Respiratory

Question 1

Hemoptysis

Answer 1

• RESPIRATORY CARCINOMA
• PULMONARY INFARCTION
• BRONCHITIS
• BRONCHIECTASIS
• CYSTIC FIBROSIS

CARDIAC

• MITRAL STENOSIS

BLEEDING DISORDERS

Question 2

Bronchopneumonia signs

Answer 2

• EXPANSION –REDUCED
• TACTILE FREMITUS -> INCREASED ON AFFECTED SIDE
• PERCUSSION-DULL
• BREATH SOUNDS-BRONCHIAL
• ADDITIONAL SOUNDS-RALES
• VOCAL RESONANCE-INCREASED ON AFFECTED SIDE
• PEURAL RUB MAY BE HEARD AEGOPHONY
• WHISPERING PECTORILOQUY

Question 3

Bronchial Asthma signs

Answer 3

• WHEEZING
• TACHYPNOEA
• TACHYCARDIA
• PROLONGED EXPIRATION
• PROLONGED FORCED EXPIRATORY TIME(PEAK FLOWRATE&FEV DECREASED)
• USE OF ACCESSORY MUSCLES OF RESPIRATION
• HYPERINFLATED CHEST

Question 4

Bronchiectasis signs

Answer 4

• SYSTEMIC –FEVER,CACHEXIA,SINUSITIS
• CLUBBING AND CYANOSIS
• SPUTUM-VOLUMINOUS,PURULENT,FOUL SMELLING
• COARSE INSPIRATORY CREPITATIONS

Question 5

Emphysema signs

Answer 5

• BARREL SHAPED CHEST
• PURSED LIP BREATHING
• USE OF ACCESORY RESPIRATORY MUSCLES PALPATION-REDUCED EXPANSION PERCUSSION-HYPERINFLATED -> Hyper-resonance
• BREATH SOUNDS-DECREASED
• SIGNS OF HEART FAILURE

Question 6

Chronic bronchitis signs

Answer 6

• COUGH,SPUTUM
• CYANOSIS: more than >5 g deoxy Hb in blood
• PALPATION-HYPERINFLATED CHEST WITH REDUCED EXPANSION
• PERCUSSION-RESONANCE/ HYPERRESONANCE
• BREATHSOUNDS – VESICULAR WHEEZING,INSPIRATORY CRACKLES
• RIGHT HEART FAILURE

Question 7

Pleural effusion sigsn

Answer 7

• TRACHEA,APEX BEAT- DISPLACEDAWAY FROM
• MASSIVE EFFUSION
• EXPANSION- REDUCED
• PERCUSSION –STONY DULL -> Tactile fremitus reduced
• BREATH SOUNDS-REDUCED OR ABSENT VOCAL RESONANCE-REDUCED

Question 8

Pneumothorax signs

Answer 8

• EXPANSION-REDUCED ON AFFECTED SIDE
• PERCUSSION-HYPER RESONANCE
• BREATH SOUNDS-REDUCED OR ABSENT
• SUBCUTANEOUS EMPHYSEMA

Question 9

Tension pneumothorax

Answer 9

• TACHYPNOEIC,CYANOSED,HYPOTENSIVE
• TRACHEA,APEXBEAT-DISPLACEDAWAY FROM AFFECTED SIDE
• EXPANSION-REDUCED
• PERCUSSION-HYPER RESONANT
• BREATH SOUNDS-ABSENT
• VR-REDUCED

Question 10

Bronchogenic carcinoma

Answer 10

• HAEMOPTYSIS
• CLUBBING
• LOBAR COLLAPSE
• PNEUMONIA
• PLEURAL EFFUSION
• FIXED RESPIRATORY WHEEZE
• TENDER RIBS
• MEDIASTINAL COMPRESSION
• LYMPHADNOPATHY

Question 11

Pulmonary embolism

Answer 11

• GENARAL-TACHYCARDIA,TACHYPNOEA,FEVER
• LUNGS-PLEURAL FRICTION RUB
• MASSIVE EMBOLISM-ELEVATED JVP
• RIGHT VENTRICULAR GALLOP
• RIGHT VENTRICULAR HEAVE
• TRICUSPID REGURGITATION MURMUR
• INCREASED PULMONARY COMPONENT OF 2ND HEART SOUND.

Question 12

Tactile fremitus

Answer 12

• incr in consolidation (ie. pneumonia);
• decr in pleural effusion (ie. pneumothorax)

Question 13

Abnormal sounds (partial list)

Answer 13

• Crackles:“wet sounds” discontinuous, intermittent, nonmusical, brief, fine, course
  
  • in pulmonary edema, left heart failure, bronchiectasis
• Wheezing:“high pitched”–continuous, musical, prolonged
  
  • in respiratory diseases, ie. asthma
• Rhonchi:“dry sounds”–similar to wheezing but low pitched, continuous
• Pleural rub: grating sounds during inspiration and expiration (problem with parietal & visceral memb)
• Rales: extra breath sounds