Respiratory Exam

Question 1

What is the appropriate patient positioning? (2)

Answer 1

• Undressed to the waist
• 45°supine or seated

Question 2

What do you look for on general inspection? (4)

Answer 2

Question 3

What are the types of cough character? (5)

Answer 3

Question 4

Sputum characteristics: (3)

Answer 4

• Colour and volume
• Purulent/Mucoid/Mucopurulent
• Blood

Question 5

Hoarseness: (3)

Answer 5

• Laryngitis
• Recurrent laryngeal nerve injury
• Inhaled corticosteroids

Question 6

Stridor: (3)

Answer 6

Question 7

What is the respiratory examination of the hands?

Answer 7

Question 8

What is HPO?

Answer 8

Question 9

What do you look in the nose?

Answer 9

• Nose
  – Deviated septum, inflammation, engorged turbinates, polyps

Question 10

What do you look in the mouth?

Answer 10

• Mouth
  – Cyanosis, inflammation (red, swollen pharynx and tonsils ±pus)

Question 11

What does tenderness over sinuses indicate?

Answer 11

Sinusitis

Question 12

What causes Horner’s syndrome? (3)

Answer 12

Question 13

What is Pemberton’s sign?

Answer 13

Question 14

Tracheal deviation?

Answer 14

Question 15

Tracheal tug?

Answer 15

Question 16

Cor pulmonale:

Answer 16

Question 17

DVT:

Answer 17

Question 18

Shape and symmetry: (3)

Answer 18

• Barrel-shaped chest
  – Increased AP diameter
  – Severe asthma or COPD
• Pigeon chest (Pectus carinatum)
  – Outward bowing sternum/costal cartilages
  – Chronic childhood respiratory infections and rickets
• Funnel chest (Pectus excavatum)
  – Developmental defect - depression lower end of sternum
  – Severe: decreased lung capacity

Question 19

What is Harrison’s sulcus? (2)

Answer 19

• Linear depression lower ribs just above costal margins
  – Severe asthma in childhood and rickets

Question 20

Hoover’s sign:

Answer 20

– On inspiration chest moves in and abdomen out (COPD)
* paradoxical movement
* significant hyperinflation

Question 21

Kyphosis/Scoliosis/Kyphoscoliosis:

Answer 21

Reduced lung capacity when significant

Question 22

Scars: (2)

Answer 22

• previous surgery
• previous ICD

Question 23

Radiotherapy:

Answer 23

Erythema

Question 24

Prominent veins (facial plethora) indicate…

Answer 24

SVC obstruction

Question 25

Trauma: (4)

Answer 25

⎻ Bruising ⎻ Swelling ⎻ Erythema ⎻ Lacerations

Question 26

* Symmetry (Anterior and posterior) * Expansion - Upper lobes : - Lower lobes:

Answer 26

- from behind looking down at the clavicles - inspect posteriorly

Question 27

Reduced movement Unilateral:

Answer 27

Question 28

Reduced movement Bilateral:

Answer 28

Question 29

Chest expansion: (3)

Answer 29

Question 30

* Apex Beat (Will be covered in CVS) ⎼5th ICS just medial to MCL ⎼ Displaced * Towards side of lesion: * Away from lesion:

Answer 30

- collapse lower lobe, localized fibrosis - pleural effusion, tension pneumothorax

Question 31

Impalpable apex beat:

Answer 31

COPD hyperinflation

Question 32

Cardiomegaly: Lung pathology:

Answer 32

- Apex beat displaced but trachea central - Apex beat central but trachea deviated

Question 33

Vocal fremitus: (5)

Answer 33

– Palms placed on the chest wall – Patient says “99” – Compare vibrations left and right – Increased in consolidation – Same as vocal resonance

Question 34

* Ribs – tenderness: (2)

Answer 34

– Fracture (trauma/malignancy) – Costochondritis(joints)

Question 35

* Subcutaneous emphysema:

Answer 35

– Air tracking from the lungs

Question 36

* Symmetrical Percussion:

Answer 36

Question 37

Stony dull - fluid: (2)

Answer 37

- Pleural effusion - Haemothorax

Question 38

Dull: (2)

Answer 38

- Consolidated Lung (fluid in the alveoli) - Solid structure

Question 39

Resonant:

Answer 39

Normal lung

Question 40

Hyper-resonant: (2)

Answer 40

- Pneumothorax - Hollow structure (bowel)

Question 41

Liver dullness:

Answer 41

6th ICS MCL

Question 42

Cardiac dullness:

Answer 42

Left precordium: - resonance = hyperinflation (COPD/Asthma)

Question 43

Auscultation:

Answer 43

Question 44

* Normal breath sounds (vesicular): (3)

Answer 44

* Most of chest area * Inspiration longer and louder than expiration * No gap between inspiration and expiration

Question 45

* Bronchial breathing: (5)

Answer 45

* Hollow, blowing quality * Audible in expiration * Gap between inspiration and expiration * Sound of turbulence in the upper airway without filtering by the alveoli (bronchial breathing is heard normally over the upper airways but not over the lung fields) * Consolidated lung (e.g. lobar pneumonia) conducts turbulent sound from the upper airway without filtering

Question 46

Amphoric breathing: (3)

Answer 46

– Exaggerated bronchial sounds – Hollow sound like blowing over a bottle – Large cavity

Question 47

Intensity of breath sounds * Normal or reduced * Reduced = (6)

Answer 47

Question 48

Added sounds: (2)

Answer 48

Question 49

Wheeze:

Answer 49

Question 50

Crackles:

Answer 50

Question 51

Pleural friction rub: (3)

Answer 51

Question 52

Vocal resonance: - Normal = - Consolidation = - Whispering pectoriloquy =

Answer 52

– Normal – muffled sounds – Consolidation – Numbers become clearly audible (consolidated lung transmits higher frequencies better) – Whispering pectoriloquy – whispered speech distinctly heard