Respiratory Exam Theory

Question 1

what are normal and abnormal breath sounds?

Answer 1

Normal - vesicular.

Abnormal - Diminished or bronchial.

Question 2

What are possible added sounds?

Answer 2

• Wheeze,
• Crackles,
• Pleural rub,
• Stridor

Question 3

Why do you check the JVP in a respiratory exam?

Answer 3

• If it is raised then it indicates pulmonary hypertension.
• If acutely raised then may be a sign of tension pneumothorax or large PE
• May indicate right heart failure secondary to chronic lung disease or PE

Question 4

Why measure the cricosternal distance?

Answer 4

Because if it is smaller than three fingers width then it indicates hyperinflation

Question 5

Explain how and why you test vocal resonance

Answer 5

Conformation of lung consolidation. Using stethoscope listen to patients lung as they whisper ‘one one one’. When over healthy lung this should be muffled however over consolidated lung it is heard loudly.

Question 6

How many lobes are in each lung?

Answer 6

3 lobes in the right lung but 2 lobes in the left

Question 7

What are the normal and abnormal percussion sounds?

Answer 7

Normal - resonant.

Abnormal - dull (consolidation) or hyper-resonant (too much air)

Question 8

What are the respiratory causes of clubbing?

Answer 8

Lung cancer, mesothelioma, pulmonary fibrosis and any chronic suppurative lung disease eg emphysema.

Question 9

What signs are you looking for in the face?

Answer 9

Polycythaemia secondary to chronic lung disease or smoking. Pursing of the lips on expiration (suggesting emphysema), central cyanosis, pharynx and larynx and Horner’s syndrome (might suggest Pancoast tumour)

Question 10

What is spirometry?

Answer 10

Lung function test that tests how much a patient can breath out from full inspiratory volume

Question 11

What are the restrictive and obstructive spirometry results?

Answer 11

Restrictive - FEV1/FVC ratio is over 0.7
Obstructive - FEV1/FVC ratio is below 0.7

Question 12

What are some causes of restrictive spirometry results?

Answer 12

• Pulmonary fibrosis
• Pulmonary oedema
• Sarcoidosis
• Asbestosis
• Ankolysing spondylitis, kyphoscoliosis, morbid obesity
• Neuromusclae diseases eg, MND, GBS, ALS

Question 13

What are some causes of an obstructive spirometry result?

Answer 13

• COPD
• Asthma
• Bronchiectasis
• Cystic fibrosis

Question 14

When is reversibility testing used?

Answer 14

To rule in/out asthma. Considered reversible if >12% increase in FEV1 or an increase of 200ml in volume

Question 15

What are some causes for the following percussion?
Dull,
Stoney dull,
Hyperresonant

Answer 15

Dull - maligancy or infection
Stoney dull - pleural effusion
Hyperresonant - Pneumothroax

Question 16

What crackles can be heard in pulmonary fibrosis vs bronchiectasis?

Answer 16

Pulmonary fibrosis - fine inspiratory crackles like velcro.
Bronchiectasis - Coarse late expiratory crackles