Resp MedEd

Question 1

How would you explain the resp exam to a patient?

Answer 1

Check of your lungs and breathing which will involve me having a look at you hands, arms, face neck and leg and a closer look at your chest. Then a quick listen and feel of your chest and back

Question 2

What items do you look for around the bed?

Answer 2

1. Oxygen: how much and how
2. Sputum pot: amount and colour
3. Medicines: inhalers and diuretics
4. Peak flow meters
5. Cigarettes
6. Anything attached to patient, ECG, fluids, IV lines
7. Mobility aids

Question 3

What are the different types of oxygen device?

Answer 3

1. venturi mask
2. non-rebreathing mask
3. nasal cannulae
4. Look for CPAP or Bipap

Question 4

What are you looking at on the patient at the end of bed?

Answer 4

1. Cyanosis
2. SOB
3. Cough
4. Wheeze
5. Stridor
6. Cachexia

Question 5

Why may the patient be cyanotic?

Answer 5

1. poor circulation (peripheral vasoconstriction secondary to hypovolaemia)
2. inadequate oxygenation of blood (right to left cardiac shunting)

Question 6

What are signs of SOB?

Answer 6

1. nasal flaring
2. pursed lips
3. use of accessory muscles
4. intercostal muscle recession
5. tripod position

Question 7

What could SOB suggest?

Answer 7

1. asthma
2. pulmonary oedema
3. pulmonary fibrosis
4. lung cancer
5. COPD

Question 8

What could a productive cough be suggestive of?

Answer 8

1. pneumonia
2. bronchiectasis
3. COPD
4. CF

Question 9

What could a dry cough suggest?

Answer 9

1. asthma

2. interstitial lung disease

Question 10

What is a wheeze often associated with?

Answer 10

1. asthma
2. COPD
3. bronchiectasis

Question 11

What could be a cause of stridor?

Answer 11

1. foreign body (acute)

2. subglottic stenosis (chronic)

Question 12

What could pallor suggest?

Answer 12

1. underlying aneamia (haemorrhage or chronic disease)

2. poor perfusion (congestive heart failure)

Question 13

When may there be oedema?

Answer 13

right ventricular failure

Question 14

What is pulmonary oedema associated with?

Answer 14

secondary to left ventricular failure

Question 15

What is cachexia associated with?

Answer 15

1. lung cancer

2. end stage COPD

Question 16

What general things do you look for in the hands?

Answer 16

1. Colour
2. Tar staining
3. Skin changes
4. Joint swelling or deformity

Question 17

What would cyanosis of the hands suggest?

Answer 17

underlying hypoxaemia

Question 18

What would bruising and thinning of skin of hands suggest?

Answer 18

long term steroid use e.g. COPD, asthma, ILD

Question 19

Why is joint swelling relevant?

Answer 19

RA can have resp manifestations e.g. pleural effusions / pulmonary fibrosis

Question 20

What are respiratory causes of clubbing?

Answer 20

1. Lung cancer
2. Interstitial lung disease
3. Cystic fibrosis
4. Bronchiectasis
   NOT COPD

Question 21

What are the special things to look for on the hands?

Answer 21

1. finger clubbing
2. fine tremor
3. asterixis
4. temp

Question 22

When might there be a fine tremor?

Answer 22

beta-2-agonist use (e.g. salbutamol

Question 23

Why might there be asterixis?

Answer 23

1. CO2 retention (T2 resp failure)
2. Uraemia
3. Hepatic encephalopathy

Question 24

What would cool hands suggest?

Answer 24

poor peripheral perfusion

Question 25

What would excessively warm and sweaty hands suggest?

Answer 25

CO2 retention

Question 26

What do you do on the arms?

Answer 26

1. heart rate 2. resp rate 3. offer BP

Question 27

What are the 2 pulse abnormalities?

Answer 27

1. bounding pulse | 2. pulsus paradoxus

Question 28

When might there be a bounding pulse?

Answer 28

1. underlying CO2 retention (e.g. type 2 respiratory failure) 2. anaemia

Question 29

What is pulsus paradoxus?

Answer 29

pulse wave volume decreases significantly during the inspiratory phase

Question 30

When would there be pulsus paradoxus?

Answer 30

1. late sign of cardiac tamponade 2. severe acute asthma 3. severe exacerbations of COPD

Question 31

When may you have bradypnoea?

Answer 31

opiate overdose

Question 32

When may you have tachypneoa?

Answer 32

acute asthma

Question 33

What does a raised JVP indicate?

Answer 33

venous hypertension

Question 34

What are resp causes of raised JVP?

Answer 34

pulmonary hypertension

Question 35

When does pulmonary hypertension happen?

Answer 35

1. Right sided heart failure 2. COPD 3. ILD

Question 36

What would clear sputum suggest?

Answer 36

COPD + bronchiectasis with no current infection

Question 37

What would yellow sputum suggest?

Answer 37

acute lower resp tract infection + asthma

Question 38

What would green sputum suggest?

Answer 38

current infection either new or acute exacerbation of a chronic condition

Question 39

What would red/rusty brown sputum suggest?

Answer 39

pneumococcal pneumonia

Question 40

What would a mucus plug suggest?

Answer 40

asthma

Question 41

What would blood in sputum suggest?

Answer 41

1. Lung cancer (streaks) 2. PE with pleurtic chest pain 3. Bronchiectasis

Question 42

What would pink frothy sputum suggest?

Answer 42

acute pulmonary oedema (seen in LHF)

Question 43

What would thenar/hypothenar wasting suggest?

Answer 43

pancoasts tumour

Question 44

What do you look for on palmar side of hands?

Answer 44

1. thenar/hypothenar wasting 2. temperature 3. between fingers for tar staining

Question 45

What do you look for on dorsal side of hands?

Answer 45

1. cap refill 2. clubbing 2. dorsal guttering 4. thin skin / brusing

Question 46

What does dorsal guttering mean?

Answer 46

1. TB and cancer | 2. ulnar nerve palsy

Question 47

What is pulse alternans?

Answer 47

alternating strong and weak pulse

Question 48

When might there be pulse alternans?

Answer 48

LHF causing pulmonary oedema

Question 49

What are LHF signs?

Answer 49

1. tired 2. fatigue 3. breathlessness 4. PND/orthopnoea

Question 50

What are RHF signs?

Answer 50

1. peripheral oedema | 2. elevated JVP