Clinical signs in respiratory Flashcards
What are the causes of finger clubbing?
- Bronchial carcinoma
- Fibrosing alveolitis
- Lung suppuration (e.g. (bronchiectasis, lung abscess, empyema)
- Cyanotic congenital heart disease
- Infective endocarditis
- Malabsorption states
- Congenital, idiopathic
What are the symptoms of Horner’s syndrome?
Small pupil
Ptosis (dropping of upper eyelid)
Enophthalmos
Unilateral loss of sweating
What is uveitis and it what is it a sign of?
Inflammation of the uvea (pigmented layer of the eye)
Sign of TB and sarcoidosis
What are dilated retinal veins a sign of?
Chronically raised pCO2
Name the lymph nodes around the neck
– supra-clavicular – cervical chain – sub-mental, submandibular – parotid – post-auricular, pre-auricular – occipital
What are the symptoms of cor pulmonale?
- Cyanosis
- Raised JVP (jugular venous pressure)
- Pitting oedema
- Parasternal heave
- Loud P2
What are the 4 stages in chest examinations?
Inspect
Palpate
Percuss
Auscultate
What do you look for on inspection?
Chest wall deformities
Operation scars
Expansion
Abnormal respiratory movement
Give 4 examples of chest wall deformities
– Kyphoscoliosis – Pectus excavatum – Hyperinflation (emphysema) – Thoracoplasty
What do you feel for on palpation
Trachea deviation
Crepitation (crackling sensation)
Chest expansion
What are the three different sounds to listen for during percussion and what does each demonstrate?
- hyper-resonance - emphysema, pnuemothorax
- Impaired resonance - consolidation, pleural thickening, raised hemi-diaphragm
- Stony dull percussion - pleural effusion
What side of the stethoscope do you use for high-pitched sounds?
The diaphragm of the stethoscope (bell for low-pitched sounds)
What 3 categories of sounds do you listen for on auscultation?
- Breath sounds
- Added sounds
- Voice sounds
List 5 added sounds that may be heard on auscultation
Wheeze Squeaks Crackle Pleural rub Pleural click
If the PEFR is decreased does it indicate an obstructive or a restrictive condition?
Obstructive
What would the FEV1/FVC ratio be in a patient with a restrictive condition?
> 75%
What would be the FEV1 response to a B2-agonist in an asthma and a COPD patient?
> 15% asthma
<15% COPD
What affect would a restrictive condition have on a patients FVC?
Decreased FVC
What is the normal vause for FEV1/FVC ratio?
Approx. 80%
What is diffusing capacity?
It is a measurement of how well oxygen and carbon dioxide are diffused between the lungs and the blood
What is exhaled breath nitric oxide used for?
It is a non-invasive marker of eosinophilic airway inflammation in asthma
What are the actions of a spacer device?
Avoid coordination problems with pMDI
Reduces oropharyngeal and laryngeal side effects
Reduces systemic absorption from swallowed fraction
Acts as a holding chamber
Reduces the particle size and velocity
Improves lung deposition
Name the oral steroid is given for acute exacerbations
Prednisolone
low therapeutic ratio
Name the inhaled steriod used in maintenance therapy
Beclomethasone
Name a leukotriene antagonist used only in asthma
Montelukast
oral route, OD, high therapeutic ratio
Name an anti-IgE monoclonal antibody drug given to patients with severe persistent allergic asthma despite maximum therpay (step 5)
Omalizumab (Xolair)
injected
Name a short acting muscarinic antagonist
Ipratripium
inhaled, od, high therapeutuc ratio
Name a long acting muscarinic antagonist
Tiotropium
inhaled, od, high therapeutic ratio
Name a methylxanthine drug given for maintenance therapy
Theophylline
oral
Name a methylxanthine given for acute attacks
Aminophylline
IV
Name a PDE4 inhibitor used in COPD
Roflumilast
oral, od
