Resp exam findings

Question 1

Which signassesses finger clubbing?

Answer 1

Schamroth’s window

Question 2

What can cause a fine tremor?

Answer 2

Beta-2-agonist use

Question 3

What is asterixis?

Answer 3

flapping tremor

Question 4

What ca cause asterixis?

Answer 4

CO2 retention (eg. from conditions that cause type 2 resp failure like COPD)

Question 5

What is raised JVP evidence of?

Answer 5

venous hypertension
(can be due to pulmonary hypertension, congestive heart failure, tricuspid regurgitation and constrictive pericarditis )

Question 6

What is conjunctival pallor suggestive of?

Answer 6

anaemia

Question 7

Name 3 eye signs of Horner’s syndrome and what causes it

Answer 7

miosis, ptosis, enophthalmos
sympathetic trunk damaged (eg. by lung cancer at apex of lung)

Question 8

What is oral candidiasis associated with?

Answer 8

steroid inhaler use (local immunosuppression)

Question 9

Describe oral candidiasis

Answer 9

white slough, easily wiped away to reveal erythematous mucosa

Question 10

Median sternotomy scar procedures

Answer 10

cardiac valve replacement
coronary artery bypass grafts (CABG)

Question 11

Axillary thoracotomy scar procedures

Answer 11

insertion of chest drains

Question 12

Posterolateral thoracotomy scar procedures

Answer 12

lobectomy
pneumonectomy
oesophageal surgery

Question 13

Infraclavicular scar procedures

Answer 13

pacemaker insertion

Question 14

Name some radiotherapy-associated skin changes

Answer 14

xerosis(dry skin)
telangiectasia
scale
hyperkeratosis
depigmentation

Question 15

What is chest wall asymmetry associated with?

Answer 15

pneumonectomy
thoracoplasty (eg. TB)

Question 16

What is pectus excavatum?

Answer 16

caved-in or sunken appearance of the chest

Question 17

What is pectus carinatum?

Answer 17

protrusion of the sternum/ribs

Question 18

Describe hyperexpansion of the chest (‘barrel chest’)

Answer 18

chest wall appears wider and taller than normal

Question 19

What is ‘barrel chest’ associated with?

Answer 19

chronic lung diseases eg. asthma, COPD

Question 20

What does the trachea deviate away from?

Answer 20

tension pneumothorax
large pleural effusions

Question 21

What does the trachea deviate towards?

Answer 21

lobar collapse
pneumonectomy

Question 22

What causes a reduced cricosternal distance?

Answer 22

underlying lung hyperinflation (eg. asthma, COPD)

Question 23

What can cause a displaced apex beat?

Answer 23

right ventricular hypertrophy (eg. pulmonary hypertension, COPD, ILD)
large pleural effusion
tension pneumothorax

Question 24

What can cause symmetrical reduced chest expansion?

Answer 24

pulmonary fibrosis (due to reduced lung elasticity)

Question 25

What can cause asymmetrical reduced chest expansion?

Answer 25

pneumothorax pneumonia pleural effusion

Question 26

What can cause resonant percussion of chest?

Answer 26

normal finding

Question 27

What can cause dullness on percussion of the chest?

Answer 27

increased tissue density (eg. cardiac dullness, consolidation, tumour, lobar collapse)

Question 28

What can cause stony dullness on percussion of the chest?

Answer 28

pleural effusion

Question 29

What can cause hyper-resonance on percussion of the chest?

Answer 29

decreased tissue density (eg. pneumothorax)

Question 30

What can cause increased vibrations during tactile vocal fremitus?

Answer 30

increased tissue density (eg. consolidation, tumour, lobar collapse)

Question 31

What can cause decreased vibrations during tactile vocal fremitus?

Answer 31

presence of fluid/air outside of the lung (eg. pleural effusion, pneumothorax)

Question 32

What do vesicular breath sounds indicate?

Answer 32

healthy lung

Question 33

Describe bronchial breath sounds What do they indicate?

Answer 33

harsh-sounding, inspiration and expiration equal with a pause in between associated with consolidation

Question 34

What do quiet breath sounds indicate?

Answer 34

reduced air entry into that region (eg. pneumothorax, pleural effusion)

Question 35

What is a wheeze? Which conditions can it be heard in?

Answer 35

continuous, coarse, whistling sound asthma, COPD, bronchiectasis

Question 36

What is stridor? Which conditions can it be heard in?

Answer 36

high-pitched extra-thoracic breath sound from turbulent airflow through narrowed upper airways foreign body inhalation, subglottic stenosis

Question 37

What do coarse crackles sound like? Which conditions are they heard in?

Answer 37

brief, popping lung sounds pneumonia, bronchiectasis, pulmonary oedema

Question 38

What do fine end-inspiratory crackles sound like? Which conditions are they heard in?

Answer 38

separating velcro sound pulmonary fibrosis

Question 39

What is pitting sacral and pedal oedema suggestive of?

Answer 39

congestive heart failure

Question 40

What signs can be seen on calves that are suggestive of a DVT?

Answer 40

swelling increased temperature erythema visible superficial veins

Question 41

What is erythema nododum associated with?

Answer 41

sarcoidosis

Question 42

What further investigations/assessments might you offer to do/order after a respiratory examination?

Answer 42

Check oxygen saturation and apply supplemental oxygen if indicated Check other vital signs (temperature, BP) Take a sputum sample Perform peak flow assessment Request a CXR Take an ABG Perform full cardiovascular exam (eg. if suspecting cor pulmonale)