Respi week: hx & ex

Question 1

What are respi causes of clubbing

Answer 1

• lung cancer
• interstitial lung disease
• bronchiectasis

Question 2

What are respi causes of cervical lymphadenopathy

Answer 2

• lung cancer
• TB
• lymphoma

Question 3

What are respi causes of JVP elevation

Answer 3

• cor pulmonale
• tension pneumothorax
• severe acute asthma
• massive PE
• superior vena cava obstruction (usually due to lung cancer)

Question 4

When are wheeze and stridor heard and what causes them

Answer 4

Wheeze: expiration (due to narrowed bronchi)

Stridor: inspiration (due to large airway obstruction)

Question 5

Define massive haemoptysis

Answer 5

200ml in 24h

150-200ml is normal volume of airway

Question 6

Which drugs cause cough

Answer 6

ACE inhibitors

Question 7

Which drugs cause pulmonary fibrosis

Answer 7

• Methotrexate (chemo)

- Amiodarone (K channel blocker for arrhythmia)

Question 8

List acute causes of dyspnoea

Answer 8

• acute asthma
• pneumothorax
• pulmonary embolism

Question 9

List chronic causes of dyspnoea

Answer 9

• COPD
• lung cancer
• pulmonary fibrosis
• angina
• heart failure
• pulmonary hypertension
• anaemia

Question 10

What conditions cause fine crackles

Answer 10

Chronic bronchitis,
lung collapse, 
pneumonia, 
Interstitial lung disease 
CHF

Question 11

What conditions cause coarse crackles

Answer 11

Fluid in lungs

Question 12

What causes transudate

Answer 12

Low protein <25

Oedema due to renal/heart failure

Question 13

What causes exudate

Answer 13

High protein >35

Inflammation eg TB, cancer, pneumonia

Question 14

What causes carpopedal spasms during hyperventilation eg in an anxiety attack

Answer 14

Hyperventilation leading to respiratory alkalosis

Question 15

What is the carina and its clinical significance

Answer 15

Cartilage at division of 2 main bronchi

Most sensitive area for triggering a cough reflex

Widening indicates carcinoma of regional lymph nodes

Question 16

What causes hyper-resonant percussion

Answer 16

Pneumothorax

Question 17

What causes dull percussion

Answer 17

• Pulmonary consolidation
• Pulmonary collapse
• Severe pulmonary fibrosis
• Pleural effusion
• Haemothorax

Pleural effusion and haemothorax are stony dull

Question 18

What would the following signs point to:

• reduced chest expansion
• raised JVP
• ankle swelling

Answer 18

COPD

Question 19

What would the following signs point to:

• reduced chest expansion
• dull percussion
• increased vocal resonance
• bronchial breath sounds
• pleural rub

Answer 19

Pneumonia

Question 20

What would the following signs point to:

• reduced chest expansion
• fine crackles
• clubbing

Answer 20

Pulmonary fibrosis

Question 21

What would the following signs point to:

• reduced chest expansion
• dull percussion
• reduced breath sounds
• reduced vocal resonance

Answer 21

Lung cancer

Question 22

Clinical signs of effusion

chest expansion, percussion, resonance, breath sounds

Answer 22

• reduced chest expansion
• dull percussion
• reduced resonance
• reduced breath sounds

Question 23

Clinical signs of collapse

chest expansion, percussion, resonance, breath sounds

Answer 23

• reduced chest expansion
• dull percussion
• reduced resonance
• reduced breath sounds

Question 24

Clinical signs of consolidation

chest expansion, percussion, resonance, breath sounds

Answer 24

• reduced chest expansion
• dull percussion
• increased vocal resonance
• bronchial breath sounds + pleural rub

Question 25

Symptoms of pulmonary hypertension

Answer 25

• dyspnoea
• syncope
• tiredness
• chest pain
• leg swelling
• tachycardia

Question 26

3 most common causes of chronic cough in non-smoker

Answer 26

1. asthma
2. post-nasal drip
3. GORD