Respiratory Exam

Question 1

How does type of cough guide differential?

Answer 1

Productive: COPD, CF, Pneumonia, Bronchiectasis
Dry: Asthma + interstitial lung disease

Question 2

3 conditions a/w WHEEZE

Answer 2

COPD
Asthma
Bronchiectasis
(LRT pathology)

Question 3

2 causes of stridor

Answer 3

Inhaled foreign object
Subglottic stenosis
URT pathology

Question 4

List 6 signs of respiratory distress

Answer 4

Tachypnoea
Nasal flaring
Tracheal tug (pulling of thyroid cartilage towards sternal notch in insp). Descent of trachea with insp limiting airflow.
Use of access muscles
Intercostal, subcostal, sternal recession
Pulsus paradoxus

Question 5

What is indicated by cachexia?

Answer 5

Malignancy
End stage lung disease e.g. COPD

Question 6

4 respiratory causes of clubbing

Answer 6

Chronic hypoxia in lung cancer (esp. Squamous cell carcinoma)
Interstitial lung disease
CF
Bronchiectasis

Question 7

What may cause a plethoric complexion of the face?

Answer 7

Polycythaemia secondary to COPD

CO2 retention in T2 respiratory failure

Question 8

What is the relevance of signs of horners syndrome to a respiratory exam?

Answer 8

Occurs when sympathetic trunk is damaged by pathology e.g. tumour in apex (pancoast tumour)

Question 9

What respiratory pathology can cause a raised JVP?

Answer 9

Pulmonary HTN due to COPD/ ILD can cause cor pulmonale leading to raised JVP

Question 10

5 radiotherapy associated skin changes that may be seen in respiratory exams

Answer 10

Xerosis (dry skin)
Scale
Hyperkeratosis (thickened skin)
Depigmentation
Telangiectasia

Question 11

Describe what causes deviation of the trachea away and towards a pathology

Answer 11

Towards: Lobar collapse, Pneumonectomy, Pulmonary fibrosis
Away: Tension pneumothorax, Large pleural effusion

Question 12

What does this indicate?

Answer 12

Lung volume reduction surgery

Question 13

What is seen here?

Answer 13

Healed chest drain incision

Question 14

What is seen here? What does this indicate?

Answer 14

Posterolateral thoracotomy
Lobectomy
Pneumonectomy

Question 15

What is seen here? What does this indicate?

Answer 15

Clamshell/ bilateral anterolateral thoracotomy / transverse sternotomy
Lung transplantation

Question 16

Give 2 causes of an asymmetrical chest wall

Answer 16

Pneumonectomy (e.g. lung cancer)

Thoracoplasty (e.g. tuberculosis)

Question 17

What is Pectus excavatum?

Answer 17

Caved-in/ sunken chest

Question 18

What is Pectus carinatum?

Answer 18

Protrusion of sternum + ribs
= pigeon chest
Chronic resp disease in childhood

Question 19

What is hyper expansion of the chest? What is it also known as? Which conditions is this seen in?

Answer 19

Chest wall wider + taller
Barrel chest
Chronic lung diseases e.g. Asthma + COPD

Question 20

What causes symmetrical reduced chest expansion? How?

Answer 20

Pulmonary fibrosis

Reduces lung elasticity, restricting overall chest expansion

Question 21

Give 3 causes asymmetrical reduced chest expansion

Answer 21

Pneumothorax
Pneumonia
Pleural effusion

Question 22

Give 3 causes of a displaced apex beat

Answer 22

RV hypertrophy
Large pleural effusion
Tension pneumothorax

Question 23

What is indicated by dullness to percussion?

Answer 23

Increased tissue density:
cardiac dullness
consolidation
tumour
lobar collapse

Question 24

What is indicated to stony dullness on percussion?

Answer 24

Pleural effusion

Question 25

What is indicated by hyper-resonance on percussion?

Answer 25

Decreased tissue density- pneumothorax

Question 26

Bronchial breath sounds

Answer 26

Harsh, pause in-between inspiration + expiration a/w consolidation

Question 27

What is suggested by quiet breath sounds?

Answer 27

Reduced air entry into that region of the lung e.g. pleural effusion, PTX

Question 28

Describe fine end-inspiratory crackles and what conditions they are associated with

Answer 28

“separating velcro” High pitched best heard at lung bases Pulmonary fibrosis

Question 29

Describe pleural rub and what conditions they are associated with

Answer 29

"walking on snow" inspiration + expiration Mesothelioma (asbestos exposure, RA + lupus) Pneumonia Pleurisy Pulmonary infarction

Question 30

What is indicated by increased volume on vocal resonance?

Answer 30

Increased tissue density Consolidation Tumour Lobar collapse

Question 31

What is indicated by decreased volume on vocal resonance?

Answer 31

Fluid or air outside of the lung Pleural effusion PTX

Question 32

List 4 respiratory causes of lymphadenopathy

Answer 32

Lung cancer URTI Tuberculosis Sarcoidosis

Question 33

If you hear crepitations what should you do?

Answer 33

Ask patient to cough Note whether creps clear after coughing Ask patient to lean forward Note whether creps clear on leaning forward