Examination of the Respiratory Flashcards
What are the basics for a respiratory examination?
- Introduction and explanation, - Inspection, - Palpation - Percussion - Auscultation.
What is Stridor?
- Loud, harsh, high pitched respiratory sound which usually occurs on inspiration. Usually occurs because of airway obstruction.
What is erythema nodosum?
Swollen fat under the skin causing red bumps and patches
What are the respiratory causes of clubbing?
- Bronchial Carcinoma, - Mesothelioma, - Chronic suppurative lung disease (Bronchiectasis, lung abscess and empyema), - Pulmonary fibrosis, - Cystic fibrosis.
What is a ruddy complexion cause by?
Polycythaemia
What is Horner’s syndrome?
Damage to sympathetic nerves caused by a Pancoast tumour. Clinical features are unilateral miosis, partial ptosis and facial anhydrosis.
What are the different hand tremors
Fine tremor - excessive use of B-agonists. Flapping tremor - caused by severe ventilatory failure with CO2 retention. When wrists cocked-back look for a flapping tremor.
What is pectus excavatum?
Where the breast bone is sunken into chest
What is kyphoscoliosis
Abnormal bending of spine.
How do you examine for subcutaneous emphysema?
It will feel like a crackling sensation due to air in subcutaneous tissue.
What is a pneumothorax?
Collection of air in the pleural cavity between the lungs and chest wall resulting in a collapsed lung on affected side.
How do you examine tracheal position?
Right middle finger 2cm superior to the suprasternal notch. Gently press down and palpate space to either side. It should be central.
What are some of the causes of a deviation of trachea
Displacement towards the lesion - Lobar collapse, pneumonectomy and pulmonary fibrosis. Displacement away from the lesion - Large pleural effusion and tension pneumothorax.
How do you check for chest expansion?
With patient sitting anteriorly and posteriorly, hands on either side of chest. Ask patient to breath deeply, thumbs should move apart equally.
Where are the percussion sites
What are the causes of hyper resonant and dull/ very dull percussion?
Hyper resonant - Emphysema, large bullae or pneumothorax. Dull - Collapse, consolidation or fibrosis. Very dull - Pleural effusion or haemothorax.
How did you feel for tactile vocal fremitus
- Use the ulnar border of hand in the intercostal space. Ask patient to say ‘99’ and feel for vibration.
What does increased and decreased fremitus mean?
Increased - consolidation or fibrosis. Decreased - pleural effusion, pneumothorax or collapse
Describe normal/vesicular breath sounds?
Longer inspiration, soft expiratory sound, low pitch and over most lungs.
What can cause diminished vesicular breath sounds?
Obesity, pleural effusion, pneumothorax, collapse or hyperinflation
What are bronchial (abnormal) breath sounds?
Expiratory sounds last longer, high pitch, loud and the similar sound over trachea as in large airway.
Describe crackles and what they are caused by
- High-pitches, discontinuous sounds. It is caused by pulmonary oedema, pulmonary fibrosis, bronchial secretions, COPD, pneumonia, lung abscess and TB
Describe pleural rub and what it is caused by?
Sounds like a creaking, low pitched noise which may be associated with pleuritic pain. It is caused pulmonary embolism, pneumonia or vasculitis.
Describe wheeze and what it is caused by
Continuous oscillation of opposing airway walls. It is louder in expiration and caused by asthma and COPD, localised wheeze is caused by lung tumour.
