Resp, GI + Cardio Examinations

Question 1

What do you look for in General inspection in resp exam?

Answer 1

• Around bed: inhalers, oxygen mask, sputum pot
• Patient: cyanosis, sob, cough, wheeze, stridor

Question 2

What would bruising or thinned skin in hands suggest?

Answer 2

Long term steroid use

Question 3

What does fine tremor in resp exam suggest

Answer 3

B2 agonist use - salbutamol

Question 4

What does asterisks in Resp exam suggest

Answer 4

CO2 retention

Question 5

What is normal resp rate?

Answer 5

12-20 breaths per minute

Question 6

Resp exam: when would JVP be raised?

Answer 6

Cor pulmonale

Question 7

Resp exam: what facial central cyanosis indicate?

Answer 7

Hypoxia

Question 8

What does conjunctival pallor indicate

Answer 8

Anaemia

Question 9

Resp exam: scar in central chest. What is it likely to be?

Answer 9

Sternotomy, thoracotomy

Question 10

Resp exam: scar in clavicular region. What is it likely to be?

Answer 10

Pacemaker

Question 11

Resp exam: scar in mid-axillary line. What is is likely to be?

Answer 11

Chest drain

Question 12

Anatomically describe where to find apex beat

Answer 12

5th intercostal space, MCL

Question 13

What (2 things) does reduced chest expansion indicate?

Answer 13

• Lung collapse
• Pneumonia

Question 14

Percuss lung fields: what does resonant percussion suggest

Answer 14

Normal!

Question 15

Percuss lung fields: what does dull percussion note suggest? (4 things)

Answer 15

• Consolidation
• Collapse
• Effusion (stony dullness)
• Cardiac dullness

Question 16

Lung auscultation: what does inspiratory stridor suggest?

Answer 16

Upper airway obstruction

Question 17

Lung auscultation: what does wheeze suggest? (2 things)

Answer 17

• Asthma
• COPD

Question 18

Difference between wheeze and stridor?

Answer 18

Stridor is usually just on inspiration and wheeze is both inspiration and expiration

Question 19

Lung auscultation: what do coarse crackles suggest? (2)

Answer 19

• Pneumonia
• Pulmonary oedema

Question 20

Lung auscultation: what to fine crackles suggest? (1)

Answer 20

• Pulmonary fibrosis

Question 21

Lungs: What does increased vocal resonance suggest? (3) + Explain

Answer 21

Increased vibration suggests greater density
- Consolidation
- Lobar collapse
- Tumor

Question 22

Lungs: what does decreased vocal resonance suggest?

Answer 22

Decreased vibration suggests lesser density
- Pleural effusion
- Pneumothorax

Question 23

Causes of Lymphadenopathy

Answer 23

• Infection
• Malignancy
• Sarcoidosis

Question 24

What does unilaterally reduced chest expansion suggest? (2)

Answer 24

• Pneumonia
• Lung collapse

Question 25

Chest wall percussion: what does hyper-resonant percussion note indicate?

Answer 25

Pneumothorax

Question 26

Resp exam: what does pedal oedema indicate?

Answer 26

- RV failure

Question 27

Resp exam: what does pain in calf indicate?

Answer 27

- DVT

Question 28

What do you do to complete resp exam?

Answer 28

- Sputum sample - Oxygen sats - Peak flow

Question 29

What do you look for in abdo inspection?

Answer 29

- Body habits - Jaudice - Scars - Abdo distention - Masses - Unwell - Consciousness

Question 30

What does asterixis indicate in abdo exam?

Answer 30

- Hepatic encephalopathy - Uraemia

Question 31

What does Xanthelasma suggest?

Answer 31

Hyperlipidamia

Question 32

What does yellowing of eyes suggest?

Answer 32

- Jaundice: raised bilirubin

Question 33

Where is virchows lymph node

Answer 33

Left supraclavicular fossa

Question 34

What is virchows lymph node associated with?

Answer 34

Gastric malignancy

Question 35

What angle should the bed be when palpating abdo?

Answer 35

0! lie them down flat

Question 36

What do you feel for in soft palpation of abdo?

Answer 36

- Tenderness - Guarding (voluntary/involuntary) - Masses

Question 37

What do you feel on deep palpation of abdo?

Answer 37

Try to visualise the organs

Question 38

Palpate aorta: what does expansion pulsating mass suggest?

Answer 38

- Abdominal aortic aneurysm

Question 39

What do you do to complete abdo exam?

Answer 39

ISHRUG - Check for inguinal lymph nodes - Stool sample - Check hernial orifices - Digital rectal exam - Urine sample - Examination of external genitalia

Question 40

Abdo exam: what does lower limb pitting oedema suggest?

Answer 40

Hypoalbuminaemia (potentially due to liver cirrhosis)

Question 41

What could cause a collapsing pulse?

Answer 41

- Normal physiological states: fever, pregnancy - Cardiac lesions: aortic regurgitation

Question 42

What is slow-raising pulse associated with

Answer 42

Aortic stenosis

Question 43

What is bounding pulse associated with? (2)

Answer 43

- Aortic regurgitation - CO2 retention

Question 44

What is thready pulse associated with?

Answer 44

- Hypovolaemia (like sepsis) Makes sense: thready is small

Question 45

What heart murmur is associated with malaria flush?

Answer 45

Mitral stenosis

Question 46

What murmur could be heard at apex point with patient rolled (45) to their left

Answer 46

Mitral stenosis

Question 47

what murmur: 4th/5th intercostal space to the left of the sternum on held expiration, diaphragm

Answer 47

Aortic regurgitation

Question 48

What signs found in hands to indicate infective endocarditis? what do they look like

Answer 48

- Splinter haemorrhages (nails) - Janeway lesions (non-tender, haemorrhagic lesions on thenar + hypothenar) - Oslers nodes (red/purple, slightly raised, tender lumps) - Clubbing

Question 49

What could finger clubbing suggest in cardiac exam?

Answer 49

- IE - Congenital heart disease

Question 50

What is normal capillary refill time (s) ?

Answer 50

Less than 2 seconds

Question 51

What does radio-radial delay suggest?

Answer 51

Aortic coarctation

Question 52

When should check for carotid bruits during exam?

Answer 52

Before checking carotid pulse

Question 53

What does corneal arcus suggest?

Answer 53

Hyperlipidaemia

Question 54

What do you do to complete a cardiac exam?

Answer 54

- Complete peripheral vascular exam - 12 lead ECG - Measure BP