Examination

Question 1

General examination at foot of bed

Answer 1

Gait
Physique
Acute illness ? Chronic illness ?
Nutritional status ? Cachexia ?
Fever ? Sweating ? Chills ?
Breathless ?
Audible wheeze ? Stridor ?
Hoarse voice ?
Cyanosis ?
Pallor ?
Intercostal recession
Visible pulses ?
Bedside table (inhalers , peak flow meter, tissues, sputum pot , oxygen mask )

Question 2

Signs of breathlessness on patients

Answer 2

Use of accessory muscles (sternocleidomastoid )

Pursed lips

Question 3

Angle of bed in respiratory exam

Answer 3

45 degrees

Question 4

Hand examination in respiratory exam

Answer 4

Clubbing
Pallor
Cyanosis
Flapping of the hands
Fine tremor
Respiratory rate

Question 5

Respiratory causes of clubbing

Answer 5

Carcinoma of bronchus
Pulmonary fibrosis
Bronchiectasis
Lung abscess
Pleural empyema

Question 6

When do you see fine tremor in respiratory disease

Answer 6

Inhaled beta agonists (salbutamol)

Question 7

Normal respiratory rate

Answer 7

14-16 breaths / min

Question 8

Tachypnoea DEFINTION

Answer 8

Increased RR

Question 9

Dyspnoea

Answer 9

Symptom of breathlessness experienced by patient

Question 10

Apnoea

Answer 10

Cessation of respiration

Question 11

Cheyenne stokes breathing

Answer 11

Cyclical deepening and quickening of respiration followed by diminished respiratory rate and effort which can be associated with short apnea period
Cycle then repeats

Question 12

When do you see Cheyne stoke breathing

Answer 12

Severely ill patients
Severe cardiac failure
Narcotic drug poisoning
Neurological disorders
Elderly sleeping with no signs of dx

Question 13

Obstructive sleep apnea
What is it and when do you see it

Answer 13

Apnea despite continuation of respiratory efforts

Seen in obese patients dye to obstruction of upper airways by soft tissues

Question 14

Face exam

Answer 14

Eyes for anemia
Eyes for Horner’s syndrome (miosis, ptôsis, anhidrosis )
Lips and tongue for central cyanosis
Oral candida

Question 15

Dx of the lungs with horners syndrome possible

Answer 15

Pancoast tumor of the lung apex invading cervical sympathetic chain

Question 16

What can cause oral candida

Answer 16

Inhaled steroids
Debilitation
Underlying immune suppression of patient

Question 17

Chest inspection

Answer 17

Rate of respiration
Rythm of respiration

Chest expansion

Symmetry (bilaterally symmetrical and elliptical in cross section, kyphosis, scoliosis )

Barrel shaped

Obvious scars (thoracotomy running from below scapula posteriorly to anterior chest wall , intercostal draining with small scars in axilla or posteriorly)

Lumps

Symmetrical movement

Intercostal recession on inspiration

Paradoxical Inwards movement of lower ribs in inspiration in COPD

Question 18

Anatomical landmark bifurcation of trachea

Answer 18

Sternal angle

Question 19

Disease with barrel shaped chest due to lungs overinflation

Answer 19

Long term COPD

Question 20

Causes of severe intercostal recession on inspiration

Answer 20

Severe upper airways obstruction in laryngeal dx, tumors of trachea

Question 21

Palpation of chest

Answer 21

Lymph nodes in neck
Swellings
Trachea position
Cardiac apex
Chest expansion
Tactile vocal fremitus

Question 22

Sounds possibly heard on Percussion of the chest

Answer 22

Resonance
Dullness
Hyper-resonance

Question 23

Most and least resonant part of the lungs

Answer 23

Most resonsnat below clavicles and scapula posterior
Least resonant over scapulae

Question 24

When do you have dull percussion of the chest

Answer 24

Fluid like in Pleural effusion
Consolidation or collapse

Question 25

type of dullness in pleural effusion

Answer 25

Stony dullness

Question 26

Causes of hyper resonance

Answer 26

Pneumothorax

Question 27

Side of stethoscope used in chest auscultation

Answer 27

Diaphragm

Question 28

Normal breath sound quality

Answer 28

Vesicular

Question 29

When do you hear bronchial breathing

Answer 29

Consolidation

Question 30

Added breath sounds

Answer 30

Wheezes
Crackles
Pleural rub

Question 31

When do you hear wheezes

Answer 31

Asthma
COPD

Question 32

Crackles

Answer 32

Short explosive sounds ,bubbling or clicking

Question 33

Crackles at beginning of inspiration heard in

Answer 33

COPD

Question 34

Localized pound and coarse crackles heard in

Answer 34

Bronchiectasis

Question 35

Fine character crackles in late inspiration heard in

Answer 35

Diffuse interstitial fibrosis

Question 36

Pleural rub associated with what dx

Answer 36

Pleural inflammation