Respiratory Examination Essentials Quiz

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Questions and Answers

What are the causes of fine late crackles?

Cryptogenic Fibrosing Alveolitis

What is the sound of a pleural rub described as?

Like 'creaking leather'

What does increased resonance on vocal resonance indicate?

Consolidation or fibrosis

What is the cause of a silent chest in severe airways obstruction?

Generalised – Asthma / COPD; Localised – lung tumour Signup and view all the answers

What is the purpose of asking the patient to whisper 'one, one, one' during vocal resonance examination?

To detect if whispering is heard over a normal lung or in consolidation Signup and view all the answers

What are the learning outcomes of the respiratory examination?

To demonstrate an understanding of the process of respiratory examination, to detect signs of respiratory pathology on clinical examination, to relate clinical signs to underlying pathology, and to use history & examination findings to direct appropriate treatment/investigations. Signup and view all the answers

What are the components of the history lecture that should be considered in a respiratory examination?

Presenting complaint (PC), history of presenting complaint (HPC), past medical history (PMH), medication/allergies (DH), family history (FH), and social history (SH). Signup and view all the answers

What is the purpose of the examination in the respiratory examination process?

To gather information, refine the differential diagnosis, and use history and examination together to help reach a management plan. Signup and view all the answers

How should history and examination findings be utilized in the respiratory examination?

They should be used together to help reach a management plan and not lose sight of findings from history. Signup and view all the answers

What are the relevant examination steps in the respiratory examination?

Using history and examination together to direct appropriate treatment/investigations and to not lose sight of findings from history. Signup and view all the answers

What are the key steps involved in the respiratory examination process?

The key steps involved in the respiratory examination process include inspection, palpation, percussion, and auscultation, which are preceded by systems enquiry/review (SE), general inspection, and close inspection and palpation. Signup and view all the answers

What specific signs should be focused on during close inspection and palpation in the respiratory examination?

During close inspection and palpation in the respiratory examination, specific signs such as central cyanosis, nail clubbing, and tremors should be focused on as they can indicate underlying respiratory conditions. Signup and view all the answers

What are the purposes of palpation in the respiratory examination?

Palpation in the respiratory examination is used to assess for Horner’s syndrome, polycythaemia, signs of hyperventilation or severe ventilatory failure, lymph nodes, tracheal position, and mediastinal abnormalities. Signup and view all the answers

How is percussion utilized in the respiratory examination?

Percussion in the respiratory examination is performed at specific sites on the chest to assess resonance, which can help identify conditions such as emphysema, collapse, or pleural effusion. Signup and view all the answers

What is the aim of the respiratory examination?

The aim of the respiratory examination is to systematically assess the patient's respiratory system, identify abnormal findings, and guide further diagnostic and treatment decisions. Signup and view all the answers

Explain the concept of, and clinical significance of the bronchopulmonary segments.

The bronchopulmonary segments are functionally independent units within the lung, each supplied by its own tertiary bronchus, artery, vein, and lymphatics. They are clinically significant because they can be individually removed or treated in cases of localized lung diseases or tumors. Signup and view all the answers

Describe the neurovascular (including lymph drainage) supply of the lungs.

The lungs are supplied by the pulmonary arteries and drained by the pulmonary veins. Lymph drainage occurs through lymphatic vessels that accompany the bronchial tree and connect to the pulmonary and bronchopulmonary lymph nodes. Signup and view all the answers

State the relations of the trachea.

The trachea is related anteriorly to the sternum, posteriorly to the esophagus, and laterally to the right and left brachiocephalic veins. Signup and view all the answers

Describe the structure and relations of each lung.

Each lung is enclosed within the pleural cavity and is surrounded by the diaphragm, ribs, and mediastinum. The right lung has three lobes, while the left lung has two lobes. Signup and view all the answers

Recall the structures that form the conducting and respiratory portions of the respiratory tract.

The conducting portion of the respiratory tract includes the nose, nasal cavity, paranasal sinuses, pharynx, larynx, trachea, bronchi, bronchial tree, and terminal bronchioles. The respiratory portion includes the respiratory bronchioles and alveoli for gas exchange. Signup and view all the answers

Explain the structure and function of the trachea, including its surrounding structures and neurovascular supply.

The trachea is a cartilaginous tube that connects the larynx to the primary bronchi. It is composed of C-shaped cartilage rings with posterior trachealis muscle. Surrounding structures include the esophagus, thyroid gland, and various blood vessels and nerves. The neurovascular supply includes the inferior thyroid artery, bronchial arteries, and the pulmonary plexus. Signup and view all the answers

Describe the histology of the respiratory tree, including the trachea, bronchi, bronchioles, and alveoli.

The trachea contains ossified cartilage and ciliated pseudostratified columnar epithelium. Bronchi have smooth muscle and complete cartilage rings, while bronchioles have smooth muscle but no cartilage or glands. The alveoli are lined with a single cell layer and surrounded by capillary beds. Signup and view all the answers

What are the functions and anatomical features of the lungs?

