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anatomy & diagnostics (phase 1b) > (CPA) respiratory exam > Flashcards

(CPA) respiratory exam Flashcards

1
Q

what position & exposure should the patient be in for the respiratory exam?

A

patient should be placed at a 45-degree angle, with the anterior chest wall exposed

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2
Q

how is the posterior chest wall exposed?

A

patient leans forwards

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3
Q

what do you inspect for in a respiratory exam?

A

general appearance

gait and posture

facial appearance/expression and speech

jaundice - sclera, skin

cyanosis - skin, mucosa, tongue, lips

pallor - in anaemia – mucosa of tongue, sclera

hair distribution

body habitus

hydration - sunken eyes, dry mucosa, skin turgidity

hands – tremors, joint distortion, nails, clubbing

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4
Q

how is respiratory rate assessed?

A

visually observing the anterior wall (and abdominal walls), measure the rate of breathing for 30 seconds (then x2) BUT pretend to take the radial pulse

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5
Q

how is breathing rate expressed?

A

breaths/minute

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6
Q

where does the trachea bifurcate?

A

at the level of the sternal angle (T4/T5)

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7
Q

where is the trachea found?

A

resides in the midline of the neck and suprasternal (jugular) notch of the manubrium

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8
Q

where is the trachea palpable?

A

palpable throughout from the larynx to the suprasternal notch

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9
Q

explain how you would palpate the trachea

A

before examining the patient, warn them that this can be uncomfortable

ask the patient to lean back (lower their neck slightly so their neck is relaxed)

place forefinger of your right hand at the suprasternal notch of the patient and push to upwards and backwards until the trachea is felt

= if trachea is in the midline then finger will not be able to progress further

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10
Q

what is felt when the trachea is displaced?

A

if displaced, finger will feel only one side of the trachea instead of its middle

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11
Q

give three causes for tracheal deviation TOWARDS the side of the lung lesion

A

upper lobe collapse

upper lobe fibrosis

pneumonectomy

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12
Q

give three causes for tracheal deviation AWAY FROM the side of the lung lesion

A

extensive pleural effusion

chest expansion

tension pneumothorax

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13
Q

explain how anterior chest expansion is assessed

A

stand facing the subject

place hands on the 5th-6th ribs with the thumbs on the anterior midline, resting lightly on the chest wall

ask the patient to take a deep breath

tips of your thumbs should move apart at least 5cm in a healthy adult

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14
Q

explain how posterior chest expansion is assessed

A

place hands on approx T10 with the thumbs on the posterior midline, resting lightly on the chest wall so respiration can occur

ask the patient to take a deep breath and look for any asymmetry

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15
Q

where are the hands placed in anterior chest expansion?

A

at the level of the 5th/6th ribs in the anterior midline

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16
Q

where are the hands placed in posterior chest expansion?

A

at the level of the 10th thoracic vertebrae in the posterior midline

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17
Q

for females, where are the hands placed in anterior chest expansion?

A

hands beneath the breast

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18
Q

what do movements of the anterior chest wall indicate?

A

expansion of the upper and middle lobes

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19
Q

what do movements of the posterior chest wall indicate?

A

expansion of the lower lung lobes

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20
Q

what does unilateral decreased chest expansion indicate?

A

pneumothorax
pleural effusion
collapsed lung
consolidation

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21
Q

what does bilateral decreased chest expansion indicate?

A

asthma or COPD

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22
Q

what does normal chest expansion feel like?

A

expands symmetrically on both sides during inspiration (when lungs inflate)

healthy adults = approx 5cm

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23
Q

what does reduced unilateral chest wall expansion suggest?

A

a lesion on that side

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24
Q

what does a resonant/tympanic percussion sound indicate?

A

over air-filled spaces such as the lung

i.e. normal

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25
Q

what does a dull percussion sound indicate?

A

over solid organs such as the heart/liver

over fluid collection

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26
Q

what does a hyperresonant percussion sound indicate?

