Respiratory Examination

Question 1

Respiratory causes of clubbing

Answer 1

IPF
Lung neoplasm 
CF
Bronchiectasis 
Sarcoidosis 
TB

Question 2

Pectus carinatum

Answer 2

Childhood asthma

Rickets

Question 3

Pectus Excavatum

Answer 3

Marfan’s

Question 4

Asymmetrical chest wall expansion

Answer 4

Lung fibrosis 
Atelectasis 
Pneumonectomy 
Pleural effusion 
Pneumothorax

Question 5

Tracheal deviation

Answer 5

Ipsilateral side- mass/ atelectasis

Contralateral side- tension pneumothorax/ pleural effusion

Question 6

Chest wall percussion

Answer 6

Dull- consolidation, atelectasis (when over the lung), pleural effusion
Hyperresonant- COPD, pneumothorax (air)

Question 7

Decreased air entry

Answer 7

COPD, pneumothorax, pleural effusion, atelectasis, status asthmaticus

Question 8

Pleural rub

Answer 8

Pulmonary infarction, pneumonia, pleurisy, pleural malignancy

Question 9

Wheeze

Answer 9

Asthma, COPD

Question 10

Crackles

Answer 10

Coarse- bronchiectasis/ consolidation
Fine inspiration at bases- pulmonary oedema
Fine end inspiration- pulmonary fibrosis

Question 11

Focused Examination- COPD

Answer 11

Barrel chest, accessory muscle use, purses lip breathing, ruddy plethoras complexion, peripheral cyanosis, tar staining on hands, flapping tremor, central cyanosis, raised JVP, right ventricular heave, polyphonic wheeze, if infection- reduces expansion, tachypnoea, cough and sputum, fever

Question 12

Focused examination- asthma

Answer 12

Dyspnoea, signs of atopy(eczema), bruises from steroid use, hyper inflated chest, hyperesonant percussion note, maybe absent or reduced breath sounds or a wheeze (depends on patients current disease state)

Question 13

Focused Examination- lung cancer

Answer 13

Cachexia, tar staining, clubbing, conjunctival pallor (anaemia), hoarse voice or horners syndrome due to pain past tumour, pleural effusion could lead to a dull percussion note, reduced breath sounds and tracheal deviation away from the effusion. May see SVC obstruction, vocal fremitus increased with mass but decreased if effusion, ectopic ACTH ,weds to cushings appearance

Question 14

Focused Examination- Pneumonia

Answer 14

Fever, SOB at rest, cough, tachypnoea, tachycardia, peripheral cyanosis, hypotension, conjunctival pallor, central cyanosis, reduced chest expansion, dullness to percussion, bronchial breathing and reduced breath sounds, increased vocal resonance and tactile fremitus both increased on the affected side,tracheal deviation away if large enough

Question 15

Focused examination- pulmonary embolism

Answer 15

Tachypnoea, tachycardia, SOB at rest, hypotension, JVP raised, signs of a DVT and pleural effusion, pleural rub

Question 16

Focused examination- pneumothorax

Answer 16

Tachycardia, tachypnoea, reduced chest expansion, tracheal deviation away from affected side (towards if tension), hyper resonance to percussion over air, reduced breath sounds, signs of a chronic lung disease eg, Asthma or COPD, hypotension, distended neck veins if a tension one

Question 17

Sounds heard on auscultation

Answer 17

Decreased air entry- emphysema, pneumothorax, pleural effusion, collapse

Wheeze- asthma, COPD

Coarse crepitations- bronchiectasis, consolidation

Fine inspiratory crepitations- pulmonary oedema

Fine end inspiratory crepitations- pulmonary fibrosis

Bronchial breathing- consolidation

Pleural rub- pleurisy, PE, pneumonia, pleural malignancy

Question 18

Focused Examination- Pleural Effusion

Answer 18

Dyspnoea, tachypnoea, tachycardia, reduced chest expansion, peripheral cyanosis, dullness to percussion, reduced breath sounds, decreased tactile fremitus, cough, decreased vocal resonance