Respiratory system exam

Question 1

What is the normal respiratory rate range?

Answer 1

The normal respiratory rate is between 12 and 16 breaths per minute.

Question 2

What is tachypnoea?

Answer 2

Tachypnoea is a medical term used to describe fast breathing.

Question 3

What is dyspnoea?

Answer 3

Dyspnoea is a medical term used to describe difficulty in breathing.

Question 4

When is a patient said to be using accessory muscles of respiration?

Answer 4

A patient is said to be using accessory muscles of respiration when they are using other muscles besides the diaphragm and intercostal muscles to help with breathing.

Question 5

What is pursed-lip breathing?

Answer 5

Pursed-lip breathing is a breathing technique where the patient inhales through the nose and exhales through pursed lips, as if blowing out a candle. It can help to reduce shortness of breath.

Question 6

What is the normal respiratory cycle?

Answer 6

The normal respiratory cycle consists of inspiration, which is an active process, followed by expiration, which is a passive process and takes slightly longer.

Question 7

What should be noted when assessing the chest wall during respiration?

Answer 7

Any abnormalities of the chest wall or any asymmetry of the chest wall should be noted.

Question 8

When one side of the chest moves less than the other, what does it indicate?

Answer 8

When one side of the chest moves less than the other, it indicates that the affected side is the side of pathology.

Question 9

How can we assess if the patient is breathing with difficulty?

Answer 9

We can assess if the patient is breathing with difficulty by checking for dyspnoea, using accessory muscles of respiration, and observing for pursed-lip breathing.

Question 10

Why is it important to assess the patient’s respiratory rate?

Answer 10

: It is important to assess the patient’s respiratory rate because an abnormal respiratory rate can indicate an underlying medical condition and can be a sign of respiratory distress.

Question 11

What should be done if the patient’s respiratory rate is outside the normal range?

Answer 11

If the patient’s respiratory rate is outside the normal range, further assessment and investigation should be done to determine the cause of the abnormal respiratory rate.

Question 12

What are some potential causes of an increased respiratory rate?

Answer 12

Some potential causes of an increased respiratory rate include anxiety, fever, pneumonia, asthma, chronic obstructive pulmonary disease (COPD), and heart failure.

Question 13

What are some potential causes of difficulty breathing?

Answer 13

Some potential causes of difficulty breathing include asthma, pneumonia, COPD, pulmonary embolism, and congestive heart failure.

Question 14

What are some potential complications of respiratory distress?

Answer 14

Some potential complications of respiratory distress include respiratory failure, hypoxia, and cardiac arrest.

Question 15

How can oxygen saturation be assessed?

Answer 15

Oxygen saturation can be assessed using a pulse oximeter, which measures the percentage of hemoglobin in the blood that is carrying oxygen.

Question 16

What is scoliosis?

Answer 16

Scoliosis is a medical condition characterized by a lateral curvature of the spine, and it is more common in females.

Question 17

What is pectus excavatum?

Answer 17

Pectus excavatum, also known as funnel chest, is a congenital abnormality characterized by an inward depression of the sternum and ribs. It is more common in males and occurs in about 1 in 300-400 births.

Question 18

: What is pectus carinatum?

Answer 18

Pectus carinatum, also known as pigeon chest, is a congenital abnormality characterized by an outward protrusion of the sternum and ribs. It is more common in males.

Question 19

What is kyphosis?

Answer 19

Kyphosis is a medical condition characterized by an abnormal front-to-back curvature of the spine. It can occur in adolescents when several vertebrae become wedged together, or it can be acquired in the elderly due to osteoporosis, degeneration, or spondylolisthesis.

Question 20

What can cause acquired kyphosis?

Answer 20

Acquired kyphosis can be caused by osteoporosis, degeneration of the discs and joints of the spine, or spondylolisthesis (slippage of a vertebral body).

Question 21

What is thoracic injury?

Answer 21

Thoracic injury refers to any damage or trauma to the chest wall, including the ribs, sternum, and thoracic spine. This can be caused by accidents, falls, or direct blows to the chest.

Question 22

What should be assessed when examining the hands?

Answer 22

When examining the hands, the temperature (warm or cold), whether they are sweaty/clammy, peripheral cyanosis (blue), white/pale (Raynaud’s syndrome), and capillary refill should be assessed.

Question 23

What should be assessed when examining the nails?

Answer 23

When examining the nails, clubbing and tar staining (from cigarette smoking) should be assessed.

Question 24

What is palmar erythema?

Answer 24

Palmar erythema is a reddening of the palms and is associated with GI system disorders.

Question 25

What is Dupuytren’s contracture?

Answer 25

Dupuytren’s contracture is a condition in which the fingers become permanently bent due to thickening of the connective tissue in the palm of the hand, and it is also associated with GI system disorders.

Question 26

What is a tremor?

Answer 26

A tremor is an involuntary rhythmic movement of the hands, fingers, or other body parts.

Question 27

What can cause a tremor?

Answer 27

A tremor can be caused by neurological diseases such as Parkinson’s disease or thyrotoxicosis, as well as overuse of β-2 agonist (salbutamol) in a patient with asthma or COPD.

Question 28

What is a carbon dioxide (CO2) retention flap?

Answer 28

A carbon dioxide (CO2) retention flap is a coarse flapping tremor that occurs when a patient has a high level of CO2 in the blood.

Question 29

How is a CO2 retention flap assessed?

Answer 29

A CO2 retention flap is assessed by asking the patient to stretch both hands out, then cock the wrists up, keeping fingers apart, and observing for 30 seconds.

Question 30

What are some respiratory causes of clubbing?

Answer 30

Respiratory causes of clubbing include lung cancer (bronchogenic carcinoma), idiopathic pulmonary fibrosis (IPF), “suppurative” lung disease (chronic infection), bronchiectasis, empyema, and lung abscess.

Question 31

What are some cardiovascular causes of clubbing?

Answer 31

Cardiovascular causes of clubbing are less common than respiratory causes, but can occur in some cases of congenital heart disease and infective endocarditis.

Question 32

What are some gastrointestinal causes of clubbing?

Answer 32

Gastrointestinal causes of clubbing are rare, but can occur in diseases such as inflammatory bowel disease (IBD) and cirrhosis.

Question 33

What is idiopathic clubbing?

Answer 33

Idiopathic clubbing is clubbing of the fingers or toes without an underlying medical cause.

Question 34

What is the normal range for blood pressure?

Answer 34

The normal range for blood pressure is typically considered to be 120/80 mmHg.

Question 35

What is the jugular venous pressure (JVP)?

Answer 35

The jugular venous pressure (JVP) is the measurement of the pressure of the blood in the jugular veins, which can be observed in the neck.

Question 36

: How is the JVP assessed?

Answer 36

The JVP is assessed by observing the pulsations of the jugular veins between the two heads of the sternocleidomastoid muscle with the patient sitting at a 45-degree angle.

Question 37

What can a raised JVP indicate?

Answer 37

A raised JVP can indicate right heart failure, which can occur with lung diseases and with superior vena cava (SVC) obstruction.

Question 38

What is a displaced apex beat?

Answer 38

A displaced apex beat refers to the location of the point where the heartbeat can be felt most strongly, which may be shifted from its normal location due to mediastinal shift.

Question 39

What is a right ventricular heave?

Answer 39

A right ventricular heave is a visible pulsation of the right side of the chest, which can indicate right ventricular hypertrophy due to lung disease or other conditions

Question 40

What is a loud P2?

Answer 40

A loud P2 refers to an abnormally loud second heart sound, which can indicate pulmonary hypertension or other conditions affecting the pulmonary artery.

Question 41

What is conjunctival pallor?

Answer 41

Conjunctival pallor refers to a pale appearance of the conjunctiva, which can indicate anemia.

Question 42

What is Horner’s syndrome?

Answer 42

Horner’s syndrome is a medical condition characterized by a combination of ptosis (drooping eyelid), miosis (constricted pupil), enophthalmos (sunken appearance of the eye), and anhidrosis (decreased sweating) due to damage to the sympathetic chain in the neck.

