/COPD (also cardiac tamponade)

Question 9

Mucosal pallor of conjunctivae

Answer 9

Anaemia

Question 10

Jaundice of sclera

Answer 10

Anaemia

Question 11

Horner’s syndrome

Answer 11

Ptosis
Miosis and enophthalmos
Caused by compression of the sympathetic chain in chest cavity (Pancoast tumour, sarcoidosis, fibrosis)

Question 12

Red sclera

Answer 12

Anterior uveitis (TB, sarcoidosis)

Question 13

Central cyanosis

Answer 13

Hypoxaemia

Question 14

Oral candidiasis

Answer 14

Inhaled steroid use or immunosuppressants

Question 15

JVP

Answer 15

Increased in pulmonary hypertension (e.g. COPD, interstitial lung disease)

Question 16

Tracheal deviation- away

Answer 16

Pneumothorax

Large pleural effusions

Question 17

Tracheal deviation- towards

Answer 17

Lung collapse

Pneumonectomy

Question 18

Scars in chest

Answer 18

Chest drain in MAL

Thoracotomies

Question 19

Chest wall deformities

Answer 19

Scoliosis
Kyphosis
Barrel chest (hyperinflation; COPD)
Pectus carinatum/excavatum

Question 20

Resp effort and breathing pattern

Answer 20

Prolonged expiration phase- asthma/COPD exacerbations

Question 21

Asymmetry of chest movement

Answer 21

Pneumonectomy or thoracoplasty

Question 22

Symmetrical decreased chest expansion

Answer 22

Pulmonary fibrosis

Question 23

Asymmetrical decreased chest expansion

Answer 23

Pneumothorax
Pneumonia
Pleural effusion

Question 24

Normal percussion sound

Answer 24

Resonant

Question 25

percussion dullness

Answer 25

Over areas of increased density | Consolidation, collapse, pulmonary oedema, abscess

Question 26

Stony dullness on percussion

Answer 26

Pleural effusion

Question 27

Hyper-resonance on percussion

Answer 27

Areas of decreased density | Pneumothorax, emphysema bullae, COPD

Question 28

Bronchial breathing

Answer 28

``` Caused by increased density of matter in peripheral lung allowing sound from the larynx to the stethoscope unchanged, hollow/blowing quality Consolidation Lung abscess at chest wall Dense fibrosis Squashed lung above pleural effusion ```

Question 29

Reduce volume breath sounds- Locally

Answer 29

``` Effusion Tumour Pneumothorax Pneumonia Lung collapse ```

Question 30

Reduce breath sounds volume globally

Answer 30

COPD | Asthma

Question 31

Polymorphic wheeze on expiration

Answer 31

Asthma | COPD

Question 32

Monomorphic wheeze on expiration

Answer 32

Foreign body | Carcinoma

Question 33

Stridor

Answer 33

High pitched extra-thoracic breath sounds | Upper airway obstruction

Question 34

Crackles

Answer 34

Crepitations, rales | On inspiration

Question 35

Coarse crackles

Answer 35

Early inspiration Fluid Infection

Question 36

Fine crackles

Answer 36

Later in inspiration Fluid Fibrosis

Question 37

Rub

Answer 37

At height of inspiration- inflamed pleural surfaces rubbing against one another

Question 38

Hyper-resonance on vocal resonance

Answer 38

Consolidation | Collapse

Question 39

Decreased resonance on vocal resonance

Answer 39

Fluid | Air (plural effusion, pneumothorax)

Question 40

Legs

Answer 40

Sacral oedema Pedal oedema DVT Erythema nodosum e.g. sarcoidosis

Question 41

Extra tests

Answer 41

``` Obs Cardio exam Peak flow Sputum MC+S ABG CXR ```