ANZCA Final Exam Resources

Medical Viva

Examination

General Structure

Set of observations

General inspection

Hands and arms

Head and neck

Chest

Abdomen/pelvis/lower limbs

Cardinal Signs

Cardiovascular

Respiratory

Auscultation of breath sounds

Normal (vesicular) breath sounds are louder/longer on inspiration and continuous with expiratory sounds

Bronchial breath sounds occur due to large-airway turbulence and are louder and higher pitched on expiration, with a gap between inspiratory and expiratory sounds (heard over areas of consolidation)

Intensity of breath sounds may be reduced symmetrically or asymmetrically depending on location of pathology

Adventitious sounds

Continuous (wheeze) → occur due to significant airway narrowing; most commonly heard during expiration (as airways normally narrow during expiration) but inspiratory wheeze can also occur

Interrupted (crackles) → occur due to opening and closing of small airways

Early inspiratory crackles → COPD

Late/pan-inspiratory

Fine crackles → interstitial lung disease

Medium crackles → LV failure

Coarse crackles → bronchiectasis

Pleural rub → continuous/intermittent grating sound due to pleura rubbing together

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