Resp MedEd 2

Question 1

What do you look for in the face?

Answer 1

plethoric complexion

Question 2

When might you have a plethoric complexion?

Answer 2

1. polycythaemia (e.g. COPD)

2. CO2 retention (e.g. T2 resp failure)

Question 3

What do you look for in the eyes?

Answer 3

1. conjunctival pallor

2. ptosis miosis and enophthalmos

Question 4

Why do you ask about conjuctival pallor?

Answer 4

underlying anaemia

Question 5

Why do you ask about ptosis, miosis and enophthalmos?

Answer 5

horners syndrome

Question 6

Why is horner’s syndrome relevant for resp?

Answer 6

sympathetic trunk is damaged by pathology such as lung cancer affecting the apex of the lung (e.g. Pancoast tumour)

Question 7

What are you looking for in the mouth?

Answer 7

1. central cyanosis

2. candidiasis

Question 8

Why may there be central cyanosis?

Answer 8

hypoxaemia

Question 9

Why might someone have oral candidiasis?

Answer 9

steroid inhaler use (due to local immunosuppression)

Question 10

What Scars on the chest do you look for?

Answer 10

1. median sternotomy scar
2. axillary thoracotomy scar
3. posteriolateral thoractotomy scar
4. infraclavicular scar
5. radiotherapy associated skin changes

Question 11

Why may there be a median sternotomy scar?

Answer 11

1. cardiac valve replacement

2. CABG

Question 12

When might there be an axillary throacotomy scar?

Answer 12

insertion of chest drains

Question 13

When might there be a posterolateral thoracotomy scar?

Answer 13

1. lobectomy
2. pneumonectomy
3. oesophageal surgery

Question 14

Why may there be a infraclavicular scar?

Answer 14

pacemaker insertion

Question 15

What are some radiotherapy-assoicated skin changes?

Answer 15

1. xerosis (dry skin)
2. scale
3. hyperkeratosis (thickened skin)
4. depigmentation
5. telangiectasia

Question 16

What are examples of chest wall deformities?

Answer 16

1. asymmetry
2. pectus excavatum
3. pectus carinatum
4. hyperexpansion (barrel chest)

Question 17

Why might there be asymmetry?

Answer 17

1. pneumonectomy (e.g. lung cancer)

2. thoracoplasty (e.g. tuberculosis).

Question 18

What is pectus excavatum?

Answer 18

caved-in or sunken appearance of the chest

Question 19

What is pectus carinatum?

Answer 19

protrusion of the sternum and ribs

Question 20

What is hyperexpansion / barrel chest usually due to?

Answer 20

• chest wider and taller than normal

- chronic lung diseases such as asthma and COPD

Question 21

When is the trachea deviated away?

Answer 21

1. tension pneumothroax

2. large pleural effusion

Question 22

When is a trachea deviated towards?

Answer 22

1. lobar collapse

2. pneumonectomy

Question 23

What are the respiratory causes of a displaced apex beat?

Answer 23

1. Right ventricular hypertrophy (e.g. pulmonary hypertension, COPD, interstitial lung disease)
2. Large pleural effusion
3. tension pneumothorax

Question 24

What are the respiratory causes of a symmetrically reduced chest expansion?

Answer 24

pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion.

Question 25

What are the respiratory causes of an asymmetrically reduced chest expansion?

Answer 25

1. pneumothorax 2. pneumonia 3. pleural effusion

Question 26

What would a resonant percussion note suggest?

Answer 26

normal finding

Question 27

What would dullness on percussion suggest?

Answer 27

increased tissue density 1. cardiac dullness 2. consolidation 3. tumour 4. lobar collapse

Question 28

What would stony dullness on percussion suggest?

Answer 28

pleural effusion

Question 29

What would hyper-resonance on percussion suggest?

Answer 29

- decreased tissue density | 1. pneumothorax

Question 30

What would increased vibration in tactile vocal fremitus suggest?

Answer 30

- increased density 1. consolidation 2. tumour 3. lobar collapse

Question 31

What would decreased vibration in tactile vocal fremitus suggest?

Answer 31

- presence of fluid or air outside of the lung 1. pleural effusion 2. pneumothorax

Question 32

What would vesicular breath sounds suggest?

Answer 32

normal

Question 33

What are bronchial breath sounds?

Answer 33

harsh-sounding (similar to auscultating over the trachea), inspiration and expiration are equal and there is a pause between

Question 34

What are bronchial breath sounds associated with?

Answer 34

consolidation

Question 35

What would quiet breath sounds suggest?

Answer 35

- reduced air entry into that region of the lung 1. pleural effusion 2. pneumothorax - presenting your findings, state ‘reduced breath sounds’, rather than ‘reduced air entry’.

Question 36

What are examples of added sounds?

Answer 36

1. wheeze 2. stridor 3. coarse crackles 4. fine end-inspiratory crackles

Question 37

What does wheeze sound like?

Answer 37

continuous, coarse, whistling sound produced in the respiratory airways during breathing

Question 38

What is a wheeze associated with?

Answer 38

1. asthma 2. COPD 3. bronchiectasis

Question 39

What is a stridor breath sound?

Answer 39

high-pitched extra-thoracic breath sound resulting from turbulent airflow through narrowed upper airways

Question 40

What are causes of stridor breath sound?

Answer 40

1. foreign body inhalation (acute) | 2. . subglottic stenosis (chronic)

Question 41

What do coarse crackles sound like?

Answer 41

discontinuous, brief, popping lung sounds

Question 42

What are coarse crackles usually associated with?

Answer 42

1. pneumonia 2. bronchiectasis 3. pulmonary oedema

Question 43

What are fine end-inspiratory crackles?

Answer 43

sounding similar to the noise generated when separating velcro

Question 44

When might you hear fine end-inspiratory crackles?

Answer 44

pulmonary fibrosis

Question 45

What are the respiratory causes of lymphadenopathy?

Answer 45

1. lung cancer with metastases 2. tuberculosis 3. sarcoidosis

Question 46

What is the name of the different lymph nodes?

Answer 46

1. Submental 2. Submandibular 3. Pre-auricular 4. Post-auricular 5. Superficial cervical 6. Deep cervical 7. Posterior cervical 8. Supraclavicular – left supraclavicular region is where Virchow’s node may be noted (associated with upper gastrointestinal malignancy)

Question 47

How could you see respiratory distress?

Answer 47

flared nostril and pursed lip breathing

Question 48

Why might there be an abnormal cricosternal distance?

Answer 48

distance of fewer than 3 fingers suggests underlying lung hyperinflation 1. asthma 2. COPD

Question 49

Why might there be an abnormal cricosternal distance?

Answer 49

distance of fewer than 3 fingers suggests underlying lung hyperinflation 1. asthma 2. COPD

Question 50

How could you see DVT on legs?

Answer 50

1. Inspect: red and swollen 2. Palpate: tender and hot 3. Watch their face for pain

Question 51

What would erythema nodosum on the legs suggest?

Answer 51

sarcoidosis