Exam - Resp

Question 1

What should you look for in general inspection of a respiratory exam?

Answer 1

•“Sick or not sick”
•Orientated or confused or drowsy
•Respiratory distress (at rest or undressing)
–obvious respiratory effort (we are not usually able to see someone breathe), noisy breathing (eg stridor)
•Other
–febrile
–sputum mug!!! (do not forget!)
–Equipment
•IV treatment, supplemental oxygen, Non-invasive ventilation

Question 2

Causes of clubbing

• (3) resp
• (3) cardiac
• (3) others

Answer 2

1. Respiratory
–Suppurative lung disease (bronchiectasis, TB, lung abscess)
–Lung cancer (NSCLC)
–Pulmonary fibrosis
NOTE: not in COPD

2. Cardiac
   –Subacute bacterial endocarditis
   –Congenital cyanotic heart disease
   –Left atrial myxoma
3. Others
   –Inflammatory bowel disease
   –Primary biliary cirrhosis
   –Idiopathic

Question 3

What are the 2 types of cyanosis & their mechanisms?

Answer 3

Peripheral: circulatory insufficiency -> high­ extraction of O2

Central: respiratory insufficiency -> low O2 saturation of Hb

Question 4

What should you examine in the neck during resp exam?

Answer 4

•Jugular Venous Pressure (JVP)
•Trachea
•Lymph nodes
–Stand behind the patient except when examining the supraclavicular LNs

Question 5

What (3) could increased percussion mean in resp exam?

Answer 5

• pneumothorax
• hyperinflation
• lung cyst

Question 6

What (6) could decreased percussion mean in resp exam?

Answer 6

• consolidation
• collapse
• dense fibrosis
• pleural fluid
• thickening
• elevated hemidiaphragm (pulled-up, pushed-up or paralysed)

Question 7

What (4) could reduced breath sounds be due to?

Answer 7

1. Airflow obstruction or hyperinflation
2. Pleural effusion or pneumothorax
3. Thick chest wall
4. Lung collapse

Question 8

What (5) could crepitations be due to?

Answer 8

• Pulmonary oedema
• Pulmonary fibrosis
• Pneumonia
• Bronchiectasis
• Atelectasis

Question 9

More than how many seconds of forced expiratory time does it indicate significant airflow obstruction?

Answer 9

> 6 seconds

Question 10

Pneumothorax O/E

Answer 10

• Shift of mediastinum (depending on size)
• low movement (sometimes)
• ­ high percussion note
• low breath sounds
• low vocal resonance

Question 11

List (10) spectrum of signs in COPD

Answer 11

–Respiratory distress
–Cachexia
–Cyanosis
–Plethoric facies
–Signs of hyperinflation
–Wheezes
–Signs of pulmonary hypertension +/- right heart failure
–Prolonged forced expiratory time

Question 12

(4) Pulmonary hypertension O/E

Answer 12

–Palpable RV heave and 2nd heart sound
–Loud H2
–4th heart sound
–Pulmonary flow murmur

Question 13

(3) Right heart failure O/E

Answer 13

–Elevated JVP
–3rd heart sound
–Peripheral oedema, ascites, pleural effusions