Clinical Signs in Respiratory Disease Flashcards
What are peripheral signs of respiratory disease?
- Mouth - pursed lip breathing, cyanosis
- Hands - clubbing, cyanosis
- Skin perfusion
- CO2 flap
- Lymph nodes
- JVP
- Chest
What is the difference between symptoms and signs?
Symptoms - what the patient feels, found by taking patient history
Signs - physical variations from the norm, found by examining the patient
What are signs of respiratory distress?
- Wheeze
- Stridor
- Orthopnoea
Why does shortness of breath not equal hypoxia?
Patient does not necessarily have hypoxia - they just have to work harder to keep oxygen saturation up
What is central cyanosis?
Blue tinge around the lips, mouth, tongue
Can be accompanied by secondary polycythaemia
What is peripheral cyanosis?
Blue tinge on the hands, feet, nose
What can peripheral cyanosis indicate?
- Cardiovascular collapse
* Peripheral vascular disease
Why does a CO2 flap occur?
Due to hypercapnic encephalopathy - CO2 retention
What is a CO2 flap?
Irregular flapping of hand when wrist hyperextended
Also happens in asterixis - liver flap
What are other symptoms of hypercapnic encephalopathy other than CO2 flap?
- Confusion
* Peripheral vasodilation
What are signs of respiratory disease to look out for on the skin?
- Yellow fingernails (nicotine, tar, fungus)
- Eczema (link between eczema and asthma in children)
- Erythema nodosum (sarcoidosis, TB)
- Lupus pernio (sarcoidosis)
- Cutaneous sarcoid (sarcoidosis)
What is sarcoidosis?
Inflammatory disease that can affect the lungs and cause the formation of granulomas
What is finger clubbing?
- Increased curvature of the nail
* Loss of nail bed angle
What are the causes of finger clubbing?
- Bronchial carcinoma
- Fibrosing alveolitis
- Lung suppuration (bronchiectasis, lung access, empyema)
- Cyanotic congenital heart disease
- Infective endocarditis (infection of endocardial surface of the heart)
- Malabsorption states (ulcerative colitis, Crohn’s disease, cirrhosis of the liver)
- Chronic lung infections (cystic fibrosis)
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What are signs of respiratory disease in the eyes?
- Horner’s syndrome (caused by interruption of cervical chain due to lung tumour) - small pupils, ptosis, exophthalmos, unilateral loss of facial sweating
- Uveitis - sarcoidosis, tuberculosis
- Dilated retinal veins/papilloedema - chronically raised PCO2
What are the lymph nodes in the neck used to check for respiratory disease?
- Submental
- Submandibular
- Anterior triangle
- Posterior triangle
- Pre-auricular
- Post-auricular
- Occipital
- Supra-clavicular
What can enlarged lymph nodes in the neck indicate?
Pathology in the chest
What is Cor Pulmonale?
Right heart failure due to chronic lung disease e.g. COPD
What are the symptoms of Cor Pulmonale?
- Cyanosis
- Raised JVP
- Pitting oedema
- Parasternal heave (pulsations of the chest wall)
- Loud P2 (sounds produced by heart upon closure of pulmonic valve)
What are the steps of examination of the chest?
- Inspection
- Palpation
- Percussion
- Auscultation
What does a chest inspection involve?
- Looking for chest wall deformities
- Operation scars
- Chest expansion
- Respiratory abdominal movement (e.g. paradoxical breathing movement)
- Superior vena cava obstruction (protrusion of veins on chest)
What are example of chest wall deformities?
- Kyphoscoliosis
- Pectus excavatum
- Hyperinflation (emphysema)
- Thoracoplasty
What is pectus excavatum?
Abnormal development of the rib cage where the sternum caves in, resulting in a sunken chest wall deformity
What are the clinical signs of pectus excavatum?
- Pulmonary artery flow murmur
- Right lower lobe CXR changes
- Diminished basal lung volumes lead to diminished lung sounds
What does palpation in chest examination involve?
- Palpation of trachea to identify tracheal deviation
What can tracheal deviation indicate?
- Pneumothorax or pleural effusion - trachea will deviate away from pressure
What is crepitation?
A crackling or rattling sound in the chest
What does crepitation of the chest indicate?
- Surgical emphysema
- Chest wall trauma
- Ruptured oesophagus
What can reduced chest expansion indicate?
- Unilateral pneumothorax
- Pleural effusion
- Blocked central bronchus
- Diaphragm palsy
- Bilateral restrictive ling disease e.g. hyperinflation (emphysema)
What does hyper-resonant percussion of the chest indicate?
- Emphysema
* Pneumothorax
What does impaired resonant percussion of the chest indicate?
- Pulmonary consolidation (lungs filled with fluid e.g. pneumonia)
- Pleural thickening
- Raised hemi-diaphragm
What does stony dull percussion of the chest indicate?
Pleural effusion
When is it normal to have impaired resonance?
- Over heart
- In obesity
- In right base (liver pushes up diaphragm)
What end of the stethoscope is used for auscultation of low pitched sounds?
The bell
What end of the stethoscope is used for auscultation of high pitched sounds?
The diaphragm
What 3 sounds can be auscultated in the chest?
- Breath sounds
- Added sounds
- Voice sounds
What are the 3 types of breath sounds?
- Normal (vesicular)
- Reduced
- Transmitted (bronchial)
What can cause reduced breath sounds?
- Effusion
- Collapse
- Bronchial obstruction
- Emphysema
What can cause harsher, louder breath sounds (bronchial breath)?
Consolidation with patent bronchial system (e.g. pneumonia, pulmonary fibrosis)
What is aegophony?
Increased resonance of voice sounds heard when auscultating the lungs - caused by lung consolidation and fibrosis
What is whispering pectoriloquy?
Words that are not normally heard via auscultation when whispered - can be heard due to consolidation and pulmonary fibrosis
What are examples of whispering pectoriloquy?
- “99”
- “1-1-1”
- “Toy boat”
- “Scooby doo”
What is bronchophony?
Abnormal transmission of sounds from the lungs or bronchi
What are examples of added sounds in auscultation?
- Wheeze (rhonchi)
- Squeaks
- Crackles (crepitations)
- Pleural rub
- Pleural click
What does localised wheeze sound indicate?
Large airway tumour
What does a generalised (polyphonic) wheeze sound indicate?
Small airway obstruction e.g. asthma, bronchitis
What can squeaks and crackles indicate?
Bronchiolitis
What causes crepitation in the chest?
Explosive re-opeing of small airways blocked by exudate, inflammation or fibrosis
What is a pleural rub?
Leathery, cracking sound made by inflamed pleural surfaces rubbing together
What is a pleural rub caused by?
- Pneumonia
- Pulmonary embolus
- Viral or auto-immune pleurisy
What is a pleural click caused by?
Pneumothorax
