Clinical Examination - Respiratory Flashcards
When observing a patient from the end of the bed, what objects or medical equipment suggestive of respiratory disease might you look for?
- Oxygen delivery devices
- Sputum Pot
- Inhalers/nebulisers
- Cigarettes, vapes
- Mobility aids
- Vital signs
- Fluid balance charts
- Prescriptions
When observing the patient, what signs would you look for suggestive of respiratory disease?
- Age
- Cyanosis - bluish discoloration of the skin
- SOB
- Cough
- Wheeze
- Stridor
- Cachexia
- Pallor
- Oedema
List some differential diagnosis for stridor
- Foreign body inhalation
- Epiglottis
- Croup
- Laryngitis
- Anaphylaxis
What are some signs of shortness of breath?
- Increased respiratory rate
- nasal flaring
- pursed lips
- use of accessory muscles
- tripod position.
- inability to complete sentences.
What would you look for in the hands of a patient that migh suggest repiratory disease?
- Colour - pallor, cyanosis
- temperature
- Tar staining
- Skin changes suggestive of long term steroid use
- Finger clubbing
- Fine tremor - associated with salbutamol use.
What are the repiratory causes of asterixis (flapping tremor)?
CO2 retention (type 2 respiratory failure), sometimes seen in COPD patients
What repiratory disease could warm and excessivly sweaty hands suggest?
CO2 retention (COPD)
What respiratory diseases are suggested by clubbing?
Lung cancer, interstitial lung disease, cystic fibrosis and bronchiectasis
What abnormality in breathing is seen in people with COPD?
Prolonged expiratory phase
What might ptosis, miosis and enopthalmos suggest?
Horners syndrome, can occur when the sympathetic trunk is damaged by pathology such as lung cancer affecting the apex of the lung (e.g. Pancoast tumour).
What does might a deviated trachea tell you about the patient?
The trachea deviates away from tension pneumothorax and large pleural effusions
The trachea deviates towards lobar collapse and pneumonectomy
What might a reduced crictosternal distance suggest?
Lung hyperinflation due to asthma or COPD
Do you palpate the heart in the respiratory exam?
Yes - feel for the apex beat, if displaced this may be due to right ventricular hypertrophy secondary to pulmonary hypertension, COPD or interstitial lung disease. It could be due to a large pelural effusion or a tension pneumothorax
When percussing the chest, what does dullness, stony dullness and hyper resonant suggest?
- dullness - increased tissue density due to consolidation, tumour, lobar collapse
- stony dullness - pleural effusion
- hyper resonance - due to decreased tissue density such as pneumothorax.
What does increased or decreased vocal tactile fremitus tell you?
Increased - increased tissue density such as consolidation, lobar collapse
Decreased - fluid or air outside of the lung such as a pleural effusion or pneumothorax.
