In collaboration with the Warwick Medical School’s very own Clinical Skills Society, MedGuide proudly presents another OSCE-like quiz.  Best of luck! 

Reviewed by Katrina Bogus on 25th November 2019

  • Introduce, explain and consent a patient to undergo a full respiratory examination
  • Perform a structured general inspection and examination relevant to the respiratory exam 
  • Perform a structured inspection, palpation, percussion and auscultation relevant to the respiratory exam 
  • Note any further tests that would be undertaken in a patient who has had an respiratory examination 

Clinical Skills - Introduction to the Respiratory Examination

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Question 1
An 8 year-old male presents acutely short of breath.  Which of the following differentials are the more likely?
  Choose as many correct options as you believe. 
A
Cystic fibrosis
B
Chronic obstructive pulmonary disease
C
Interstitial lung disease
D
Idiopathic pulmonary fibrosis
E
Asthma
Question 1 Explanation: 
First, the question. In a young patient with acute onset respiratory issues, infective, asthmatic and CF are differentials to exclude first. Don't worry if the abbreviations scared you. You'll soon get used to them and in terms of "common" respiratory conditions, there aren't many beyond a few infective, obstructive and fibrotic causes.
Question 2
A patient, during rounds on a general medical ward, is short of breath. At the end of bed inspection, a sputum pot is noted with expectorate present.  Which of the following is the most likely diagnosis?
A
ILD
B
Emphysema
C
Asthma
D
Pulmonary fibrosis
E
Extraarticular rheumatoid arthritis
Question 2 Explanation: 
COPD/bronchiectasis commonly present with productive cough.
Question 3
A patient acutely short of breath may be seen to have which sign?
A
Pectoral recession
B
Intercostal recession
C
SCM recession
D
Subcostal recession
E
Superficial temporal recession
Question 3 Explanation: 
When there is reduced intrathoracic pressure in your chest, the intercostal muscles are "sucked" inward and are therefore seen to recede in the space. This is classically seen with a lower airway obstruction.
Question 4
A barrel-shape general examination finding of a patient, confirmed with chest radiography, is indicative of which best diagnosis?
A
Asthma
B
Interstitial lung disease
C
Pneumonia
D
Chronic bronchitis
E
Recurrent LRTI
Question 4 Explanation: 
In the obstructive lung disease COPD, there is reduced FEV1 to an extent that hyperinflation of the chest occurs over the time - think "you can't blow out the air sufficiently". This causes a barrel-shaped chest appearance.
Question 5
An older patient presenting with productive cough is more likely to have which diagnosis?
A
CF
B
Asthma
C
Emphysema
D
Upper airway obstruction
E
Sleep apnoea
Question 6
On examination, the patient has an absence of Schamroth's window. Which of the following diagnoses is least likely therefore?
A
Cystic fibrosis
B
Lung cancer
C
Emphysema
D
Ulcerative colitis
E
Idiopathic pulmonary fibrosis
Question 6 Explanation: 
COPD is not a recognised part of the clubbing differential.
Question 7
A flapping tremor in a patient with long-term COPD is most likely caused by
A
Salbutamol use
B
Cachexia
C
Ammonia deposition in the motor cortices
D
Type two respiratory failure
E
None of the above
Question 7 Explanation: 
Unlike type 1 respiratory failure, the second type is sufficient alveolar malfunction to cause derangement of both O2 and CO2. This "retention" of CO2 causes muscles to work ineffectively and, long story short, a flapping is seen when the hands are extended in the general examination.
Question 8
On examination, a patient is noted to have a double-pulsatile wave in the anterolateral neck region between the two heads of SCM muscle. What is the most likely cause for this circumstance?
A
Cor pulmonale
B
Left hypertrophic cardiomyopathy
C
Bicuspid valve regurgitation
D
Aortic valve stenosis
E
Infective exacerbation of COPD
Question 9
A small mid-axillary line scar to the left patient's thorax is most indicative of which procedure?
A
Thoracotomy
B
Chest drain
C
Valvular replacement
D
Open heart surgery
E
Thoracoplasty
Question 10
In the respiratory examination, which does the physician not palpate?
A
Sacral oedema
B
Calves for ?DVT
C
Trachea for deviation
D
Heaves of the anterior thorax
E
Chest expansion for symmetry
Question 10 Explanation: 
Heaves and thrills are noted on the cardiovascular examination. In practice, it is routine to merge the CV and respiratory exam/focused history as the two systems are intimately related.
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