The Respiratory Examination

Question 1

The lungs are protected by a cylinder made up of:

Answer 1

• Ribs
• Vertebra
• Diaphragm

Question 2

What does pleural effusion mean?

Answer 2

Accumulation of fluid within the pleural cavity

Question 3

What makes up the Mediastinum?

Answer 3

The heart, trachea, oesophagus and great blood vessels and nerves sit between the lungs and make up a structure called the mediastinum

Question 4

Left lung structure

Answer 4

Apex of the heart points to the left, making the left lung smaller:

• 2 lobes
• separated by the oblique fissure

Question 5

Right Lung Structure

Answer 5

• Both horizontal (upper) and oblique (lower) fissures

- 3 lobes

Question 6

Muscles of respiration are:

Answer 6

1. Diaphragm

2. Intercostal muscles

Question 7

Normal Respiratory Rate

Answer 7

16-25 breaths / minute

Question 8

Tachypnoea is defined as:

Answer 8

Rapid respiratory rate: >25 breaths per minute

Question 9

Bradypnoea is defined as:

Answer 9

Respiratory rate below 8

- a level associated with sedation and adverse prognosis

Question 10

In normal relaxed breathing, what muscles are active?

Answer 10

The diaphragm is the only active muscle, and is active only in inspiration
- expiration is a passive process

Question 11

What is a sign of an increase in the work of breathing?

Answer 11

The use of accessory muscles of inspiration

Question 12

The use of accessory muscles in respiration are a characteristic sign of what condition?

Answer 12

COPD

Question 13

What are the accessory muscles?

Answer 13

• Sternocleidomastoids
• Platysma
• Strap muscles of the neck

Question 14

What does use of the accessory muscles characteristically cause?

Answer 14

Elevation of the shoulders with inspiration - aid respiration by increasing chest expansion

Question 15

Contraction of the abdominal muscles during expiration may occur in:

Answer 15

Patients with obstructed airways

Question 16

What is often seen in patients with severe COPD on inspiration?

Answer 16

In-drawing of the intercostal and supraclavicular spaces - this is due to a delayed increase in lung volume despite the generation of large negative pleural pressures

Question 17

What is a characteristic breathing pattern seen in COPD?

Answer 17

Pursed-lips breathing

Question 18

Tracheal tug is seen in:

Answer 18

1. COPD

2. Severe asthma - especially in kids

Question 19

What is a tracheal tug?

Answer 19

Increased diaphragmatic movements may cause downward displacement of the trachea during inspiration: tracheal tug

Question 20

What is the benefit of pursed-lips breathing in COPD?

Answer 20

This manoeuvre reduces the patient’s breathlessness possibly by providing continuous positive airway pressure and helping to prevent airway collapse during expiration

Question 21

What makes patients with severe COPD feel more comfortable?

Answer 21

Leaning forward with their arms on their knees
- this position compresses the abdomen and pushes the diaphragm upwards partly restoring its normal domed shape and improving effectiveness during inspiration

Question 22

Central cyanosis becomes evident at what point?

Answer 22

When the absolute concentration of deoxygenated Hb is 50g/L of capillary blood

Question 23

Cyanosis is usually obvious when arterial oxygen saturation falls below what point?

Answer 23

Below 90% in a person with normal Hb

Question 24

What are examples of lung diseases serious enough to cause central cyanosis?

Answer 24

• pneumonia
• COPD
• pulmonary embolism

Question 25

Cough character: lack of the usual explosive beginning may indicate what?

Answer 25

Vocal cord paralysis (the bovine cough)

Question 26

Cough character: A muffled, wheezy, ineffective cough suggests what?

Answer 26

Obstructive pulmonary disease

Question 27

Cough character: A very loose, productive cough suggests what?

Answer 27

Excessive bronchial secretions due to: - chronic bronchitis - pneumonia - bronchiectasis

Question 28

Cough character: A barking or croupy cough suggests what?

Answer 28

Suggests a problem with the upper airway: | - the pharynx / larynx or pertussis infection

Question 29

Cough character: What may cause a dry, irritating cough?

Answer 29

Occurs with: - chest infection - asthma - carcinoma of the bronchus - sometimes with LV failure or interstitial lung disease

Question 30

What causes stridor?

Answer 30

Obstruction of the larynx or trachea: - foreign body - tumor - infection - inflammation

Question 31

Causes of hoarseness (dysphonia):

Answer 31

- may indicate recurrent laryngeal nerve palsy associated with carcinoma of the lung (usually left sided) - most common cause = laryngitis or use of inhaled corticosteroids for asthma - non respiratory: hypothyroidism

Question 32

What is Hypertrophic Pulmonary Osteoarthropathy?

Answer 32

An uncommon but important association with clubbing: - characterized by the presence of periosteal inflammation at the distal ends of long bones, the wrists, the ankles, the metacarpal and metatarsal bones. - swelling and tenderness over the wrists and other involved areas

Question 33

Causes of HPO

Answer 33

- primary lung carcinoma | - pleural fibromas

Question 34

What can cause wasting of the small muscles of the hand and weakness of finger abduction?

Answer 34

Compression and infiltration by a peripheral lung tumor of a lower trunk of the T1 nerve

Question 35

What are important cardiac signs of severe asthma?

Answer 35

Tachycardia and pulsus paradoxus

Question 36

Why is tachycardia seen in asthma?

Answer 36

- tachycardia is a common SE of the treatment of asthma with beta-blockers - and accompanies dyspnoea or hypoxia of any cause

Question 37

Clinical signs of severe CO2 retention

Answer 37

- confusion - warm peripheries - bounding pulse

Question 38

A flapping tremor with a 2- to 3- second cycle may occur in what conditions?

Answer 38

In severe CO2 retention (usually due to COPD) | - also seen in liver and renal failure

Question 39

Clinical examination of the nose (nostrils) what could polyps indicate?

Answer 39

Asthma

Question 40

Clinical examination of the nose (nostrils) what could enlarged turbinates indicate?

Answer 40

Various allergic conditions

Question 41

Clinical examination of the nose (nostrils) what could a deviated septum indicate?

Answer 41

Nasal obstruction