Respiratory exam

Question 1

What signs are there of respiratory distress on general inspection?

Answer 1

Tachypnoea (rapid breathing)
Nasal flaring
Tracheal tug
Accessory muscle
Intercostal, subcostal and sternal recession
Pulsus paradoxus

Question 2

What is pulsus paradoxus?

Answer 2

Systolic pressure weakens by >10mmHg on inspiration

Question 3

What is tracheal tug?

Answer 3

Pulling of thyroid cartilage towards sternal notch in inspiration.

Question 4

Which are the accessory muscles?

Answer 4

Sternocleidomastoid
Platysma
Infrahyoid

Question 5

What should you look for around the patient?

Answer 5

O2
Nebulisers
Inhaler
Sputum pots (look!)
Cigarettes

Question 6

When would you see paradoxical breathing?

Answer 6

Paralysed diaphragm

Question 7

How does paradoxical breathing present?

Answer 7

Abdomen sucked in with inspiration.

Question 8

On general inspection what do you look for?

Answer 8

Cachetic?
Uncomfortable at rest. 
Pain
Cyanotic
Alert/drowsy

Question 9

What might respiratory distress be due to? 4 things.

Answer 9

COPD
Pleural effusion
Pneumothorax
Severe asthma

Question 10

On general inspection, what would you listen for?

Answer 10

Speech
Stridor
Wheeze
Cough
Clicks
Gurgling

Question 11

Abnormal speech due to?

Answer 11

Obstruction, recurrent laryngeal nerve palsy.

Question 12

Causes of stridor?

Answer 12

Airway obstruction (broncial carcinoma, retrosternal thyroid)

Question 13

How would you categorise a cough?

Answer 13

Dry, bovine (non-explosive, unable to close glottis), productive.

Question 14

Causes of clubbing?

Answer 14

Idiopathic pulmonary fibrosis
Lung cancer
Sarcoidosis

Question 15

What is Pancoast’s tumour?

Answer 15

A tumour at the pulmonary apex, invades the sympathetic plexus of the neck, brachial plexus, recurrent laryngeal nerve.

Question 16

Why would intrinsic hand muscles waste?

Answer 16

T1 lesion/damage of brachial plexus due to Pancoast’s tumour.

Question 17

How would an apical lung tumour invading sympathetic neck plexus present?

Answer 17

Ipsilateral Horner’s

Question 18

How would an apical lung tumour invading recurrent laryngeal nerve present?

Answer 18

Hoarse voice, bovine cough.

Question 19

How would an apical lung tumour invading brachial plexus present?

Answer 19

Wasting of intrinsic muscles of hand (and arm).

Question 20

Why do you check for hand tremor?

Answer 20

Beta agonist use

Question 21

What is asterixis?

Answer 21

Flap of the hands. CO2 retention (i.e too little co2 removed by the lungs).

Question 22

What would tender wrists indicate?

Answer 22

Hypertrophic pulmonary osteoarthropathy (ca)

Question 23

Bounding pulse indicates?

Answer 23

Co2 retention (leaping and forceful that quickly disappears).

Question 24

What is Horner’s syndrome?

Answer 24

Deficiency in sympathetic outflow - symptoms appear on the ipsilateral side as the site of the lesion.

Question 25

What are the symptoms of Horner's syndrome?

Answer 25

Ptosis, miosis, anhydrosis.

Question 26

What distance of crico-sternal expansion is hyperexpansion?

Answer 26

>3cm

Question 27

How would severe airflow limitation manifest?

Answer 27

Tracheal tug (with inspiration)

Question 28

What is Cor Pulmonale?

Answer 28

Enlargement and failure of the right ventricle due to increased pulmonary pressure/vascular resistance. Raised JVP.

Question 29

What might cause lymphadenopathy?

Answer 29

Cancer | TB

Question 30

Would a tension pneumothorax cause tracheal deviation away from or towards?

Answer 30

Away

Question 31

Why might the apex beat be impalpable?

Answer 31

Pleural effusion COPD Dextrocardia

Question 32

How far should the chest wall expand?

Answer 32

5cm or more

Question 33

What does increased consolidation imply (tactile vocal fremitus).

Answer 33

d

Question 34

Why should you palpate the left supraclavicular node (aka Virchow's node?

Answer 34

It drains the thoracic duct. An elarged node indicates metastatic neoplasm e.g. lung or abdominal.

Question 35

What is an enlarged supraclavicular node called?

Answer 35

Troisier's sign.

Question 36

What 5 things might cause a dull percussion note?

Answer 36

``` Consolidation Pleural effusion Collapse Fibrosis Pleural thickening ```

Question 37

Where does liver dullness usually reach?

Answer 37

Up to the 5th rib, right mid-clavicular line

Question 38

What does it imply if you hear resonant percussion below the 5th rib, right mid-clavicular line?

Answer 38

Lung hyper-expansion. | COPD, asthma

Question 39

On percussion, what does hyper-resonance indicate?

Answer 39

Pneuothorax or hyperinflation (COPD)

Question 40

What might cause hyperinflation?

Answer 40

COPD, cystic fibrosis or asthma

Question 41

What is bronchial breathing and how does it sound?

Answer 41

Harsh. Gap between inspiration and expiration. Expiration may be high pitched.