Respiratory

Question 1

Clubbing may be congenital true or false

Answer 1

True

Question 2

Central cyanosis is examined by looking at the tongue for bluish discolouration.
True or false

Answer 2

True

Question 3

Peripheral cyanosis gives a bluish discolouration of the distal parts of body like fingers, toes and lips. Peripheral cyanosis is usually due to increased oxygen extraction with a slow moving circulation. It is seen in cold weather or in Raynaud’s phenomenon or peripheral vascular disease. Central cyanosis gives rise to peripheral cyanosis but not vice versa.
True or false

Answer 3

True

Question 4

Pigeon shaped chest is seen in which condition

Answer 4

Pectus carinatum

Question 5

The sternum is depressed in which condition

Answer 5

Pectus excavatum

Question 6

Pursed lip breathing is a sign of severe airway obstruction.
If on lying flat the patient becomes breathless or pre-existing breathlessness worsens, a condition called
orthopnoea, then one should think of pulmonary oedema or bilateral diaphragmatic paralysis.
True or false

Answer 6

True

Question 7

The normal chest expansion measured with a tape measure at the level of the nipple is about 5cm or more.
True or false

Answer 7

True

Question 8

Now palpate for the position of the trachea with the middle finger as well as the index and ring fingers. Feel for the trachea in the supra-sternal notch with the middle finger of the right hand. The ring and index fingers help to confirm if the trachea is deviated to one or the other side
True or false

Answer 8

True

Index,middle,ring

Question 9

Tactile fremitus is palpable over normal lung and remains palpable or increased over consolidated lung but is reduced over an effusion. When one finds reduced percussion note for which the reason is not clear then a reduction in tactile fremitus favours a pleural effusion or thickening.
True or false

Answer 9

True

Question 10

If sound heard after percussion is dull what does it mean

Answer 10

Consolidated lung or long collapse

Stony dull if there’s fluid
Example in pleural effusion

Question 11

In consolidated pneumonia sound is higher if it’s ? And sound is lower if?

Answer 11

Higher- air

Lower-fluid

Question 12

Stridor is a harsh, often musical note heard at the mouth marked on inspiration and denoting major airway obstruction.

Sound heard over a normal lung is vesicular true or false

Answer 12

True

Question 13

Wheeze are the sounds heard with the naked ear and the same sounds heard with a stethoscope are called rhonchi. Wheeze is musical sounds produced by airway walls oscillating between the open and nearly closed position.

Always suspect stridor if the inspiratory noise of wheeze is louder than the expiratory sound
True or false

Answer 13

True

Question 14

Crackles or rakes are heard when and when are coarse and fine crackles found

Answer 14

Heard in consolidation of lungs in pneumonia

Secretions in the terminal bronchi and alveoli give rise to coarse crackles. Pulmonary oedema gives rise to fine crackles.

Question 15

Pleural rub is heard in both inspiration and expiration and it disappears when fluid collects between the two surfaces of the pleura.
True or false

Answer 15

True

Question 16

What are you looking for in auscultation

Answer 16

Air entry. Is this reduced / absent or increased.

2. Type of breath sounds. Is this vesicular or bronchial
3. Presence or absence of adventitious sounds – crackles, rhonchi / wheeze and rub.

Question 17

Tachypnea,hyperventilation,bradypnea,normal or eupnea, have which breathing patterns

Answer 17

Tachyons- 20bpm
Brady-less than 12bpm
Hyperventilation-rapid,deep respiration less greater than 20 bpm
Eupnea-regular,comfortable at 12-20bpm

Question 18

What did the emergent therapeutic procedure for pneumothorax

Answer 18

Treatment of tension pneumothorax is immediate needle decompression by inserting a large-bore (eg, 14- or 16-gauge) needle into the 2nd intercostal space in the midclavicular line. Air will usually gush out.

Question 19

What’s re the accessory muscle of respiration

Answer 19

Accessory muscles of respiration include the sternocleidomastoid, scalene, trapezius, internal intercostal, and abdominal muscles

Question 20

Differentials for chest pain

Answer 20

Pericarditis
Pulmonary embolism
Myocardial infarction
Aortic dissection

Cardiac: myocardial infarction, unstable angina, acute pericarditis, coronary spasm, hypertrophic cardiomyopathy, anaemia, myocarditis, aortic dissection and pulmonary hypertension;

• Pulmonary: pulmonary embolism, pneumonia, pleuritis and pneumothorax;
• Gastrointestinal: oesophageal reflux/spasm, oesophageal rupture and biliary colic;

Musculoskeletal: fractured rib, costochondritis (an inflammation of the costal cartilage of the anterior chest wall, characterised by pain and tenderness), chest wall trauma and Herpes zoster;

• Miscellaneous: anxiety/panic attacks, depression, cocaine use and lymphoma, for example.

Question 21

What causes increased tactile frematus and decreased tactile frematus

Answer 21

dense or consolidated or collapse of lung or presence of solid mass or inflamed lung tissue (as occurs in pneumonia)

it’s decreased in asthma meaning the lung is filled w air(as occurs in pneumothorax)or fluid in the pleural spaces(as occurs in pleural effusion)or decrease in lung tissue density (as occurs in COPD)

Question 22

An estimated 4.1 percent of people who have diabetes experience palmar erythema. Autoimmune diseases: More than 60 percent of people who have rheumatoid arthritis experience palmar erythema. Thyroid disease: About 18 percent of people with too much thyroid hormone have palmar erythema and liver cirrhosis
True or false

Answer 22

True

Question 23

Kyphosis may cause a deformity such as a humpback or hunchback or give patients a pitched-forward appearance. Abnormal kyphosis is more commonly found in the thoracic or thoracolumbar (chest area/middle back)
True or false

Answer 23

True

Question 24

What’s re the respiratory causes of clubbing

Answer 24

Pulmonary TB
Emphysema
Bronchiectasis 
Chronic fibrosing alveolitis 
Severe chronic cyanosis

Question 25

What is lung consolidation

Answer 25

Lung consolidation occurs when the air that usually fills the small airways in your lungs is replaced with something else. Depending on the cause, the air may be replaced with: a fluid, such as pus, blood, or water.

Question 26

Name five diseases associated with splinter hemorrhage

Answer 26

subacute infective endocarditis, scleroderma, trichinosis, systemic lupus erythematosus (SLE), rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome, haematological malignancy, and trauma.

Question 27

What causes leuconychia striata or muehrcke’s nails

Answer 27

appearance of Muehrcke’s lines is associated specifically with marked hypoalbuminemia (serum albumin ≤ 2.2 g/dL) indicating decreased protein synthesis, which may occur during periods of metabolic stress (e.g. systemic infection, trauma, AIDS, chemotherapy), or in hypoalbuminemic states such as the nephrotic .

Question 28

Osler’s nodes and Janeway lesions are seen in

Answer 28

Endocarditis

Question 29

Oslers nodes are found where on the body

Answer 29

the pulp of the terminal phalanx of the finger.

Question 30

Shifting fullness is done by auscultation true or false

Answer 30

False

Question 31

the fluid wave test or fluid thrill test is a test for ascites (free fluid in the abdominal cavity). It is performed by having the patient (or a colleague) push their hands down on the midline of the abdomen. The examiner then taps one flank, while feeling on the other flank for the tap. True or false

Answer 31

True

Question 32

Presence of radio radial delay suggests

Answer 32

Aortic dissection
Aprtic coarctation
Subclavian stenosis

Question 33

Example of conditions that causes crackles,wheezing,rhonchi

Answer 33

Conditions such as pneumonia or left-sided heart failure may cause this buildup.
Wheezing: Wheezing is a common symptom of conditions that narrow the small airways in the lungs, such as asthma and COPD.
Rhonchi: Rhonchi occur due to conditions that block airflow through the large airways, including the bronchi. There may also be inflammation and fluid in these airways. Conditions such as acute bronchitis and COPD may cause rhonchi,pneumonia,cystic firbiosis ,bronchiectasis as well
Stridor: Stridor occurs in people with an upper airway blockage. A blockage may occur if a person breathes in a foreign object, chemical, or other harmful substance. A traumatic neck or chest injury involving the upper airway could result in a blockage too. Stridor can also be a symptom of inflammatory conditions, such as tonsillitis, epiglottitis, or croup (laryngotracheitis