Examination and History

Question 1

Which conditions do use of accessory muscles indicate?

Answer 1

Severe COPD and asthma

Question 2

What are the 3 accessory muscles?

Answer 2

Sternocleidomastoid, platysma, trapezius

Question 3

What is paradoxical breathing?

Answer 3

When, on inspiration, the abdomen moves inwards and the chest moves out.

Question 4

When does breathing through pursed lips occur?

Answer 4

COPD

Question 5

What is the function of pursed lips breathing?

Answer 5

To increase the positive end expiratory pressure which decreases small airway collapse.

Question 6

When does central cyanosis occur?

Answer 6

When concentration of deoxygenated haemoglobin is > 50g/l

Question 7

Normally, what does the partial pressure of oxygen need to be for someone to be cyanosed?

Answer 7

8kPa (02 saturation < 80%)

Question 8

When might cyanosis not appear, despite low oxygen saturation?

Answer 8

Hypovolaemia or anaemia

Question 9

When might cyanosis appear at higher oxygen saturations?

Answer 9

Polycythaemia

Question 10

Name 3 respiratory causes of clubbing

Answer 10

Lung cancer, interstitial lung disease, bronchiectasis

Question 11

What is a fine tremor caused by?

Answer 11

Beta-agonist overuse

Question 12

What is asterixis caused by?

Answer 12

CO2 retention which causes failure in parietal mechanisms to maintain posture