A

excessive air

e.g. percussing puffed up cheeks

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27
Q

describe how lung percussion is carried out

A

percuss anteriorly: both apices, infraclavicular regions, 3rd, 5th and 7th intercostal spaces on both LEFT and RIGHT + right mid-axillary line

percuss posteriorly: level of trapezius, level of scapular spine, 10th and 11th rib levels and laterally on right and left

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28
Q

give three causes of hyper-resonant percussion sounds in the lungs

A

pneumothorax
hollow bowels
COPD

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29
Q

give three causes of hypo-resonant percussion sounds in the lungs

A

pleural effusion (stoney dull)

lung tumour (flat dull)

consolidation (flat dull)

lung collapse (flat dull)

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30
Q

which areas must lung percussion include?

A

apices of the lungs

base of the lungs

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31
Q

what is auscultation?

A

listening to the lung sounds using a stethoscope

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32
Q

why are lung sounds heard?

A

due to air turbulence within the airways

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33
Q

what are the two types of normal lung sounds?

A

bronchial sounds

vesicular sounds

34
Q

what are bronchial lung sounds?

A

high pitched notes

35
Q

where are bronchial lung sounds heard?

A

anteriorly
- normally heard over trachea, suprasternal notch, manubrium, sternal angle, and sternoclavicular joints

(where alveolar tissue is absent)

posteriorly
- between C7 and T3

36
Q

what are vesicular lung sounds?

A

low pitched notes

37
Q

where are vesicular lung sounds heard?

A

normally heard over the rest of the chest area (where normal lung tissue is present)

38
Q

describe and explain the difference between bronchial and vesicular lung sounds

A

bronchial sounds are from airways that are not surrounded by alvoelar tissue so the air turbulence can be heard unfiltered = HIGH PITCHED

however vesicular sounds are from alveolar tissue which filters the sounds of air turbulence = LOW PITCHED

39
Q

explain how lung auscultation is carried out

A

lie at 45 degrees, exposed from the waist up

use the diaphragm to auscultate most areas of the chest, except the supraclavicular apical auscultation for which you will use the bell

auscultate for bronchial breathing

(!cannot auscultate over breast tissue!)

compare results both anterior and posterior

40
Q

in which locations is the lung auscultated on the anterior chest wall?

A

supraclavicular (bell)

infraclavicular/2nd ICS (diaphragm)

3rd ICS (diaphragm)

6th ICS (diaphragm)

AXILLAE (!!)

41
Q

in which locations is the lung auscultated on the posterior chest wall?

A

level of trapezius

level of scapular spine

level of the 10th and 11th rib

AXILLAE (!!) - only left

42
Q

what must you remember when auscultating the lungs in females?

A

must not auscultate over the breast tissue

43
Q

where is the apex of the lung auscultated?

A

supraclavicular region using the bell of the stethoscope

44
Q

where is the superior lobe of the lung auscultated?

A

2nd ICS

45
Q

where is the middle lobe of the lung auscultated?

A

4th ICS (just under the right axilla!)

= as middle lobe only present on right side

46
Q

where is the inferior lobe of the lung auscultated?

A

6th ICS

47
Q

what can you do if breath sounds are inaudible?

A

ask the patient to take deep breaths in and out

48
Q

where are the inspiratory and expiratory components of VESICULAR breath sounds produced?

A

inspiratory = lobar & segmental airways

expiratory = central airways

49
Q

describe the characteristics of vesicular breath sounds

A

low pitched

length, intensity and pitch of inspiratory phase > expiratory phase

no pause bw inspiration and expiration

50
Q

give causes of the reduced intensity of vesicular breath sounds

A

shallow breathing

airway obstruction

hyperinflation

pneumothorax

pleural effusion

pleural thickening

obesity

(i.e. if there is poor air generation in the airways or sound transmission through the tissues)

51
Q

describe the characteristics of bronchial breath sounds

A

high pitched, hollow

expiratory phase > inspiratory phase

distinct pause bw inspiration and expiration

52
Q

which pathologies are bronchial breath sounds heard over?

A

consolidation

localised pulmonary fibrosis

pleural effusion

collapsed lung

53
Q

when can the expiration phase become prolonged?

A

in obstructive lung disease e.g. asthma or chronic bronchitis

54
Q

what is tactile vocal fremitus?

A

vibration of the chest wall during vocal sound

55
Q

why does tactile vocal fremitus occur?

