Paediatric Resp Examination

Question 1

appearance/behaviour

Answer 1

alertness
cyanosis: bluish discolouration of the skin
shortness of breath
pallor: pale colour of the skin, may suggest anaemia or poor perfusion
weight
syndromic features

Question 2

sounds

Answer 2

cough with wheeze: asthma, viral-induced wheeze
productive cough: lower respiratory tract infection
narking cough: croup, laryngomalacia
dry cough: allergies, tuberculosis
hoarse voice: laryngitis
hot potato voice: peritonsillar abscess
acute stridor: croup, foreign body, bacterial tracheitis, epiglottitis
chronic stridor: laryngomalacia, subglottic stenosis

Question 3

hot potato voice:

Answer 3

peritonsillar abscess

Question 4

acute stridor

Answer 4

croup, foreign body, bacterial tracheitis, epiglottitis

Question 5

chronic stridor

Answer 5

laryngomalacia, subglottic stenosis

Question 6

if a child is taking ppancreatic enzymes it is because they have

Answer 6

cystic fibrosis

Question 7

if a child has a tremor they may have

Answer 7

may be caused by beta 2 agonist eg. salbutamol

Question 8

what are some signs to look for on examination of the hands

Answer 8

colour
tremour
eczema
finger clubbing

Question 9

finger clubbing

Answer 9

may be relevant in a paediatric respiratory examination as a sign of bronchiectasis, cystic fibrosis and primary ciliary dyskinesia
loss of schamroth’s window

Question 10

pulse

Answer 10

assess radial pulse (or femoral pulse in babies)

Question 11

hearing loss is associated with

Answer 11

primary ciliary dyskinesia

Question 12

inspection of the nose

Answer 12

deviated nasal septum: may contribute to breathing difficulties
nasal polyps: associated with atopy and cystic fibrosis

Question 13

inspection of the mouth

Answer 13

central cyanosis - bluish discolouration of the lips and/or tongue associated with hypoxaemia (e.g. persistent pulmonary hypertension, bronchospasm, lower respiratory tract infection)
cleft palate

Question 14

inspection of the throat

Answer 14

tonsillar hypertrophy - may indicate history of recurrent tonsillitis and airway obstruction

Question 15

causes of tracheal deviation

Answer 15

trachea deviates away from pneumothorax and large pleural effusions
trachea deviates towards lobar collapse and pneumonectomy

Question 16

inspection of the anterior chest

Answer 16

• scars suggestive of previous thoracic surgery
• pectus excavatum: caved in, sunken appearance of the chest
• pectus carinatum: protrusion of the sternum and ribs
• asymmetry of the chest wall movement: may indicate underlying pneumothorax or consolidation
• harrison’s sulcus: associated with poorly controlled asthma
• chest hyper expansion: associated with asthma and chronic respiratory obstruction

Question 17

normal resp rate

Answer 17

Question 18

asymmetry between inspiratory and expiratory phases

Answer 18

the expiratory phase is often prolonged in asthma exacerbations

Question 19

signs of increased work of breathing

Answer 19

general signs:
- difficulty speaking or feeding
recession:
- tracheal tug
- supraclavicular recession
- intercostal recession
- subcostal recession
use of accessory muscles
- nasal flaring
- abdominal breathing
- head bobbing (secondary to sternocleidomastoid contractions)

Question 20

thoracic scars - median sternotomy scar

Answer 20

located in the midline of the thorax
this surgical approach is used for cardiac valve replacement and pulmonary artery banding

Question 21

thoracic scars - right thoracotomy scar

Answer 21

located between the lateral border of the sternum and the mid-axillary line at the 4th or 5th intercostal space on the right. This surgical approach is used to perform pulmonary artery banding and a Blalock–Taussig shunt.

Question 22

thoracic scars - left thoracotomy scar

Answer 22

located between the lateral border of the sternum and the mid-axillary line at the 4th or 5th intercostal space on the left. This surgical approach is used to perform pulmonary artery banding, patent ductus arteriosus ligation, a Blalock–Taussig shunt and coarctation of the aorta repair.

Question 23

thoracic scars - infraclavicular scar

Answer 23

located in the infraclavicular region (on either side). This surgical approach is used for pacemaker insertion.

Question 24

thoracic scars - left mid-axillary scars

Answer 24

this surgical approach is used for the insertion of a subcutaneous implantable cardioverter-defibrillator (ICD).

Question 25

palpating the apex beat

Answer 25

place fingers horizontally across the chest
typically located in the 5th intercostal space in the midclavicular line

Question 26

causes of displaced apex beat

Answer 26

leftward displacement: cardiomegaly, right pleural effusion, right tension pneumothorax
rightward displacement: dextrocardia, diaphragmatic hernia, left pleural effusion, left tension pneumothorax

Question 27

assessing chest expansion

Answer 27

place hands on the chests chest inferior to the nipples
wrap fingers around either side of the chest
bring thumbs together in the midline so that they touch
observe if your thumbs move out symmetrically

Question 28

causes of reduced chest expansion

Answer 28

lung collapse, pneumonia and restrictive lung disease

Question 29

types of percussion notes

Answer 29

resonant - normal finding
dullness - suggests increased tissue density
stony dullness - caused by underlying pleural effusion
hyper-resonance: the opposite of dullness, suggestive of decreased tissue density (e.g. pneumothorax)

Question 30

quality of breath sounds

Answer 30

vesicular - the normal quality of breath sounds in healthy individuals
bronchial - harsh sounding inspiration and expiration, associated with consolidation.

Question 31

volume of breath sounds

Answer 31

quiet sounds - reduced air entry into that region of the lung (eg. pleural effusion, pneumothorax)

Question 32

wheeze

Answer 32

wheeze: a continuous, source, whistling sound produced in the respiratory airways during breathing. often associated with asthma and bronchiectasis

Question 33

stridor

Answer 33

a high-pitched extra thoracic breath sound resulting from turbulent airflow through narrowed upper airways. stridor has a wide range of causes, including foreign body inhalation (acute) and subglottic stenosis (chronic).

Question 34

coarse crackles

Answer 34

discontinuous, brief, popping lung sounds typically associated with pneumonia, bronchiectasis and pulmonary oedema

Question 35

fine end-inspiratory crackles

Answer 35

often describes as sounding similar to the noic generated with seperated velcro
find end-inspiratory crackles are associated wth pulmonary fibrosis

Question 36

increased vocal resonance over an area suggests

Answer 36

increased tissue density
eg. consolidation, tumour, lobar collapse

Question 37

decreased vocal resonance over an area suggests

Answer 37

presence of fluid or air outside of the lung eg. pleural effusion, pneumothorax

Question 38

further tests or investigations that may be recommended

Answer 38

cardiovascular examination
inhaler technique assessment
full set of vital signs
peak expiratory flow rate
sputum sample
plot height and weight on a flow chart
venous blood gas
chest x-ray

Question 39

syndromes that may impact the respiratory system

Answer 39

DiGeorge syndrome - chromosomal
downs syndrome - chromosomal
fetal alcohol spectrum disorder - lung hypoplasia and altered surfactant production
marfan syndrome - pneumothorax and chest wall deformities
pierre robin sequence
stickler syndrome - connective tissue disorder
treacher collins syndrome - underdevelopment of the facial bones