The lungs primarily function in gas exchange and pH balance. They are divided into right and left lobes, separated by fissures, and occupy the lateral parts of the thoracic cavity. They are connected via the hilum, which contains the vasculature and airways entering the lung. Signup and view all the answers

Explain the segmentation and supply of lung segments.

The lung segments are supplied by tertiary (segmental) bronchi, with 10 segments per side. They have a pyramidal shape with apices converging towards the hilum and can be resected as one unit. Infections are typically confined to a segment. Signup and view all the answers

Discuss the role of the respiratory system in gas exchange and other metabolic functions.

The respiratory system is primarily responsible for gas exchange, maintaining pH balance, and contributing to other metabolic functions such as angiotensin conversion and prostaglandin synthesis. Signup and view all the answers

What are the two types of veins that drain the lungs?

The lungs are drained by bronchial veins, which drain to the azygous or hemiazygos vein, and pulmonary veins, which carry oxygenated blood towards the heart. Signup and view all the answers

What is the role of the pulmonary plexus in controlling lung function?

The pulmonary plexus, innervated by the vagus and sympathetic trunk, controls lung function, with parasympathetic input leading to bronchoconstriction and sympathetic input leading to bronchodilation. Signup and view all the answers

What are the lymphatic structures involved in draining the lower lobes of both lungs?

Lung lymphatics include the subpleural plexus, intrapulmonary nodes, hilar nodes, tracheobronchial nodes, and paratracheal nodes, which play a role in draining the lower lobes of both lungs. Signup and view all the answers

What are some clinical considerations for the lungs?

Clinical considerations for the lungs encompass conditions such as asthma, COPD, cancer, pneumothorax, pneumonia, cystic fibrosis, foreign body aspiration, pulmonary embolism, tracheostomy, and bronchoscopy. Signup and view all the answers

What is the most common lung condition and how is it managed?

Asthma, the most common lung condition, involves inflammation of the airways and is managed through a hierarchy of pharmacological treatment, including $\beta2$ adrenoreceptor agonists like salbutamol. Signup and view all the answers

What is the global burden of tuberculosis and why is it considered a major Public Health problem?

The global burden of tuberculosis is significant, with a high number of cases and deaths worldwide. It is considered a major Public Health problem due to its impact on population health, healthcare resources, and socio-economic development. Signup and view all the answers

How does Mycobacterium tuberculosis cause infection and disease?

Mycobacterium tuberculosis causes infection and disease by invading the lungs and other parts of the body, leading to the formation of granulomas and the potential for active tuberculosis disease. Signup and view all the answers

What are the strengths and limitations of current diagnostic methods for tuberculosis?

The strengths of current diagnostic methods for tuberculosis include their specificity and ability to detect the presence of Mycobacterium tuberculosis. However, limitations include the time required for results, resource requirements, and challenges in diagnosing extrapulmonary tuberculosis. Signup and view all the answers

Describe the current approaches to treatment of tuberculosis.

Current approaches to treatment of tuberculosis involve the use of combination drug therapy, directly observed treatment, short-course (DOTS), and the consideration of drug resistance patterns when selecting treatment regimens. Signup and view all the answers

What is the mechanism of action of different anti-TB drugs?

Different anti-TB drugs act through various mechanisms, including inhibition of cell wall synthesis, disruption of bacterial protein synthesis, interference with DNA replication, and other mechanisms to target and kill Mycobacterium tuberculosis. Signup and view all the answers

What is the historical timeline of key discoveries related to tuberculosis?

Key discoveries related to tuberculosis include the discovery of Mycobacterium tuberculosis, the Bacillus Calmette-Guérin (BCG) vaccine, and the antibiotic streptomycin. These discoveries have significantly impacted the understanding and management of tuberculosis over time. Signup and view all the answers

What is the significance of the World Health Organisation (WHO) annual report in reflecting the state of tuberculosis?

The World Health Organisation (WHO) annual report provides crucial insights into the global epidemiology, prevalence, and treatment outcomes of tuberculosis, guiding public health interventions and resource allocation for tuberculosis control and prevention. Signup and view all the answers

Describe the trend in estimated TB incidence from 2016 to 2021 according to the WHO Global TB Reports.

The estimated TB incidence showed a fluctuating trend from 2016 to 2021, with variations in different years as reported by the WHO Global TB Reports. Signup and view all the answers

List the countries with TB incidence of 100,000 and above in 2019 and 2020 according to the WHO Global TB Reports.

The countries with TB incidence of 100,000 and above in 2019 and 2020 were reported in the WHO Global TB Reports for those respective years. Signup and view all the answers

What was the percentage of new TB cases diagnosed by WHO approved rapid test in 2021 according to the WHO Global TB Report 2022?

The percentage of new TB cases diagnosed by WHO approved rapid test in 2021 was reported in the WHO Global TB Report 2022. Signup and view all the answers

What was the target year to end TB according to the WHO Global TB Report 2019?

The target year to end TB was set as 2035 according to the WHO Global TB Report 2019. Signup and view all the answers

What were some of the impacts of COVID-19 on global TB control as mentioned in the WHO Global TB Report 2020 and 2021?

