Respiratory

Question 1

Inspection

Answer 1

Tachypnoea, cough, cyanosis, use of accessory muscles, audible wheeze, nasal flaring, sweating

Question 2

Displaced trachea towards lung lesion

Answer 2

Upper lobe collapse
Upper lobe fibrosis
Pneumonectomy

Question 3

Displaced trachea away from lesion

Answer 3

Tension pneumothorax
Pleural effusion

Question 4

Causes of unilateral decreased chest expansion

Answer 4

Pneumothorax
Pleural effusion
Collapsed lung
Consolidation

Question 5

Causes of bilateral decreased chest expansion

Answer 5

Asthma
COPD

Question 6

Causes of hyperresonance

Answer 6

Pneumothorax
COPD

Question 7

Causes of hyporesonance

Answer 7

Tumour
Consolidation
Collapsed lung
Pleural effusion - stoney dull

Question 8

What causes wheeze, crepitations, pleural rub, stridor?

Answer 8

Wheeze - asthma, COPD
Crepitations - consolidation from pneumonia
Pleural rub - pleural effusion
Stridor - airway obstruction with foreign body

Question 9

What parts of the respiratory system produce inspiratory and expiratory sounds?

Answer 9

in - lobar/segmental
ex - central airways

Question 10

When are bronchial sounds heard pathologically?

Answer 10

Consolidation
Localised pulmonary fibrosis
Pleural effusion
Collapsed lung

Question 11

What can cause reduced intensity of vesicular breathing?

Answer 11

Shallow breathing
Airway obstruction
Hyperinflation
Pneumothorax
Pleural effusion
Pleural thickening
Obesity

Question 12

What can cause a decrease in tactile vocal fremitus?

Answer 12

Pneumothorax
COPD
Pleural effusion

Question 13

What can cause a increase in tactile vocal fremitus?

Answer 13

Consolidation in pneumonia
Lung tumour

Question 14

Outline the respiratory causes of cervical lymphadenopathy (enlarged swollen nodes)

Answer 14

Lung cancer metastasising to nodes
Respiratory tract infection
Tuberculosis
Sarcoidosis

Question 15

Indications of chest drain

Answer 15

Tension pneumothorax
Haemothorax
Pleural effusion

Question 16

Where does the needle for chest drains go?

Answer 16

upper border of 3rd, 4th, 5th rib
upwards and medially to avoid intercostal nerve

Question 17

What can be damaged if a needle is inserted anterior to MAL? What is the result of this?

Answer 17

May damage long thoracic nerve
Innervates serratus anterior
Winged scapula

Question 18

How is the chest drain procedure different for apical pneumothoraxes?

Answer 18

2nd ICS MCL

Question 19

Complications of central line

Answer 19

Pneumothorax
Carotid artery puncture

Question 20

Where does the trachea bifurcate?

Answer 20

Sternal angle
Rib 2
T4

Question 21

In which bronchi do objects tend to get stuck in?

Answer 21

Right bronchi- wider and more vertical

Question 22

In which bronchi do objects tend to get stuck in?

Answer 22

Right bronchi- wider and more vertical

Question 23

What are the red flags for lung cancer?

Answer 23

Weight loss

Fatigue

Haemoptysis

Anorexia

Cachexia

Pack years

SOB

Lethargy

Question 24

Outline some respiratory examination findings suggestive of lung cancer?

Answer 24

Finger nail clubbing

Shortness of breath on exertion and pursed lip breathing

POLYPHONIC WHEEZE

Question 25

What is an apical lung cancer called?

Answer 25

Pancoast tumour

Question 26

Outline some complications of apical lung tumour?

Answer 26

**Horners syndrome**: Involvement of sympathetic fibres as they exit the cord at T1 and ascend to the superior cervical ganglion - unilateral ptosis - Unilateral Anhidrosis - Unilateral Mitosis dysarthria **Hand weakness- atrophy of intrinsic hand muscles** - involvement of brachial plexus nerves namely ulnar nerve **Shoulder pain- along distribution of C8/T1/T2**