Question 1

"what is tracheal tug, and is it in the marking criteria?"

This term refers to the downward displacement of the trachea in some conditions.

The examiner has to stand behind the patient, bend the patient's neck backwards and grip the cricoid cartilage of the trachea. If tracheal tug is present, then the examiner will feel the pulling down sensation on the trachea during every heart beat or with inspiration depending on the cause of the tracheal tug.

There are two distinct tracheal tugs described in literature.

Tracheal Tug (Olivers sign) – Downward displacement of the cricoid cartilage with ventricular contraction – observed in patients with an aortic arch aneurysm

Original description of the technique: "Place the patient in the erect position, and direct him to close his mouth, and elevate his chin to the fullest extent, then grasp the cricoid cartilage between the finger and thumb, and use gentle upward pressure on it, when if dilatation or aneurism exist, the pulsation of the aorta will be distinctly felt transmitted through the trachea to the hand. This act of examination will increase laryngeal distress should this accompany the disease."


Tracheal Tug (Campbell’s sign) – Downward dispacement of the thyroid cartilage during inspiration – seen in patients with COPD

tracheal tug is not in the marking criteria of Respi nor CVS Physical examination, but it is well worth knowing that it is one of the presenting symptoms of Aortic Arch Aneurism and COPD, both of which are common case presentation in CSU.

to distinguish between the two signs - ask patient to hold breath. simple right?

referancehttp://www.mediscuss.org/tracheal-tug-sign-aortic-aneurysm-copd-video-737/

(there's a video of campbell's sign)