The impacts of COVID-19 on global TB control included increased stigma to TB symptoms, resources diverted to managing COVID-19, reduced access to diagnosis and treatment services, reduction in TB notifications, loss of employment and livelihoods, and excess deaths as mentioned in the WHO Global TB Reports for 2020 and 2021. Signup and view all the answers

What was the reason for the failure in global TB control according to the WHO Global TB Report 2021?

The reasons for the failure in global TB control included poverty and health system inadequacies as mentioned in the WHO Global TB Report 2021. Signup and view all the answers

Discuss the trend in TB case notifications in 2020 according to the WHO Global TB Report 2021.

There was a sharp drop in TB case notifications in 2020 as reported by the WHO Global TB Report 2021. Signup and view all the answers

What is the impact of the shrinking global economy on TB response as mentioned in the WHO Global TB Report 2020 and 2021?

The shrinking global economy put a strain on the available funds for TB response as mentioned in the WHO Global TB Reports for 2020 and 2021. Signup and view all the answers

Study Notes

Respiratory Examination: Key Steps and Findings

Systems enquiry / review (SE) is an essential part of the respiratory examination, which includes inspection, palpation, percussion, and auscultation.
A thorough respiratory examination begins with ensuring adequate hygiene, introducing oneself, confirming the patient's details, and seeking permission from the patient.
General inspection involves assessing the patient's overall appearance, use of accessory muscles, and signs of respiratory distress.
Close inspection and palpation focus on identifying specific signs such as central cyanosis, nail clubbing, and tremors, which can indicate underlying respiratory conditions.
Hands-on examination includes assessing for Horner’s syndrome, polycythaemia, and signs of hyperventilation or severe ventilatory failure.
Close inspection of the chest and neck involves looking for scars, abnormalities in chest shape, and signs of venous obstruction or jugular venous pressure (JVP) elevation.
Palpation of the neck and chest is used to assess lymph nodes, tracheal position, and mediastinal abnormalities, which can provide important diagnostic clues.
Percussion is performed at specific sites on the chest to assess resonance, which can help identify conditions such as emphysema, collapse, or pleural effusion.
Tactile vocal fremitus is used to detect increased or decreased vibration, indicating conditions like consolidation, pleural effusion, or pneumothorax.
Auscultation involves using a stethoscope to listen for breath sounds, added sounds, and abnormalities in different lung fields during inspiration and expiration.
Key breath sounds to assess include vesicular sounds, bronchial breath sounds, and added sounds like crackles, wheezes, or pleural rubs, which can indicate specific respiratory conditions.
The respiratory examination aims to systematically assess the patient's respiratory system, identify abnormal findings, and guide further diagnostic and treatment decisions.

Lung Anatomy and Clinical Considerations

The arterial supply of the lungs includes bronchial arteries and pulmonary arteries, with the latter carrying deoxygenated blood from the heart to the lungs.
The lungs are drained by bronchial veins, which drain to the azygous or hemiazygos vein, and pulmonary veins, which carry oxygenated blood towards the heart.
The pulmonary plexus, innervated by the vagus and sympathetic trunk, controls lung function, with parasympathetic input leading to bronchoconstriction and sympathetic input leading to bronchodilation.
Lung lymphatics include the subpleural plexus, intrapulmonary nodes, hilar nodes, tracheobronchial nodes, and paratracheal nodes, which play a role in draining the lower lobes of both lungs.
Clinical considerations for the lungs encompass conditions such as asthma, COPD, cancer, pneumothorax, pneumonia, cystic fibrosis, foreign body aspiration, pulmonary embolism, tracheostomy, and bronchoscopy.
Asthma, the most common lung condition, involves inflammation of the airways and is managed through a hierarchy of pharmacological treatment, including β2 adrenoreceptor agonists like salbutamol.
Chronic obstructive pulmonary disease (COPD) is a major lung condition primarily caused by smoking and characterized by mucus hypersecretion and alveolar destruction.
Lung cancer, particularly bronchial carcinoma, is the most prevalent type of primary lung tumor, often associated with a poor prognosis and frequently metastasizing via lymphatic spread.
Pneumothorax, or "collapsed lung," can occur spontaneously, particularly in tall, thin males, or due to penetrating chest injuries or damage to the lung.
Cystic fibrosis, the most common genetically transmitted disease, results in the abnormal production of thick mucus due to malfunctioning chloride transporters.
Foreign body aspiration, often occurring in the right main bronchus, may require bronchoscopy for visualization and retrieval.
Pulmonary embolism, where a blockage occurs in the pulmonary artery, is typically caused by a clot from the lower limbs and poses various risk factors including immobilization, recent surgery, and obesity.

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Description

Test your knowledge of the key steps and findings in a respiratory examination with this quiz. Explore the essential components of the examination, from general inspection to auscultation, and learn to identify crucial signs and abnormalities that can indicate various respiratory conditions. This quiz will help you understand the systematic approach to assessing the respiratory system and its significance in guiding diagnostic and treatment decisions.