Respiratory Exam

Question 1

General Inspection

Answer 1

Body habitus, well/unwell, breathless- pursed lip breathing (COPD)

Question 2

Nails

Answer 2

Clubbing

Koilonychia

Question 3

Clubbing

Answer 3

Interstitial lung disease, lung cancer, bronchiectasis

Question 4

Koilonychia

Answer 4

Iron deficiency anaemia causing shortness of breath

Question 5

Hands

Answer 5

Temperature and cap refill
Peripheral cyanosis 
Tar staining
Flapping tremor 
Fine tremor

Question 6

Temperature and Cap Refill

Answer 6

Perfusion

Question 7

Peripheral Cyanosis

Answer 7

Hypoxia

Question 8

Tar Staining

Answer 8

Smoking

Smell

Question 9

Flapping Tremor

Answer 9

Severe CO2 retention

Question 10

Fine Tremor

Answer 10

Excessive beta 2 agonist use

Question 11

Face

Answer 11

Cushingoid

Long term steroid use

Question 12

Eyes

Answer 12

Horner’s- ptosis and miosis
Conjunctival pallor
Iritis, conjunctivitis

Question 13

Horner’s

Answer 13

Ptosis and miosis

Pancoast tumour pressing on sympathetic chain of nerves in the chest

Question 14

Conjunctival pallor

Answer 14

Anaemia

Question 15

Iritis, conjunctivitis

Answer 15

TB, sarcoidosis

Question 16

Mouth

Answer 16

Central cyanosis

Hypoxia

Question 17

JVP

Answer 17

RHF, overload, massive PE, tension pneumothorax, cardiac tamponade, SVC obstruction

Question 18

Tracheal Tug

Answer 18

Trachea pulled down on inspiration due to hyperinflation

COPD

Question 19

Tracheal deviation

Answer 19

Deviates towards: collapse, pneumonectomy

Deviates away: tension pneumothorax, very big effusion

Question 20

Cricosternal Distance

Answer 20

2-3 finger breadths

Reduced with hyperinflation

Question 21

Lymph Nodes

Answer 21

Anterior and posterior triangles, supraclavicular and axilla (lymph drainage from chest wall)

Question 22

Chest Inspection

Answer 22

Deformity and symmetry
Scars
Respiratory pattern
Intercostal drawing

Question 23

Scars

Answer 23

Thoracotomy, chest drain, radiotherapy tattoo

Question 24

Deformity and symmetry

Answer 24

Barrel chest - hyperinflation
Pectus excavatum (funnel chest) - developmental defect
Pectus carinatum (Pigeon chest) - increase respiratory effort 
Paradoxical movement chest/ abdo - COPD or obstruction

Question 25

Respiratory Pattern

Answer 25

Prolonged expiratory phase - signs of smoking related lung disease if coupled with pursed lips breathing

Question 26

Intercostal drawing

Answer 26

COPD due to hyperinflation

Question 27

Palpation

Answer 27

Expansion Parasternal heave Apex beat

Question 28

Parasternal Heave

Answer 28

Cor pulmonale

Question 29

Apex Beat

Answer 29

Collapse | Tension penumothorax

Question 30

Percussion

Answer 30

Resonant- normal Hyper resonant- pneumothorax, emphysematous bullae Dull- consolidation, collapse, alveolar fluid, pleural thickening, neoplasm Stony dull- extreme dullness over a pleural effusion

Question 31

Breath sounds

Answer 31

Vesicular- normal Diminished: local- effusion, tumour, pneumothorax, pneumonia, collapse/ global- COPD Bronchial (darth vader breathing)- consolidation, upper boarder of pleural effusion Wheeze (usually expiratory): polyphonic- asthma, COPD, monophonic- carcinoma or foreign body Crepitations (crackles like velco)- infection, fluid or fibrosis Rub (footstep in fresh snow)- pneumonia, PE with infarction

Question 32

Vesicular

Answer 32

Normal

Question 33

Diminished Breath Sounds

Answer 33

Local- effusion, tumour, pneumothorax, pneumonia, collapse | Global- COPD

Question 34

Bronchial Breathing

Answer 34

Darth Vader breathing Consolidation Upper boarder of pleural effusion

Question 35

Wheeze

Answer 35

Usually expiratory Polyphonic- asthma/ COPD Monophonic- carcinoma or foreign body

Question 36

Crepitations

Answer 36

Crackles like velcro | Infection, fluid or fibrosis

Question 37

Rub

Answer 37

Footsteps in fresh snow Pneumonia PE with infarction

Question 38

Vocal Resonance

Answer 38

Rarely performed in clinical practice 'say 99 everytime I place my stethoscope on your chest' Increased- consolidation Reduced- effusion, pneumothorax

Question 39

Sacral and ankle oedema

Answer 39

Right heart failure