Respiratory Exam

Question 1

Resp causes of clubbing

Answer 1

“LIT ABC”

Lung cancer (inc mesothelioma), Interstitial fibrosis, TB, Abscess, Bronchiectasis, Cystic fibrosis. + emphysema

Question 2

Face inspection signs

Answer 2

Face: Polycythaemia (Ruddy complexion due to chronic lung disease)

Eyes: Horner’s syndrome (due to damage to the cervical sympathetic nerves. Presents as unilaterial miosis, partial ptosis, loss of sweating)

Mouth, ask to lift tongue: Emphysema (pursed lips on expiration, a part of COPD presentation), central cyanosis

Question 3

Percussion notes

Answer 3

• Hyper resonant= too much air = Emphysema, pneumothorax
• Dull= Too much solid = Consolidation, fibrosis
• Stony/very dull= Too much fluid = Pleural effusion, haemothorax

Question 4

Vocal resonance notes

Answer 4

• Increased means consolidation or fibrosis.
• Decreased means pleural effusion or collapse.

Method: Auscultate over the area of dull percussion as the patient to say “One, one, one” then compare with other side. Then ask patient to whisper “one, one, one”. Whispering shouldn’t be heard unless consolidation.

Question 5

Auscultation findings

Answer 5

Decreased breath sounds= Emphysema, pneumothorax, pleural effusion.

“Bronchial” sounds= In consolidation, heard as a gap between inspiration and expiration and with higher pitched.

Added sounds:
1. Crackles
 Coarse crackles: Pulmonary oedema, pneumonia, bronchiectasis
 Fine end respiratory crackles: Pulmonary fibrosis
2. Wheeze
 Polyphonic – Widespread airway obstruction e.g. asthma
 Monophonic – Localised airway obstruction e.g. cancer
3. Friction or pleural rub

Question 6

Offer at the end

Answer 6

30. Ankle oedema
31. Look in sputum pot
32. Peak flow. Perform peak flow 3 times and use best result.
33. Refer for spirometry
34. Obs chart: Pulse, bp, temperature