Clinical Signs

Question 1

What are the respiratory causes of clubbing?

Answer 1

Interstitial lung disease
Cancer
Mesothelioma
Bronchiectasis
Cystic fibrosis
Lung abscess
Empyema
Tuberculosis

Question 2

What are the surface markings for respiratory examination?

Answer 2

Lower borders of lungs
Anterior: 6th rib
Lateral: 8th rib
Posterior: 10th rib

Angle of scapula
T7 vertebra

Question 3

What are the common causes of unilateral lung lesion?

Answer 3

1. Collapse
2. Consolidation
3. Effusion
4. Fibrothorax
5. Pneumothorax
6. Pneunomectomy or lobectomy
7. Pulmonary fibrosis

Question 4

What are the common causes of bilateral lung lesions?

Answer 4

1. Asthma, COPD
2. Bronchiectasis
3. Effusion
4. Interstitial lung disease

Question 5

What is palmar asterixis?
What are the causes of palmar asterixis?

Answer 5

Flapping tremor at the wrist, MCP or hip joint

Causes of palmar asterixis
1. Type 2 respiratory failure (CO2 retention flap)
2. Hepatic and renal failure (metabolic encephalopathy)
3. Hypovolaemia
4. Electrolyte abnormalities (hypokalaemia, hypomagnesaemia)
5. Drugs (alcohol, barbiturate, phenytoin, primidone)
6. Wilson’s disease (wing beating tremor)
7. Focal brain lesion (in rostral midbrain tegmentum)

Question 6

What are the causes of palmar erythema?

Answer 6

1. Chronic liver disease
2. Hyperdynamic circulation
   - CO2 rentention
   - Thyrotoxicosis
   - Pregnancy
3. Rheumatoid arthritis
4. Haematological - polycythaemia, leukaemia

Question 7

How do you properly examine for tracheal deviation?

Answer 7

Head in neutral position, not turned to either side

Middle finger on trachea in suprasternal notch
Index finger and ring finger on tendons of sternocleidomastoid

Palpate trachea, then either side of it
Draw finger down trachea to determine direction of travel

Normal: central or very slightly deviated to the right

Question 8

What condition causes tracheal deviation towards lesion?
What condition causes tracheal deviation away from lesion?

Answer 8

Deviate towards lesion
- Collapse
- Fibrosis, fibrothorax
- Lobectomy or pneumonectomy

Deviate away from lesion
- Effusion
- Pneumothorax

Question 9

What are the causes of abnormal percussion?

Answer 9

Dullness
1. Reduced airspaces: consolidation, collapse
2. Pleural thickening
3. Pleural effusion (stony dullness)
4. Raised hemidiaphragm due to phrenic nerve injury or hepatic lesion (dullness from liver)

Hyper-resonance
1. Pneumothorax

Question 10

What are the causes of pleural friction rub?

Answer 10

Grating sound on inspiration and expiration due to inflammation with roughening and rubbing of pleural surfaces

1. Pneumonia
2. Pulmonary infarct (embolism)
3. Trauma
4. Haemothorax
5. Metastasis
6. Connective tissue diseases
7. Uraemia
8. Radiation
9. Asbestosis

Question 11

Describe this breath sound

Answer 11

Coarse crepitations

Question 12

Describe this breath sound

Answer 12

Fine crepitations

Question 13

Describe this breath sound

Answer 13

Pleural friction rub