A

transmits from the larynx down the bronchial tree and into the chest wall

56
Q

explain how tactile vocal fremitus is assessed

A

ask the patient to say ‘ninety-nine’

palpate across the posterior chest wall with your hands for changes in intensity

you should feel the vibrations equally in both hands

!! both posterior and anterior chest wall !!

57
Q

what are the possible causes of decreased tactile vocal fremitus?

A

pneumothorax, COPD

due to decrease in density = increased/excessive air in lungs

58
Q

what are the possible causes of increased tactile vocal fremitus?

A

consolidation in pneumonia

tumour tissue in cancer

(due to increase in density = replacement of air with another substance)

59
Q

why is decreased tactile vocal fremitus caused?

A

decrease in density caused by an increase in distance between the chest wall and lungs

(e.g. in pleural effusion due to fluid)

60
Q

how are the cervical lymoh nodes palpated?

A

position the patient sitting and examine from behind

use both hands to examine the lymph nodes on each side simultaneously

use the pads of the fingers in a circular motion palpate across all the cervical
lymph node groups, without lifting the fingers until the end

61
Q

what is the order of cervical node palpation?

A

submental nodes – inferior to the chin

submandibular nodes – inferior to the angle of the mandible

preauricular/parotid nodes – anterior to the ear

postauricular nodes – posterior to the ear

occipital nods – base of the occipital

superior deep cervical nodes – superior part of the sternocleidomastoid

inferior deep cervical nodes – inferior part of the sternocleidomastoid

supraclavicular nodes – superior to the clavicle

62
Q

where are the submental nodes palpated?

A

inferior to the chin

63
Q

where are the submandibular nodes palpated?

A

inferior to the angle of the mandible

64
Q

where are the preauricular/parotid nodes palpated?

A

anterior to the ear

65
Q

where are the postauricular nodes palpated?

A

posterior to the ear

66
Q

where are the occipital nodes palpated?

A

base of the occipital bone

67
Q

where are the superior deep cervical nodes palpated?

A

superior part of the sternocleidomastoid

68
Q

where are the inferior deep cervical nodes palpated?

A

inferior part of the sternocleidomastoid

69
Q

where are the supraclavicular nodes palpated?

A

superior to the clavicle

70
Q

give four possible causes of cervical lymohedenopathy

A

lung cancer (metastasising to the lymph nodes)

tuberculosis

sarcoidosis

respiratory tract infection

71
Q

what is lung consolidation?

A

when air in the lungs is replaced by something else (e.g. inflammatory exudate, blood, pus, oedema)

72
Q

what are the indications for a chest drain?

A

pleural effusion
pneumothorax
haemothorax

73
Q

what is the most common position for chest drain insertion?

A

anterior to the mid-axillary line avoiding the long thoracic nerve lying behind the ‘safe triangle’

74
Q

what are the four borders of the safe triangle for chest drain insertion?

A

posterior
latissimus dorsi - posterior axillary fold

anterior
pectoralis major - anterior axillary fold

inferior
5th intercostal space at mid-axillary line

superior
below apex of axilla

75
Q

which ribs does the triangle of safety encompass?

A

overlies 2nd to 5th intercostal spaces

76
Q

where can the needle be inserted for a chest drain?

A

once triangle of safety is marked out

= needle may be inserted in the 2nd, 3rd, 4th and 5th intercostal spaces anterior to the mid-axillary line

77
Q

why is the needle for a chest drain inserted in the upper border of the rib?

A

to avoid injuring the neurovascular bundle

78
Q

what is the purpose of a chest drain?

A

the remove excess fluid/air from the pleural cavity

79
Q

why is a tracheostomy performed?

A

to create an artificial air passage into the trachea

80
Q

when is a tracheostomy performed?

A

upper airway obstruction

respiratory failure

81
Q

how is a tracheostomy performed?

A

opening is created on the anterior wall of the trachea between the 1st and 2nd tracheal cartilage rings

infrahyoid muscle and thyorid isthmus retracted

tracheostomy tube inserted and secured

82
Q

what are the surface markings of the lungs?

A

long - check insendi

anatomy & diagnostics (phase 1b) (7 decks)

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