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Clinical 3001 > Examination of the Respiratory System > Flashcards

Examination of the Respiratory System Flashcards

1
Q

Outline the basic structure of a respiratory examination

A
  • Introduction and explanation
  • Inspection
  • Palpatation
  • Percussion
  • Auscultation
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2
Q

What should you look for during a general inspection?

A
  • Does the patient look unwell? Cachectic? In pain?
  • Use of accessory muscles / work of breathing
  • Look around the patient
  • Look at the patient
  • Listen (audible stridor, hoarsness, pattern of speach)
  • If any pathological signs, think,
    What is the underlying cause
    How does this relate to history
    Does it increase the likelihood of respiratory pathology
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3
Q

What would be used in more serious conditions a nebuliser or an inhaler?

A

A nebuliser

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4
Q

What is stridor?

A
  • Loud, harsh, high pitched respiratory sound
  • Usually on inspiration
  • Upper airway obstruction
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5
Q

What is erythema nodosum?

A

Swollen areas of fat under skin. Typically on shins. Red/purple discolouration.
Associated with pneumonia, sarcoid, tb and IBS.

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6
Q

What should you do upon close inspection and palpatation?

A
  • Examine hands - inspect
    palpate for warmth and venodilation, flapping tremour and fine tremour, palpate radial pulse (rate and rhythm)
  • Count respiratory rate
  • Inspect face, eyes, mouth and pharynx
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7
Q

Where can you see central cyanosis?

A
  • Lips

- Tongue

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8
Q

What are the respiratory causes of clubbing?

A
  • Bronchial carcinoma
  • Mesothelioma
  • Chronic suppurative lung disease
    Bronchiectasis
    Lung abcess
    Empyema
  • Pulmonary fibrosis
  • Cystic fibrosis
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9
Q

What is mesothelioma?

A

Cancer of the lining of the lungs (often linked to asbestos exposure)

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10
Q

What does a ‘ruddy’ complexion

A

Acutely low oxygen (due to increased levels of haemoglobin.

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11
Q

What is high haemoglobin called?

A

Polycythaemia

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12
Q

What are the clinical features of horner’s syndrome?

A
  • Unilateral miosis
  • Partial ptosis
  • Loss of sweating on same side (facial anhidrosis)
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13
Q

What does a fine tremor indicate?

A

Excessive use of B-agonists

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14
Q

What is a flapping tremor?

A
  • Severe ventilatory failure with CO2 retention
  • Hold hands outstreched
  • Wrists cocked-back
  • Look for a jerky, flapping tremor
  • Associated confusion
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15
Q

What should you look at when inspecting the chest and neck closely?

A
  • Scars - cardiac surgery, thoracotomy, chest drain scars
  • Pattern of breathing
  • Shape of chest
    Symmetry
    Deformity (kyphoscliosis / pectus excavatum)
    Increase in A-P diameter (‘barrel shaped’)
  • Prominant veins on chest wall (SVC obstruction)
  • JVP
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16
Q

What is pectus excavatum?

A

Structural deformity of the anterior thoracic wall in which the sternum and rib cage are shaped abnormally. This produces a caved-in or sunken appearance of the chest.
Affects lung function

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17
Q

What can SVC obstruction appear like?

A

Visible vein distribution on chest

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18
Q

What are the lymph nodes which need to be palpated during the respiratory examination?

A
  • Postauricular
  • Preauricular
  • Occipital
  • Periparotid
  • Tonsillar
  • Posterior cervical
  • Supraclavicular
  • Submental
  • Anterior cervical
  • Submandibular
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19
Q

What should you look for when palpating the chest?

A
  • Subcutaneous (‘surgical’) emphysema (if appropriate)

- Palpate for rib fractures if appropriate (e.g history of chest trauma)

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20
Q

What is subcutaneous emphysema?

A
  • Air in subcutaneous tissues
  • Crackiling sensation under skin
  • May be diffuse chest, neck, face swelling
  • Consider trauma / pneumothorax
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21
Q

What is pneumothorax?

A

A collection of air in the pleural cavity, between lung and chest wall, resulting in collapse of lung on affected side.

22
Q

What should be palpated/checked on the neck and chest?

A
  • Tracheal position
  • Cardiac apex
  • Assessment for right ventricular heave
23
Q

How should the trachea be palpated?

A
  • On suprasternal notch
  • Right middle finger 2cm superior to notch
  • Gently press down and back
  • Palpate spce to either side
  • