Respiratory Examination Findings

Question 1

What main diseases cause finger clubbing?

Answer 1

• Malignancy
• Fibrotic lung diseases
• Bronchiectasis

Question 2

What is Hypertrophic Pulmonary Osteoarthropathy (HPOA)?

Answer 2

Aka ‘Bamberger-Marie’ Syndrome

A rare condition that causes new bone formation around the wrists and ankles. Causes inflammation of the bones in the joints (mainly wrists and ankles), as well as finger clubbing.

Question 3

What causes Asterixis?

Answer 3

Any form of encephalopathy - this can occur when excess CO2 crosses the blood-brain barrier in CO2 retention = indicator of respiratory failure.

Question 4

What causes tracheal tug?

Answer 4

A difference in pressure between the atmosphere and inside the lungs.

If tugging on the SAME SIDE as pathology = likely lung collapse due to lobectomies/pneumonectomies’

If tugging on the OPPOSITE SIDE = likely tension pneumothorax or pleural effusions

Question 5

Bronchial vs Vesicular Breathing

Answer 5

Bronchial = Same volume of expiratory and inspiratory sounds

Vesicular = normal breathing sounds. Nice inspiration heard but quiet expiration due to lungs collapsing to push air out.

Question 6

What are the different types of wheezes and what do they indicate?

Answer 6

A wheeze indicates obstruction of an airway.

Monophonic = heard in only one area, indicating a localised airway obstruction (i.e. tumour, foreign body in children)

Polyphonic = Heard throughout chest, indicating multiple airway involvement (e.g. asthma)

Question 7

Coarse crackles vs Fine crackles

Answer 7

Coarse crackles = Heard throughout inspiration + expiration (Low pitch)
Likely consolidation/ COPD exacerbation/bronchiectasis

Fine crackles = ALWAYS Inspiratory. Almost always indicates interstitial lung disease

Question 8

What causes EXUDATE pleural effusion?

Answer 8

Exudate = >30g/L protein

• Connective tissue disease
• PE
• Malignancy
• Infection

Question 9

What causes TRANSUDATE pleural effusion?

Answer 9

Transudate = <25g/L protein

• Congestive HF
• Renal/hepatic failure
• Nephrotic syndrome
• (Meig’s` Syndrome)

Question 10

What two types of CT are used?

Answer 10

High Resolution (HR) CT = No contrast used
Used to see airways and parenchyma

Staging CT = Contrast used
Used to see lymph glands and underlying CA

Question 11

What is the CURB65 Score?

Answer 11

C= Confusion (< 8/10)
R= Resp. rate >=30/min
B: BP <=90mmHg and/or diastolic <=60mmHg

Age>=65