Respiratory

Question 1

What do you look for on general inspection?

Answer 1

Cyanosis
SOB
Cough
Wheeze
Stridor
Cachexia

Question 2

What do you look for in the hands?

Answer 2

Peripheral cyanosis
Bruising / thinned skin (steroid use)
Tar staining (smoking)
Clubbing (CF, bronchiectasis, lung cancer, asbestosis)

Question 3

What do you feel on the arms?

Answer 3

Temperature

Question 4

What do you look for when you ask the patient to raise their arms out in front of them?

Answer 4

Fine tremor (B2 agonist use eg salbutamol)
Cock hands back - assess for asterixis (CO2 retention)

Question 5

What do you assess when palpating the wrist?

Answer 5

Radial pulse - rate

Respiratory rate

Question 6

Why do you assess JVP?

Answer 6

Raised in right-sided heart failure

Question 7

What do you look for in the face?

Answer 7

Central cyanosis (face and mouth)
Conjunctival pallor (anaemia)
Angular stomatitis (anaemia)

Question 8

What do you look for on close inspection of the chest?

Answer 8

Scars (sternotomy, pacemaker, chest drain, lateral thoracotomy)
Chest wall deformities

Question 9

What do you assess on palpation of the chest?

Answer 9

Tracheal position (deviated away from diseased side in pneumothorax, pleural effusion)
Cricosternal distance (3-4 fingers)
Apex beat
Chest expansion (reduced in pneumonia, pneumothorax)

Question 10

What do you assess on percussion?

Answer 10

Resonant = normal
Dull = consolidation, effusion, collapse (normal around heart)

Question 11

What do you assess on auscultation?

Answer 11

Vesicular breathing = normal
Inspiratory stridor = upper airway obstruction
Wheeze = asthma, COPD
Coarse crackles = pneumonia, pulmonary oedema
Fine crackles = pulmonary fibrosis
Repeat testing vocal resonance
BELL FOR FIRST LUNG SOUND

Question 12

What do you assess for when testing vocal resonance?

Answer 12

Increased = tumour, lobar collapse, consolidation
Decreased = pleural effusion

Question 13

What could be a cause of lymphadenopathy?

Answer 13

Infection
Malignancy
Sarcoidosis

Question 14

What do you assess on posterior chest wall?

Answer 14

Inspection (scars)
Chest expansion
Percussion
Auscultation including vocal resonance
Palpate for sacral oedema

Question 15

What are signs to look out for on posterior chest wall percussion?

Answer 15

Resonant = normal
Dull = collapse, consolidation
Stony dullness = effusion
Hyperresonant = pneumothorax

Question 16

What do you assess in the legs?

Answer 16

Pedal oedema (RV failure)
Squeeze calves and ask about pain (DVT)