Examination Flashcards
General examination at foot of bed
Gait
Physique
Acute illness ? Chronic illness ?
Nutritional status ? Cachexia ?
Fever ? Sweating ? Chills ?
Breathless ?
Audible wheeze ? Stridor ?
Hoarse voice ?
Cyanosis ?
Pallor ?
Intercostal recession
Visible pulses ?
Bedside table (inhalers , peak flow meter, tissues, sputum pot , oxygen mask )
Signs of breathlessness on patients
Use of accessory muscles (sternocleidomastoid )
Pursed lips
Angle of bed in respiratory exam
45 degrees
Hand examination in respiratory exam
Clubbing
Pallor
Cyanosis
Flapping of the hands
Fine tremor
Respiratory rate
Respiratory causes of clubbing
Carcinoma of bronchus
Pulmonary fibrosis
Bronchiectasis
Lung abscess
Pleural empyema
When do you see fine tremor in respiratory disease
Inhaled beta agonists (salbutamol)
Normal respiratory rate
14-16 breaths / min
Tachypnoea DEFINTION
Increased RR
Dyspnoea
Symptom of breathlessness experienced by patient
Apnoea
Cessation of respiration
Cheyenne stokes breathing
Cyclical deepening and quickening of respiration followed by diminished respiratory rate and effort which can be associated with short apnea period
Cycle then repeats
When do you see Cheyne stoke breathing
Severely ill patients
Severe cardiac failure
Narcotic drug poisoning
Neurological disorders
Elderly sleeping with no signs of dx
Obstructive sleep apnea
What is it and when do you see it
Apnea despite continuation of respiratory efforts
Seen in obese patients dye to obstruction of upper airways by soft tissues
Face exam
Eyes for anemia
Eyes for Horner’s syndrome (miosis, ptôsis, anhidrosis )
Lips and tongue for central cyanosis
Oral candida
Dx of the lungs with horners syndrome possible
Pancoast tumor of the lung apex invading cervical sympathetic chain
What can cause oral candida
Inhaled steroids
Debilitation
Underlying immune suppression of patient
Chest inspection
Rate of respiration
Rythm of respiration
Chest expansion
Symmetry (bilaterally symmetrical and elliptical in cross section, kyphosis, scoliosis )
Barrel shaped
Obvious scars (thoracotomy running from below scapula posteriorly to anterior chest wall , intercostal draining with small scars in axilla or posteriorly)
Lumps
Symmetrical movement
Intercostal recession on inspiration
Paradoxical Inwards movement of lower ribs in inspiration in COPD
Anatomical landmark bifurcation of trachea
Sternal angle
Disease with barrel shaped chest due to lungs overinflation
Long term COPD
Causes of severe intercostal recession on inspiration
Severe upper airways obstruction in laryngeal dx, tumors of trachea
Palpation of chest
Lymph nodes in neck
Swellings
Trachea position
Cardiac apex
Chest expansion
Tactile vocal fremitus
Sounds possibly heard on Percussion of the chest
Resonance
Dullness
Hyper-resonance
Most and least resonant part of the lungs
Most resonsnat below clavicles and scapula posterior
Least resonant over scapulae
When do you have dull percussion of the chest
Fluid like in Pleural effusion
Consolidation or collapse
type of dullness in pleural effusion
Stony dullness
Causes of hyper resonance
Pneumothorax
Side of stethoscope used in chest auscultation
Diaphragm
Normal breath sound quality
Vesicular
When do you hear bronchial breathing
Consolidation
Added breath sounds
Wheezes
Crackles
Pleural rub
When do you hear wheezes
Asthma
COPD
Crackles
Short explosive sounds ,bubbling or clicking
Crackles at beginning of inspiration heard in
COPD
Localized pound and coarse crackles heard in
Bronchiectasis
Fine character crackles in late inspiration heard in
Diffuse interstitial fibrosis
Pleural rub associated with what dx
Pleural inflammation
