Respiratory Examination

Question 1

Which accessory muscles are used in quiet inspiration? How does this differ in forced inspiration?

Answer 1

External intercostals & diaphragm. The SCM, scalene & pectoralis minor are added in forced inspiration.

Question 2

Which accessory muscles are used in forced expiration?

Answer 2

Internal & innermost intercostals and the abdominal muscles.

Question 3

Suggest some respiratory causes of nail clubbing.

Answer 3

• Lung cancer (non-small cell mostly)
• Interstitial lung disease
• Complicated TB

Question 4

Why do some respiratory diseases result in a flapping tremor? What type of pulse would you expect if there was a flapping tremor?

Answer 4

CO2 retention - which can also cause a bounding pulse

Question 5

Enlargement of which lymph node may be the first sign of metastatic lung cancer?

Answer 5

Scalene lymph node

Question 6

When palpating the chest, what type of nodule would give you the most concern?

Answer 6

• Firm, fixed masses (if there are many of them this i also concerning)

This is because they are more likely to be a cancer than something that is freely moveable.

Question 7

What is vocal resonance?

Answer 7

A test where the examiner asks the patient to repeatedly say “99” while he auscultates. There will be increased resonance if there is consolidation, whereas in an individual with normal lungs it will sound like a mumble. While, in an individual with a pleural effusion or collapse there will be decreased resonance.

Question 8

Describe bronchial breathing. Where can it be heard?

Answer 8

Inspiration and expiration are the same length & there is presence of high-pitched sounds, physiologically heard over the trachea. Pathologically, bronchial breathing can be heard more distally if there is consolidation. This is because normally alveoli filter out high pitched sounds and transmit low pitched sounds, when they are consolidated they can’t do this.

Question 9

Which part(s) of the respiratory system produce(s) the sound of breathing?

Answer 9

• Trachea

- Bronchi

Question 10

What happens to breath sounds in pleural effusion when you auscultate?

Answer 10

All sounds are reduced as they are reflected at the air-fluid interface.

Question 11

Suggest some possible causes of stridor.

Answer 11

• Obstruction of airway lumen (tumour, foreign body)
• Obstruction within the wall (oedema aka anaphylaxis, tumour, croup)
• Obstruction outside the wall (goitre, lymphadenopathy)

Question 12

What are the two main types of crepitations heard? What are each of them associated with?

Answer 12

• Coarse crackles (crepitations) - gurgling noise with COPD, pneumonia, TB, bronchiectasis
• Fine crackles (crepitations) - small friction noise with pulmonary fibrosis, pulmonary oedema, alveolitis

Question 13

What is pleural rub? What conditions can it occur in?

Answer 13

A course, grating/creaking sound (like stepping in fresh snow) caused by friction between inflammed visceral and parietal surfaces of the pleura. It can occur in