CVR Physiotherapy › Technique cards › Scales and investigations
Abnormal breathing patterns and chest signs
Breathing patterns were asked as Cheyne–Stokes respiration (S16) and three abnormal breathing patterns (S22). A small sketch of each pattern earns marks quickly. The chest signs below are the observations every case answer starts with.
- Syllabus
- Ch 2(a) Investigation and clinical implication: auscultation; chest assessment
- Priority
- Quick marks. In 2 of 20 papers (2016–2026).
- Asked as
- 3m S16S22
- Usual split
- 3-mark patterns with a sketch and causes
- Checked against
- Standard clinical examination texts and respiratory physiotherapy texts. Full list under Sources.
- Content checked
- 19 October 2026. Next review due October 2027.
- My revision
-
1Breathing patterns (3 marks in S16 and S22)
Sketches of breathing patterns
| Pattern | Description | Causes |
|---|---|---|
| Tachypnoea | Rate above about 20 a minute in adults | Fever, pneumonia, pulmonary oedema, pulmonary embolism, anxiety, pain, ILD |
| Bradypnoea | Rate below about 12 a minute | Opioids and sedatives, raised intracranial pressure, hypothermia, severe hypothyroidism |
| Hyperpnoea and Kussmaul breathing | Deep breaths; Kussmaul is deep, fast and laboured, regular | Metabolic acidosis: diabetic ketoacidosis, kidney failure (the body blows off CO₂ to compensate) |
| Cheyne–Stokes respiration (S16) | Cycles of breaths that gradually deepen, then gradually become shallow, followed by a pause (apnoea) of seconds; then repeats | Heart failure (slow circulation delays the feedback from chemoreceptors), stroke and other brain injury, high altitude, opioids; can be normal in sleeping infants and the elderly |
| Biot's (ataxic) breathing | Groups of quick, equal-depth breaths with irregular pauses; ataxic breathing is completely irregular | Damage to the medulla: meningitis, raised intracranial pressure, brainstem stroke, opioids. A sign of serious brain injury |
| Apneustic breathing | Deep gasping breath in, held, then a short breath out | Damage to the pons |
| Central neurogenic hyperventilation | Sustained deep, rapid breathing | Midbrain and upper pons lesions |
| Paradoxical breathing | Part of the chest or abdomen moves the wrong way | Flail chest (segment moves in on inspiration); diaphragm paralysis or fatigue (abdomen moves in on inspiration); airway obstruction |
| Prolonged expiration, pursed lips | Breath out much longer than breath in | COPD, asthma |
| Sighing and erratic upper-chest breathing | Irregular, with frequent sighs and yawns | Dysfunctional breathing and hyperventilation (see breathing retraining) |
Related positional terms: orthopnoea (breathless lying flat), paroxysmal nocturnal dyspnoea (waking breathless), platypnoea (breathless upright, better lying).
2Chest signs in assessment
| Sign | What it suggests |
|---|---|
| Barrel chest (front-to-back diameter increased) | Hyperinflation: emphysema, chronic asthma |
| Pectus excavatum or carinatum; kyphoscoliosis | Chest wall deformity; restrictive pattern when severe |
| Accessory muscle use, intercostal indrawing, tracheal tug | Increased work of breathing |
| Reduced expansion on one side | The disease is on that side: effusion, collapse, pneumothorax, consolidation, post-surgery |
| Trachea shifted | Pulled towards collapse or fibrosis; pushed away by a large effusion or tension pneumothorax |
| Clubbing | Bronchiectasis, cystic fibrosis, lung abscess, empyema, lung cancer, ILD, cyanotic heart disease (not COPD alone) |
| Central cyanosis (tongue, lips) | Low arterial oxygen; peripheral cyanosis alone (fingers) suggests poor circulation or cold |
| Finding | Percussion | Breath sounds |
|---|---|---|
| Normal lung | Resonant | Vesicular |
| Consolidation | Dull | Bronchial breathing; crackles; increased vocal resonance |
| Collapse | Dull | Reduced or absent |
| Pleural effusion | Stony dull | Reduced or absent; reduced vocal resonance |
| Pneumothorax | Hyper-resonant | Reduced or absent |
| Emphysema | Hyper-resonant | Quiet, prolonged expiration |
| Sound | Meaning |
|---|---|
| Wheeze | Musical; narrowed airways: asthma, COPD; a fixed single wheeze suggests a local obstruction |
| Coarse crackles | Secretions in larger airways: bronchiectasis, chest infection; often change after a cough (a sign for airway clearance) |
| Fine crackles | Late inspiratory, like Velcro: pulmonary fibrosis; fluid: pulmonary oedema |
| Pleural rub | Creaking with breathing: inflamed pleura (pleurisy) |
| Stridor | Harsh inspiratory noise: upper airway narrowing (emergency) |
3Exam corner
Past questions (MUHS, 2016–2026)
- 3-mark questionsCheyne–Stokes respiration (S16). Three abnormal breathing patterns (S22).
Test yourself
3 mDescribe Cheyne–Stokes respiration with two causes.
Cycles of gradually deepening then gradually shallower breaths, followed by a pause, repeating (draw it). Causes: heart failure, stroke or other brain injury, high altitude, opioids.
MCQDeep, rapid, regular breathing in a patient with diabetic ketoacidosis is called:A. Biot's breathingB. Kussmaul breathingC. Apneustic breathingD. Cheyne–Stokes respiration
B. Kussmaul breathing compensates for metabolic acidosis.
Sources
- MUHS BPTh syllabus (2012) and MUHS IV BPTh question papers 2016–2026 (muhsonline.com, unofficial archive; Dhole Patil College of Physiotherapy past-paper page).
- Structure and classical content: Macleod's Clinical Examination; Hough, Physiotherapy in Respiratory and Cardiac Care; Frownfelter & Dean (2022), chapter on assessment.
Educational notes for exam preparation. Not medical advice.
Version 1. Content checked 19 October 2026. Next review October 2027.