Respiratory Examination - Signs

Question 1

Upon general inspection, what signs might you find to show that a patient is struggling to breathe?

Answer 1

• Accessory muscle usage
• Tripod position
• Pursed lip breathing
• Intercostal muscle recession

Question 2

What lung conditions would you give supplementary O2 for?

Answer 2

• Interstitial lung disease
• COPD

Question 3

What lung conditions would you give inhalers or nebulisers for?

Answer 3

• Asthma
• COPD

Question 4

When would you get sputum pots from a patient - when you suspect which conditions?

Answer 4

• COPD
• Bronchiectasis

Question 5

At what O2 sats would you usually see peripheral cyanosis in patients?

Answer 5

• <85%

Question 6

What might a resting fine tremor suggest?

Answer 6

• Beta-2 agonist use

Question 7

Give 3 respiratory causes of clubbing

Answer 7

1. Lung cancer
2. Interstitial lung disease
3. Bronchiectasis

Question 8

What is the normal amount of time for capillary refill?

Answer 8

• Roughly 2 secs

Question 9

When would you see a CO2 retention flap?

Answer 9

• Type 2 respiratory failure e.g. COPD

Question 10

Why might a patient be cold to touch?

Answer 10

• Peripheral vasoconstriction
• Poor perfusion

Question 11

What are the signs of Horner’s syndrome?

Answer 11

• Ptosis
• Miosis
• Annhidrosis
• Enopthalmos
• Red eye

Question 12

What does conjunctival pallor suggest?

Answer 12

• Anaemia

Question 13

What would elevated JVP suggest + positive hepatojugular reflex suggest?

Answer 13

• Pulmonary HTN
• Fluid overload

Question 14

Tracheal deviation

Give 2 things that trachea deviates away from and 3 things it deviates towards

Answer 14

Deviates away from:

• Tension pneumothorax
• Pleural effusion

Deviates towards:

• Lobar collapse
• Pneumonectomy
• Consolidation caused by endobronchial obstruction

Question 15

Give 2 common scars you might come across in the respiratory examination and what procedures they might have been caused by

Answer 15

• Mid-axillary scars - chest drains
• Horizontal postero-lateral scars - thoractomy from e.g. lobectomy / pneumonectomy

Question 16

Give 3 chest deformities you might see in the respiratory exam, and give a cause for one of these

Answer 16

1. Pectus excavatum
2. Pectus carinatum
3. Barrel chest - COPD - emphysema

Question 17

Why might you see chest asymmetry in the patient?

Answer 17

• Pneumonectomy
• Thoracoplasty

Question 18

Causes of reduced lung expansion?

Answer 18

• Lung collapse
• Pneumonia

Question 19

Lung sounds

When would you hear the following lung sounds:

1) Resonant
2) Hyper-resonant
3) Dull
4) Stony dull

Answer 19

1) Normal
2) Pneumothorax

3)

• Consolidation
• Fluid
• Tumour

4)

Question 20

Lung sounds

When would you hear the following sounds on auscultation?

1) Vesicular
2) Bronchial
3) Reduced breath sounds
4) Wheeze
5) Coarse crackles
6) Fine crackles

Answer 20

1)

• Vesicular = normal

2)

• Bronchial = consolidation

3)

• Consolidation
• Collapse
• Pleural effusion

4)

• Asthma
• COPD

5)

• Pneumonia
• Bronchiectasis
• Fluid overload

6)

• Pulmonary fibrosis

Question 21

What can you determine from vocal fremitus auscultation?

Answer 21

• Increased volume over an area suggests increased tissue density - consolidation / tumour / lobar collapse
• Decreased volume over an area - pleural effusion

Question 22

Give 3 causes of lymphadenopathy upon cervical lymph node examination

Answer 22

1. Infection
2. Malignancy
3. Sarcoidosis

Question 23

When would you get sacral oedema?

Answer 23

• Fluid overload in cor pulmonale

Question 24

What further examinations would you suggest upon concluding the respiratory examination?

Answer 24

• Obs
• Peak flow
• Sputum pot
• Check inhaler technique
• CXR
• ABG