respiratory

Question 1

hands + arms

Answer 1

tar staining 
warmth
cyanosis 
finger clubbing 
cap refill 
tremors
pulse + resp rate

Question 2

warm and sweaty hands

Answer 2

co2 retention

Question 3

cool hands

Answer 3

poor peripheral perfusion

Question 4

resp causes finger clubbing

Answer 4

lung ca
interstitial lung disease
CF
bronchiecstasis

Question 5

reps cause fine tremor

Answer 5

beta-2-agonist use (salbutamol)

Question 6

resp cause flapping tremor

Answer 6

co2 retention

Question 7

head + face

Answer 7

conjunctivae: anaemia
tongue + lips: cyanosis
face: redness, swollen tonsils

Question 8

facial features of Horner’s syndrome

Answer 8

ptosis
miosis
enopthalmos

Question 9

neck

Answer 9

tracheal position
crico-sternal distance
lymph nodes

Question 10

causes tracheal deviation

Answer 10

pneumothorax

pleural effusion

Question 11

examination back of chest

Answer 11

inspection 
chest expansion 
percussion 
auscultate
vocal resonance

Question 12

palpation front chesr

Answer 12

tracheal position
crico-sternal distance
apex beat
chest expansion

Question 13

causes of reduced chest expansion

Answer 13

pulmonary fibrosis
pneumothorax
pneumonia
pleural effusion

Question 14

percussion notes

Answer 14

resonant: normal
dullness: consolidation, lobar collapse
stoney-dullness: pleural effusion
hyper-resonance: decreased tissue density e.g. pneumothorax

Question 15

vesicular breath ounds

Answer 15

normal

Question 16

bronchial breath sounds

Answer 16

harsh sounding

associated with consolidation

Question 17

added breath sounds

Answer 17

wheeze
stridor
coarse crackles
crepitations

Question 18

increased vocal resonance

Answer 18

increased tissue density; consolidation, tumour

Question 19

decreased vocal resonance

Answer 19

pleural effusion

pneumothorax

Question 20

resp systemic enquiry

Answer 20

cough 
sputum 
heamoptysis 
SOB
wheeze
chest pain (pleuritic) 
earache
sore throat

Question 21

resp causes SOB

Answer 21

pneumonia, COPD, asthma

Question 22

resp causes productive cough

Answer 22

pneumonia
COPD
bronchiecstais

Question 23

resp causes dry cough

Answer 23

pulmonary fibrosis

Question 24

resp causes haemoptysis

Answer 24

lung Ca

Question 25

causes wheeze

Answer 25

asthma

COPD

Question 26

pleuritic chest pain cuases

Answer 26

PE

pleurisy

Question 27

using peak flow meter

Answer 27

• stand up if can
• zero device
• maximum inspiration
• airtight seal around mouthpiece, hold meter horizontal and so fingers don’t touch slide
• forcefully exhale as fast as can
• note reading from scale
• use best reading out of 3 for chart

Question 28

recognising normal PEFR

Answer 28

look on chart and read for patient age, sex and height

M: 100l/min below average is okay
F: 85l/min below average is okay

Question 29

4 core inhaler groups

Answer 29

pressurised metered dose inhaler
pMDI with spacer device
breath accutated pressuriesed metered dose inhaler
dry powder inhaler

Question 30

using pMDI

Answer 30

• sit/stand upright and lift chin
• remove cap and shake
• breath out
• mouthpeice in mouth
• breath in and press down canister
• hold breath ~10s
• if need 2nd dose wait 30-60s

Question 31

using pMDI with spacer

Answer 31

• remove cap, shake and insert into spacer
• mouthpiece in mouth
• ensure valve opens with breathing (clicking noise)
• press down canister
• slow breath in, hold ~10s
• breath out through mouthpeice
• wait 30-60s if having 2nd dose

Question 32

using turbohaler

Answer 32

• check dose counter
• open and unscrew lid
• load dose: turn base fully anticlockwise then fully clockwise until clicks
• breath out
• mouthpiece in mouth
• strong fast breath in
• hold breath 10s
• breath out gently