Examination of The Respiratory System

Question 1

what is stridor

Answer 1

• Loud, harsh, high pitched respiratory sound
• Usually on inspiration
• Upper airway obstruction

Question 2

what is Erythema nodosum

Answer 2

reddish, painful, tender lumps most commonly located in the front of the legs below the knees

Question 3

respiratory causes of clubbing

Answer 3

 Bronchial carcinoma
 Mesothelioma
 Chronic suppurative lung disease:
– Bronchiectasis 
– Lung abscess 
– Empyema
 Pulmonary Fibrosis
 Cystic Fibrosis

Question 4

Horner’s syndrome

Answer 4

 Damage to cervical sympathetic nerves  Clinicalfeatures
– Unilateral miosis
– Partial ptosis
– Loss of sweating on same side (facial anhidrosis)
 May indicate serious pathology

Question 5

 Fine tremor

Answer 5

– Excessive use of B-agonists

Question 6

 Flapping tremor

Answer 6

– Severe ventilatory failure with CO2 retention
– Hold hands outstretched
– Wrists cocked-back
– Look for a jerky, flapping tremor 
– Associated confusion

Question 7

 Prominent veins on chest wall

Answer 7

– SVC obstruction

Question 8

Pectus Excavatum

Answer 8

caved in chest

Question 9

Kyphoscoliosis

Answer 9

curved spine on two planes

Question 10

 Subcutaneous (‘surgical’) emphysema

Answer 10

– Crackling sensation
– Air in subcutaneous tissues
– May be diffuse chest, neck, face swelling
- Consider trauma / underlying pneumothorax

Question 11

Tactile Vocal Fremitus

Answer 11

 Usepalm/ulnarborderofhand
 Say“99”
 Feelforvibration
 Increasedfremitus-consolidationorfibrosis
 Decreasedfremitus-pleuraleffusion,pneumothoraxorcollapse

Question 12

normal breath sounds =

Answer 12

vesicular

• Intensity of sounds relates to airflow
• Inspiration longer than expiration
• Low pitched, quiet, heard over most of lung fields
• No gap between inspiration and expiration (however is after expiration)

Question 13

Diminished vesicular breath sounds

Answer 13

• When normal lung displaced by air, e.g:
 Obesity
 Pleural effusion
 Pneumothorax*
 Collapse
 Hyperinflation – emphysema - in COPD

Question 14

pneumothorax in young people

Answer 14

secondary associated with underlying lung disease, traumatic or iatrogenic

Question 15

Bronchial breath sounds (abnormal)

Answer 15

 Noise originates from larger airways
 When damage to small airways / alveoli
 Harsh in nature
 Gap between inspiration and expiration
 Expiratory component dominates

Question 16

crackles

Answer 16

 High-pitched, discontinuous sounds
 Similar to the sound produced by rubbing your hair between your
fingers

Question 17

causes of crackles

Answer 17

Pulmonary oedema / pulmonary fibrosis / bronchial secretions / COPD / pneumonia / lung abscess / TB / bronchiolitis / bronchiectasis

Question 18

what are fine late crackles a feature of

Answer 18

Cryptogenic Fibrosing Alveolitis

Question 19

• Pleural

Answer 19

 May be associated with pleuritic pain (sharp on inspiration / coughing)
 Like “creaking leather”
 Low pitched
 Causes:
PE / pneumonia / vasculitis

Question 20

 Wheeze

Answer 20

 Continuous oscillation of opposing airway walls  Musical quality, high pitch
 Implies airway (small) narrowing
 Louder in expiration

Question 21

causes of wheezing

Answer 21

Generalised – Asthma / COPD Localised – lung tumour