Respiratory exam

Question 1

Causes of clubbing

Answer 1

Lung carcinoma
Bronchiectasis
IPF, asbestosis
CF
Other: IE, IBD, coeliac disease, cirrhosis, thyrotoxicosis, familial

Question 2

Transudative pleural effusion

Answer 2

Pleural:serum protein <0.5
Pleural LDH < 2/3 ULN, pleural:serum LDH <0.6
Causes- CCF, nephrotic syndrome, liver failure, Meig’s syndrome (ovarian fibroma), hypothyroidism

Question 3

Exudative pleural effusion

Answer 3

Pleural:serum protein >0.5, pleural LDH >2/3 ULN, pleural:serum LDH >0.6
Causes- pneumonia, neoplasm, TB, sarcoidosis, pulmonary infarction, pancreatitis, CT disease, drugs, radiation

Question 4

Inspiratory wheeze

Answer 4

Asthma

Upper airway extrathoracic obstruction

Question 5

Expiratory wheeze

Answer 5

Asthma

COPD

Question 6

Fixed inspiratory monophonic wheeze

Answer 6

Fixed bronchial obstruction- usually due to carcinoma

Question 7

Tracheal deviation

Answer 7

Upper lobectomy/pneumonectomy
Tension pneumothorax
Massive pleural effusion
Upper mediastinal mass

Question 8

Upper lobe fibrosis

Answer 8

Silicosis, sarcoidosis
Coal worker's pneumoconiosis
Histiocytosis
Ankylosing spondylitis, ABPA
Radiation pneumonitis
TB

Question 9

Lower lobe fibrosis

Answer 9

RA
Asbestosis
Scleroderma, MTCD
Idiopathic pulmonary fibrosis
Other drugs- amiodarone, bleomycin, methotrexate, nitrofurantoin

Question 10

UIP pattern

Answer 10

Seen in IPF 
Honeycombing
Traction bronchiectasis
Reticular fibrosis
Apical-basal gradient

Question 11

NSIP pattern

Answer 11

Seen in connective tissue disease, HIV, drugs, hypersensitivity pneumonitis
Ground glass opacity
Traction bronchiectasis
Diffuse sparing

Question 12

Bronchial breath sounds

Answer 12

Expiratory phase prolonged with blowing quality

Causes- lobar pneumonia, localised fibrosis or collapse, above a pleural effusion, large lung cavity

Question 13

Causes of reduced breath sounds

Answer 13

Large lung mass
Collapse
Consolidation
Effusion
Pneumothorax
Pneumonectomy
Emphysema
Elevated hemidiaphragm

Question 14

Causes of pneumonectomy

Answer 14

Lung cancer
COPD
Traumatic chest injury
Chronic infection- TB, bronchiectasis

Question 15

Causes for unilateral chest scar

Answer 15

Lobectomy/pneumonectomy
Lung transplant
VATS/pleurodesis
Lung biopsy
Pleurectomy
Lung volume reduction

Question 16

Clinical signs of pleural effusion

Answer 16

Tracheal deviation away from affected side
Reduced chest expansion
Decreased vocal resonance/fremitus
Stony dull percussion
Reduced/absent breath sounds
Bronchial breathing above effusion

Question 17

Clinical signs of consolidation

Answer 17

Tracheal deviation towards affected side
Reduced chest expansion
Increased vocal resonance/fremitus
Dull percussion
Inspiratoty crackles

Question 18

Clinical signs of atelectasis

Answer 18

Tracheal deviation towards affected side
Reduced chest expansion
Dull percussion
Reduced breath sounds with nil added

Question 19

Signs in bronchiectasis

Answer 19

Prolonged expiratory time
Moist cough/sputum mug
Clubbing
Hyper-expanded chest
Coarse crepitations
Signs of pulmonary HTN

Question 20

Causes of bronchiectasis

Answer 20

CF/congenital
TB
ABPA
Connective tissue disorders
NTM/MAC
Chronic recurrent infections
Immune dysregulation syndromes

Question 21

Signs in lobectomy

Answer 21

Chest wall scar
Breath sounds still present as remaining lung expands
May have elevated hemidiaphragm