Clinical Examination And Signs Of Common Resp Diseases Flashcards
What does SQITARS stand for?
Site Quality Intensity Timing Aggravating factors Relieving factors Secondary symptoms
What are the 7 principle symptoms for respiratory conditions?
Chest pain Breathlessness Cough Sputum Haemoptysis Wheeze Hoarseness
Describe pleuritic chest pain
Can be anywhere in the chest
Sharp
Made worse by deep inspiration and coughing
Give some causes of pleuritic chest pain
Lobar pneumonia
PE
Infarction
Pneumothorax
Define dyspnoea
An awareness that it is taking an abnormal amount of effort to breathe
Give some common causes of breathlessness
Unfit Infection Pleural effusion COPD Anaemia
How do we assess how bad dyspnoea is?
MRC dyspnoea score
1 - 5
Give some characteristics that can describe coughing
Throat clearing Barking With blood Painful Productive
What is the likely cause of a cough lasting < 3 weeks?
Upper/lower resp tract infection
What are some causes of a cough lasting > 3 weeks?
COPD Asthma Reflux Lung carcinoma Medication (ACEi)
Give some causes of haemoptysis
Bronchitis Bronchial carcinoma Pneumonia Pulmonary infarction TB
Give some causes of a wheeze
Asthma
COPD
Foreign body
What gives hoarseness of voice?
Transient inflammation of vocal cords
Recurrent laryngeal nerve palsy (LHS)
What drugs can give a wheeze as a side effect?
Beta blockers
When we stand back and observe the patient in resp exam, what are we looking at?
Comfort
Breathing - fast, laboured, accessory muscle use
Medication/machines/oxygen around
How can lung cancer give wasting of hands?
Apical lung tumours
T1 nerve root compression
Atrophy of muscles of hands
What is a pigeon chest?
Prominent sternum/costal cartilage
What is a funnel chest?
Depression of lower end of sternum
What happens to vocal resonance with consolidation?
Increases
We can hear 99 more clearly through the stethoscope
What investigations might you state for completion at the end of a resp exam?
Peak flow
Sputum exam and culture
Temperature
What do we call the normal breathing sounds?
Vesicular
Why might we get reduced chest movements on one side?
Pain
Lung collapse
Fluid
Obstruction
Why might we get reduced chest movement on both sides of lungs?
Stiff lungs (ILD) Hyperinflated (COPD, severe asthma)
Why do you get reduced/absent breath sounds?
Air or fluid between lung and chest wall
When is vocal resonance increased?
When bronchial breathing is present
What is tactile vocal fremitus?
Palpable vocal resonance
Describe how lobar pneumonia would appear in the clinical examination
Central trachea Reduced chest movements on affected side Dull percussion of affected area Bronchial breath sounds Increased vocal resonance Crackles \+/- pleural ribs if spread to pleura
Describe how pleural effusion would appear in the resp clinical exam
Mediastinum shifted away Reduced chest movements on affected side Stony dullness over area Vesicular breast sounds (reduced intensity on affected side) Reduced vocal resonance
Describe how pneumothorax would appear in the resp clinical exam
Mediastinum shifted away Reduced chest movements on affected side Hyperresonant over affected area Reduced/absent breath sounds on affected side Reduced vocal resonance
Describe how lobar/lung collapse would appear in the resp clinical exam
Mediastinum pulled to affected side
Decreased chest movements on affected side
Percussion - normal or dull
Breath sounds decreased or absent where affected
Reduced vocal resonance
Describe how localised lung fibrosis would appear in the resp clinical exam
Mediastinum pulled towards affected side Chest movements reduced on affected side Percussion = normal/dull Vesicular breath sounds (+ crackles) Normal or increased vocal resonance - because trachea is closer to affected part (pulled)
Describe how diffuse lung fibrosis would appear in the resp clinical exam
Central mediastinum Symmetrically reduced chest movements Normal percussion Vesicular breath sounds (+ crackles) Normal/increased vocal resonance
Describe how COPD/asthma would appear on a clinical resp exam
Central mediastinum
Chest movements reduced on both sides (already hyperinflated)
Resonant percussion (bullae may be hyperresonant)
Wheezing
Vesicular breath sounds
Normal vocal resonance
Where does the liver normally start?
5th ICS
What can happen to the liver in COPD?
May be pushed down by lungs
May be palpable in the abdomen
Lungs may stay resonant further down
