Respiratory

Question 1

What should you look for when inspecting from the end of the bed in a respiratory exam?

Answer 1

inhaler, nebuliser, drugs, oxygen, sputum pots, chest drain, heavy breathing/tripod position with accessory muscle use, pursed lips, scars, chest deformities/pigeon chest, barrel chest, pectus escavtum, kyphosis, scoliosis

Question 2

What signs should be check for in the hands in a respiratory exam?

Answer 2

temperature, clubbing, nail pitting, muscle wasting on palmer aspect, tremor, pulse and respiratory rate

Question 3

How do you check for a tremor in a respiratory exam?

Answer 3

Hold arms out with cocked wrists for 30 seconds, flap will appear by this point

Question 4

Why clubbing not the most helpful of signs?

Answer 4

It is a very generic sign of a lot of different type of diseases

Question 5

Name some respiratory causes of clubbing.

Answer 5

non-small cell tumours, brochiextramist, TB, cystic fibrosis, pulmonary fibrosis

Question 6

What causes muscle wasting on the palmer aspect of the hand, in terms of respiratory disease?

Answer 6

Pancoast/apical lung tumour

Question 7

Where are pancoast tumours found and what consequences does it have?

Answer 7

The apex of lung so presses in the upper limb nerve roots -> muscle wasting

Question 8

What signs should be looked for on the face in the respiratory exam?

Answer 8

central cyanosis, conjunctiva pallor for anaemia, myosis, ptosis, anhydrous, candidiasis, dry mouth, nose polyps

Question 9

What triad of signs are associated with Horner’s syndrome?

Answer 9

Myosis, ptosis and anhydrous

Question 10

What is the most common cause of candidiasis on the tongue?

Answer 10

Steroid inhaler causing local immunosuppression

Patients are meant to brush their teeth immediately afterwards but most don’t

Question 11

What signs should be checked for on the neck in a respiratory exam?

Answer 11

raised JVP, diverted trachea

Question 12

What way will the trachea deviate with a tension pneumothorax?

Answer 12

Away from the tension pneumothorax

Question 13

What way will the trachea deviate with a collapsed lung?

Answer 13

Towards the collapse lung

Question 14

What way will the trachea deviate when a section/lobe of lung is removed?

Answer 14

Shift towards the side with the section removed

Question 15

What 4 types of inspection should be carried out on the chest in a respiratory exam?

Answer 15

Inspection, palpating, percussion, auscultation

Question 16

What should be checked for on inspection of the chest in a respiratory exam?

Answer 16

General chest rise, discomfort, floating ribs, scars, such as median sternotomy and/or clamshell, from lung transplant surgery

Question 17

What will be seen in inspection of a chest with a double broken rib, and what is meant by the term?

Answer 17

A floating rib, on inspiration the broken section will fall and then rise on expiration. The opposite to normal

Question 18

What should be palpated for on the chest in a respiratory exam?

Answer 18

Chest expansion, apex beat, cervical lymph nodes

Question 19

What diseases would cause a unilateral decrease in chest expansion?

Answer 19

Pneumothorax, collapses lung, double rib break/floating rib

Question 20

What diseases would cause a bilateral decrease in chest expansion?

Answer 20

A broken rib, emphysema, COPD, pulmonary fibrosis, pneumonia

Question 21

Why is there a reduction in chest expansion with a broken rib?

Answer 21

Due to pain making it uncomfortable to breath

Question 22

Why does a floating rib only cause a unilateral reduction in chest expansion?

Answer 22

There is generally less pain so it is simply due to a breakage in the breathing apparatus

Question 23

Why is the apex beat palpated for in a respiratory exam?

Answer 23

To check for mediastinal shift

Question 24

Besides from generalised percussion of the chest, what should be percussed on the chest in a respiratory exam?

Answer 24

Tactile vocal fremitis

Question 25

How can tactile vocal fremitus be assessed?

Answer 25

The 99 test using either a stethoscope or your hands

Question 26

What diseases would cause an increase in tactile vocal fremitus?

Answer 26

Diseases that cause the lung to be denser or inflamed -> pleural effusion, pneumonia, TB etc

Question 27

What diseases would cause an decrease in tactile vocal fremitus?

Answer 27

Diseases that causes an increase in air or fluid around the lungs -> oedema due to core palmonari secondary to lung disease/pulmonary hypertension

Diseases that decrease lung tissue density -> COPD, asthma