Clinical Signs and Symptoms

Question 1

Describe respiratory chest pain

Answer 1

• Pain will be pleuritic as lungs contain no pain receptors
• Sharp
• Worse on inspiration
• Usually easily locatable
• Non-specific

Question 2

What questions should be asked about breathlessness

Answer 2

• What do you mean by breathless?
• Can’t breathe in, or out?
• When?
• Doing what?
• Orthopnoea?
• Paroxysmal Nocturnal Dyspnoea (PND)?
• Associated symptoms such as a wheeze, stridor or cough?

Question 3

Acute causes of breathlessness?

Answer 3

• Pulmonary embolism
• Pneumothorax
• Pulmonary Oedema

Question 4

Subacute causes of breathlessness?

Answer 4

• Pneumonia
• Pulmonary Oedema
• Pleural effusion
• Asthma/COPD

Question 5

Chronic causes of breathlessness?

Answer 5

• COPD
• Pulmonary fibrosis
• Pulmonary embolism

Question 6

Blood in cough could mean?

Answer 6

• Infection
• Carcinoma
• Pulmonary Embolism
• Bronchiectasis

Question 7

In examination of chest what are you looking for with inspection?

Answer 7

Looking at deformities such as kyphoscoliosis, pectus excavatum, hyperinflation or thoracoplasty, also looking for operation scars, expansion, respiratory abdominal movement.

Question 8

In examination of chest what is aim of palpation?

Answer 8

Feel for:

• Tracheal deviation due to collapsed lung= trachea being pulled towards collapse. Deviation due to fluid (pleural effusion) = trachea moves away from this.
• Crepitation (crackling)
• Chest expansion

Question 9

In chest examination what types of percussion indicate what?

Answer 9

– Hyper-resonance - emphysema, pneumothorax
– Impaired resonance - consolidation, pleural thickening, raised hemi-diaphragm,
– Stony dull percussion - pleural effusion.

Question 10

What are normal breath sounds called?

Answer 10

Vesicular

Question 11

What are the causes of reduced breath sounds?

Answer 11

Effusion, collapse, bronchial obstruction, emphysema

Question 12

What are the causes of transmitted breath sounds?

Answer 12

bronchial - consolidation with patent bronchial system (eg pneumonia, pulmonary fibrosis

Question 13

What could a wheeze indicate?

Answer 13

A wheeze is on breathing out and caused by air passing through narrow air ways. Localised wheezes suggest a large airway tumour and generalised suggest a small airway obstruction could be asthma or bronchitis.

Question 14

What are the lymph nodes you should palpate?

Answer 14

Submental
Submandibular
Anterior triangle
Posterior triangle
Pre-auricular
Post-auricular
Occipital
Supraclavicular

Question 15

Where will you hear the different breath sounds?

Answer 15

Vesicular- over most of both lungs
Bronchovesicular- over the first and second intercostal spaces anteriorly and between the scapulae
Bronchial- over the manubrium
Tracheal- over the trachea in the neck

Get louder and higher as you move from vesicular to trachea

Question 16

What is the oxygen target for most individuals?

Answer 16

94-98%

Question 17

What is the oxygen target for those with type 2 respiratory failure?

Answer 17

88-92%

Question 18

What is oxygen flow rate measured in?

Answer 18

l/min

Question 19

Describe nasal cannula and when you would use this?

Answer 19

If patient has low oxygen need. Deliver flow between 2 and 6 l/min equating to an FiO2 of 24-50%. They allow the patient to eat and speak with ease however they can be easily dislodged.

Question 20

Describe the simple face mask/ Hudson and when you would use this?

Answer 20

Used for short term oxygen needs, low oxygen needs. Delivering 5-10 l/min with variable FiO2.

Question 21

Describe when you would use a controlled flow mask/ Venturi?

Answer 21

When there is risk of type 2 respiratory failure and need of an exact FiO2. The flow rate is stated on the device and you can achieve an exact FiO2 stated on mask from 24-60%.

Question 22

Describe the reservoir mask?

Answer 22

This is a non-rebreather mask. Used in critical illness usually flow rate of 15 l/min and can achieve FiO2 of 60-80%.

Question 23

7 respiratory symptoms to ask about in respiratory history?

Answer 23

Breathlessness
Cough
Hoarseness
Wheeze
Chest Pain
Sputum
Haemoptysis (coughing up blood)

Question 24

Features of lobe collapse on CXR?

Answer 24

Fissures are displaced towards the collapsing lobe
Opacification
the collapsed lobe is triangular or pyramidal in shape, with the apex pointing to the hilum

Question 25

How do you tell what lobe may have collapsed?

Answer 25

Fissures are displaced towards the collapsing lobe

Also remember most of the time on the right you can’t see the lower lobe as its at the back

Question 26

How can ascites cause shortness of breath?

Answer 26

large ascites can cause SOB due to increased pressure on the diaphragm and the migration of the fluid across the diaphragm causing pleural effusions