Clinical Examination And Signs Of Common Resp Diseases

Question 1

What does SQITARS stand for?

Answer 1

Site
Quality 
Intensity 
Timing
Aggravating factors
Relieving factors
Secondary symptoms

Question 2

What are the 7 principle symptoms for respiratory conditions?

Answer 2

Chest pain
Breathlessness
Cough 
Sputum 
Haemoptysis 
Wheeze 
Hoarseness

Question 3

Describe pleuritic chest pain

Answer 3

Can be anywhere in the chest
Sharp
Made worse by deep inspiration and coughing

Question 4

Give some causes of pleuritic chest pain

Answer 4

Lobar pneumonia
PE
Infarction
Pneumothorax

Question 5

Define dyspnoea

Answer 5

An awareness that it is taking an abnormal amount of effort to breathe

Question 6

Give some common causes of breathlessness

Answer 6

Unfit
Infection 
Pleural effusion 
COPD
Anaemia

Question 7

How do we assess how bad dyspnoea is?

Answer 7

MRC dyspnoea score

1 - 5

Question 8

Give some characteristics that can describe coughing

Answer 8

Throat clearing 
Barking
With blood 
Painful 
Productive

Question 9

What is the likely cause of a cough lasting < 3 weeks?

Answer 9

Upper/lower resp tract infection

Question 10

What are some causes of a cough lasting > 3 weeks?

Answer 10

COPD
Asthma 
Reflux
Lung carcinoma 
Medication (ACEi)

Question 11

Give some causes of haemoptysis

Answer 11

Bronchitis 
Bronchial carcinoma
Pneumonia
Pulmonary infarction 
TB

Question 12

Give some causes of a wheeze

Answer 12

Asthma
COPD
Foreign body

Question 13

What gives hoarseness of voice?

Answer 13

Transient inflammation of vocal cords

Recurrent laryngeal nerve palsy (LHS)

Question 14

What drugs can give a wheeze as a side effect?

Answer 14

Beta blockers

Question 15

When we stand back and observe the patient in resp exam, what are we looking at?

Answer 15

Comfort
Breathing - fast, laboured, accessory muscle use
Medication/machines/oxygen around

Question 16

How can lung cancer give wasting of hands?

Answer 16

Apical lung tumours
T1 nerve root compression
Atrophy of muscles of hands

Question 17

What is a pigeon chest?

Answer 17

Prominent sternum/costal cartilage

Question 18

What is a funnel chest?

Answer 18

Depression of lower end of sternum

Question 19

What happens to vocal resonance with consolidation?

Answer 19

Increases

We can hear 99 more clearly through the stethoscope

Question 20

What investigations might you state for completion at the end of a resp exam?

Answer 20

Peak flow
Sputum exam and culture
Temperature

Question 21

What do we call the normal breathing sounds?

Answer 21

Vesicular

Question 22

Why might we get reduced chest movements on one side?

Answer 22

Pain
Lung collapse
Fluid
Obstruction

Question 23

Why might we get reduced chest movement on both sides of lungs?

Answer 23

Stiff lungs (ILD)
Hyperinflated (COPD, severe asthma)

Question 24

Why do you get reduced/absent breath sounds?

Answer 24

Air or fluid between lung and chest wall

Question 25

When is vocal resonance increased?

Answer 25

When bronchial breathing is present

Question 26

What is tactile vocal fremitus?

Answer 26

Palpable vocal resonance

Question 27

Describe how lobar pneumonia would appear in the clinical examination

Answer 27

``` Central trachea Reduced chest movements on affected side Dull percussion of affected area Bronchial breath sounds Increased vocal resonance Crackles +/- pleural ribs if spread to pleura ```

Question 28

Describe how pleural effusion would appear in the resp clinical exam

Answer 28

``` Mediastinum shifted away Reduced chest movements on affected side Stony dullness over area Vesicular breast sounds (reduced intensity on affected side) Reduced vocal resonance ```

Question 29

Describe how pneumothorax would appear in the resp clinical exam

Answer 29

``` Mediastinum shifted away Reduced chest movements on affected side Hyperresonant over affected area Reduced/absent breath sounds on affected side Reduced vocal resonance ```

Question 30

Describe how lobar/lung collapse would appear in the resp clinical exam

Answer 30

Mediastinum pulled to affected side Decreased chest movements on affected side Percussion - normal or dull Breath sounds decreased or absent where affected Reduced vocal resonance

Question 31

Describe how localised lung fibrosis would appear in the resp clinical exam

Answer 31

``` Mediastinum pulled towards affected side Chest movements reduced on affected side Percussion = normal/dull Vesicular breath sounds (+ crackles) Normal or increased vocal resonance - because trachea is closer to affected part (pulled) ```

Question 32

Describe how diffuse lung fibrosis would appear in the resp clinical exam

Answer 32

``` Central mediastinum Symmetrically reduced chest movements Normal percussion Vesicular breath sounds (+ crackles) Normal/increased vocal resonance ```

Question 33

Describe how COPD/asthma would appear on a clinical resp exam

Answer 33

Central mediastinum Chest movements reduced on both sides (already hyperinflated) Resonant percussion (bullae may be hyperresonant) Wheezing Vesicular breath sounds Normal vocal resonance

Question 34

Where does the liver normally start?

Answer 34

5th ICS

Question 35

What can happen to the liver in COPD?

Answer 35

May be pushed down by lungs May be palpable in the abdomen Lungs may stay resonant further down