Respiratory examination

Question 1

What is wheeze and what does wheeze indicate?

Answer 1

Continuous coarse whistling sound produced in the respiratory airways during breathing

Associated with:

• Asthma
• COPD
• Bronchiectasis

Question 2

What is stridor? What does it indicate?

Answer 2

High pitched
Exra-thoracic breath sound
Caused by turbulent airflow through narrowed upper airways.

Associated with:

• Foreign body inhalation (acute)
• Subglottic stenosis (chronic)

Question 3

Coarse crackle sounds like what? What do they indicate?

Answer 3

Discontinuous
Brief
Popping lung sounds

Indication of:

Pneumonia
Bronchiectasis
Pulmonary oedema

Question 4

Fine end-inspiratory crackles sound like and indicate what?

Answer 4

Sound similar to noise of separating velcro.

They are associated with pulmonary fibrosis.

Question 5

What causes finger clubbing?

Answer 5

Finger clubbing involves uniform soft tissue swelling of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed.

Question 6

What can finger clubbing be an indication of which 4 underlying diseases? (respiratory context)

Answer 6

lung cancer,
interstitial lung disease,
cystic fibrosis
bronchiectasis

Question 7

Asterixis (flapping tremor)

What is it, what is it caused by and what does it indicate?

Answer 7

irregular lapses of posture causing a flapping motion of the hands.

In the context of a respiratory examination, the most likely underlying cause is CO2 retention in conditions that result in type 2 respiratory failure (e.g. COPD).

Other causes of asterixis include uraemia and hepatic encephalopathy.

Question 8

Examples of pulse abnormalities and what they mean

Answer 8

Bounding pulse: can be associated with underlying CO2 retention (e.g. type 2 respiratory failure).

Pulsus paradoxus:

pulse wave volume decreases significantly during the inspiratory phase.
This is a late sign of cardiac tamponade, severe acute asthma and severe exacerbations of COPD.

Question 9

Respiratory rate:
Normal
Too slow
Too fast

Answer 9

In healthy adults, the respiratory rate should be between 12-20 breaths per minute.

A respiratory rate of fewer than 12 breaths per minute is referred to as bradypnoea (e.g. opiate overdose).

A respiratory rate of more than 20 breaths per minute is referred to as tachypnoea (e.g. acute asthma).

Question 10

What is pectus excavatum?

Answer 10

a caved-in or sunken appearance of the chest.

Question 11

What is pectus carinatum?

Answer 11

protrusion of the sternum and ribs.

Question 12

What causes Hyperexpansion (a.k.a. ‘barrel chest’)

Answer 12

Associated with chronic lung diseases such as asthma and COPD.

Question 13

Displaced apex beat may be indicative of:

Answer 13

Right ventricular hypertrophy (e.g. pulmonary hypertension, COPD, interstitial lung disease)

Large pleural effusion

Tension pneumothorax

Question 14

Symmetrical chest expansion indicates

Answer 14

pulmonary fibrosis

DUE TO reduced lung elasticity, restricting overall chest expansion.

Question 15

Asymmetrical chest expansion indicates

Answer 15

pneumothorax,
pneumonia
pleural effusion

cause ipsilateral reduced chest expansion.

Question 16

Types of percussion sounds and what they indicate

Answer 16

Resonant: a normal finding

Dullness: suggests increased tissue density (e.g. cardiac dullness, consolidation, tumour, lobar collapse).

Stony dullness: typically caused by an underlying pleural effusion.

Hyper-resonance: the opposite of dullness, suggestive of decreased tissue density (e.g. pneumothorax).

Question 17

Abnormal voice resonance:

Increased resonance indicates

Answer 17

Increased volume over an area suggests increased tissue density (e.g. consolidation, tumour, lobar collapse).

Question 18

Abnormal voice resonance: Decreased volume of resonance

Answer 18

Decreased volume over an area suggests the presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax).

Question 19

Pleural effusion

Answer 19

“fluid in the lungs”

can only be diagnosed via imaging and some patients may be asymptomatic

Question 20

Pneumothorax

Answer 20

"collapsed lung"
Increased heart rate
Cough
Chest pains 
Cyanosis