Question 43

What is telangiectasia?

Answer 43

Telangiectasia is a medical condition characterized by the appearance of small, dilated blood vessels on the skin or mucous membranes.

Question 44

What is central cyanosis?

Answer 44

Central cyanosis refers to a blue or purple appearance of the mucous membranes of the mouth, lips, and tongue, which can indicate low oxygen levels in the blood.

Question 45

What is the threshold for cyanosis?

Answer 45

Cyanosis is generally defined as a concentration of deoxygenated hemoglobin of greater than 5g/dL.

Question 46

What can a raised JVP indicate?

Answer 46

A raised JVP can indicate right heart failure (“cor pulmonale”) and SVC obstruction.

Question 47

What is lymphadenopathy?

Answer 47

Lymphadenopathy refers to the enlargement of lymph nodes, which can occur due to infection, inflammation, or cancer.

Question 48

What are some locations where lymphadenopathy may be present in the neck?

Answer 48

Lymphadenopathy may be present in the submental, submandibular, cervical, supraclavicular, pre-auricular, post-auricular, or occipital regions of the neck.

Question 49

What are some causes of lymphadenopathy?

Answer 49

Some causes of lymphadenopathy include malignancy (such as lung cancer or lymphoma), infection (viral or bacterial, including Epstein Barr Virus and Mycobacterium tuberculosis), and sarcoidosis.

Question 50

How is tracheal deviation assessed?

Answer 50

Tracheal deviation is assessed by inserting the index and middle fingers in the suprasternal notch and checking if the trachea is central or is deviated to one side.

Question 51

What are some extrathoracic causes of tracheal deviation?

Answer 51

Some extrathoracic causes of tracheal deviation include a large thyroid goiter and lymphadenopathy.

Question 52

What are some intrathoracic causes of tracheal deviation?

Answer 52

Some intrathoracic causes of tracheal deviation include pneumothorax, pleural effusion, and lung collapse.

Question 53

What is tactile vocal fremitus (TVF) and how is it assessed?

Answer 53

Tactile vocal fremitus (TVF) is the vibration felt on the chest wall when a patient speaks. It can be assessed by placing the lateral surface of the hands on the chest wall in the main zones of the lungs and feeling for the vibration under the hands while the patient says “99.”

Question 54

What is vocal resonance (VR) and how is it assessed?

Answer 54

Vocal resonance (VR) is the transmission of sound from the lungs to the chest wall when a patient speaks. It can be assessed by using a stethoscope to hear the “99” amplified as it is transmitted to the chest wall.

Question 55

What can increased TVF and VR indicate?

Answer 55

Increased TVF and VR can indicate consolidation, such as in pneumonia.

Question 56

What can decreased TVF and VR indicate?

Answer 56

Decreased TVF and VR can indicate pleural effusion.

Question 57

What can decreased or absent breath sounds indicate?

Answer 57

Decreased or absent breath sounds can indicate pleural effusion or collapse of a lobe of the lung.

Question 58

What are some types of lung sounds and what do they indicate?

Answer 58

Vesicular sounds are normal breath sounds, while wheezes are high-pitched, whistling sounds that can indicate airway obstruction. Crackles occur when respiratory bronchioles open and can indicate pulmonary edema, bronchiectasis, or retained secretions. Bronchial breathing is a harsh sound that can occur in pneumonia or at the top of a pleural effusion. A pleural rub is a “squeaky” sound that can indicate inflammation of the pleura or pulmonary infarction.

Question 59

What is sacral edema and how is it assessed?

Answer 59

Sacral edema is swelling in the sacral region, which can be assessed by feeling for the presence of pitting edema in this area.

Question 60

What is peripheral edema and how is it assessed?

Answer 60

Peripheral edema is swelling in the extremities, which can be assessed by feeling for the presence of pitting edema in these areas.

Question 61

What do sacral and peripheral edema suggest and what condition may they be secondary to?

Answer 61

Both sacral and peripheral edema suggest fluid overload and may be secondary to right heart failure.