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Respiratory: Patient History, etc > Clinical Signs in Respiratory Disease > Flashcards

Clinical Signs in Respiratory Disease Flashcards

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1
Q

What are peripheral signs of respiratory disease?

A
  • Mouth - pursed lip breathing, cyanosis
  • Hands - clubbing, cyanosis
  • Skin perfusion
  • CO2 flap
  • Lymph nodes
  • JVP
  • Chest
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2
Q

What is the difference between symptoms and signs?

A

Symptoms - what the patient feels, found by taking patient history
Signs - physical variations from the norm, found by examining the patient

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3
Q

What are signs of respiratory distress?

A
  • Wheeze
  • Stridor
  • Orthopnoea
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4
Q

Why does shortness of breath not equal hypoxia?

A

Patient does not necessarily have hypoxia - they just have to work harder to keep oxygen saturation up

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5
Q

What is central cyanosis?

A

Blue tinge around the lips, mouth, tongue

Can be accompanied by secondary polycythaemia

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6
Q

What is peripheral cyanosis?

A

Blue tinge on the hands, feet, nose

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7
Q

What can peripheral cyanosis indicate?

A
  • Cardiovascular collapse

* Peripheral vascular disease

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8
Q

Why does a CO2 flap occur?

A

Due to hypercapnic encephalopathy - CO2 retention

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9
Q

What is a CO2 flap?

A

Irregular flapping of hand when wrist hyperextended

Also happens in asterixis - liver flap

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10
Q

What are other symptoms of hypercapnic encephalopathy other than CO2 flap?

A
  • Confusion

* Peripheral vasodilation

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11
Q

What are signs of respiratory disease to look out for on the skin?

A
  • Yellow fingernails (nicotine, tar, fungus)
  • Eczema (link between eczema and asthma in children)
  • Erythema nodosum (sarcoidosis, TB)
  • Lupus pernio (sarcoidosis)
  • Cutaneous sarcoid (sarcoidosis)
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12
Q

What is sarcoidosis?

A

Inflammatory disease that can affect the lungs and cause the formation of granulomas

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13
Q

What is finger clubbing?

A
  • Increased curvature of the nail

* Loss of nail bed angle

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14
Q

What are the causes of finger clubbing?

A
  • 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)

(Best Friends Like Chatting In Men’s Cloakrooms)

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15
Q

What are signs of respiratory disease in the eyes?

A
  • 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
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16
Q

What are the lymph nodes in the neck used to check for respiratory disease?

A
  • Submental
  • Submandibular
  • Anterior triangle
  • Posterior triangle
  • Pre-auricular
  • Post-auricular
  • Occipital
  • Supra-clavicular
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17
Q

What can enlarged lymph nodes in the neck indicate?

A

Pathology in the chest

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18
Q

What is Cor Pulmonale?

A

Right heart failure due to chronic lung disease e.g. COPD

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19
Q

What are the symptoms of Cor Pulmonale?

A
  • Cyanosis
  • Raised JVP
  • Pitting oedema
  • Parasternal heave (pulsations of the chest wall)
  • Loud P2 (sounds produced by heart upon closure of pulmonic valve)
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20
Q

What are the steps of examination of the chest?

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
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21
Q

What does a chest inspection involve?

A
  • 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)
22
Q

What are example of chest wall deformities?

A
  • Kyphoscoliosis
  • Pectus excavatum
  • Hyperinflation (emphysema)
  • Thoracoplasty
23
Q

What is pectus excavatum?

A

Abnormal development of the rib cage where the sternum caves in, resulting in a sunken chest wall deformity

24
Q

What are the clinical signs of pectus excavatum?

A
  • Pulmonary artery flow murmur
  • Right lower lobe CXR changes
  • Diminished basal lung volumes lead to diminished lung sounds
25
Q

What does palpation in chest examination involve?

A
  • Palpation of trachea to identify tracheal deviation
26
Q

What can tracheal deviation indicate?

A
  • Pneumothorax or pleural effusion - trachea will deviate away from pressure
27
Q

What is crepitation?

A

A crackling or rattling sound in the chest

28
Q

What does crepitation of the chest indicate?

A
  • Surgical emphysema
  • Chest wall trauma
  • Ruptured oesophagus
29
Q

What can reduced chest expansion indicate?

A
  • Unilateral pneumothorax
  • Pleural effusion
  • Blocked central bronchus
  • Diaphragm palsy
  • Bilateral restrictive ling disease e.g. hyperinflation (emphysema)
30
Q

What does hyper-resonant percussion of the chest indicate?

A
  • Emphysema

* Pneumothorax

31
Q

What does impaired resonant percussion of the chest indicate?

A
  • Pulmonary consolidation (lungs filled with fluid e.g. pneumonia)
  • Pleural thickening
  • Raised hemi-diaphragm
32
Q

What does stony dull percussion of the chest indicate?

A

Pleural effusion

33
Q

When is it normal to have impaired resonance?

A
  • Over heart
  • In obesity
  • In right base (liver pushes up diaphragm)
34
Q

What end of the stethoscope is used for auscultation of low pitched sounds?

A

The bell

35
Q

What end of the stethoscope is used for auscultation of high pitched sounds?

A

The diaphragm

36
Q

What 3 sounds can be auscultated in the chest?

A
  • Breath sounds
  • Added sounds
  • Voice sounds
37
Q

What are the 3 types of breath sounds?

A
  • Normal (vesicular)
  • Reduced
  • Transmitted (bronchial)
38
Q

What can cause reduced breath sounds?

A
  • Effusion
  • Collapse
  • Bronchial obstruction
  • Emphysema
39
Q

What can cause harsher, louder breath sounds (bronchial breath)?

A

Consolidation with patent bronchial system (e.g. pneumonia, pulmonary fibrosis)

40
Q

What is aegophony?

A

Increased resonance of voice sounds heard when auscultating the lungs - caused by lung consolidation and fibrosis

41
Q

What is whispering pectoriloquy?

A

Words that are not normally heard via auscultation when whispered - can be heard due to consolidation and pulmonary fibrosis

42
Q

What are examples of whispering pectoriloquy?

A
  • “99”
  • “1-1-1”
  • “Toy boat”
  • “Scooby doo”
43
Q

What is bronchophony?

A

Abnormal transmission of sounds from the lungs or bronchi

44
Q

What are examples of added sounds in auscultation?

A
  • Wheeze (rhonchi)
  • Squeaks
  • Crackles (crepitations)
  • Pleural rub
  • Pleural click
45
Q

What does localised wheeze sound indicate?

A

Large airway tumour

46
Q

What does a generalised (polyphonic) wheeze sound indicate?

A

Small airway obstruction e.g. asthma, bronchitis

47
Q

What can squeaks and crackles indicate?

A

Bronchiolitis

48
Q

What causes crepitation in the chest?

A

Explosive re-opeing of small airways blocked by exudate, inflammation or fibrosis

49
Q

What is a pleural rub?

A

Leathery, cracking sound made by inflamed pleural surfaces rubbing together

50
Q

What is a pleural rub caused by?

A
  • Pneumonia
  • Pulmonary embolus
  • Viral or auto-immune pleurisy
51
Q

What is a pleural click caused by?

A

Pneumothorax

Respiratory: Patient History, etc (10 decks)

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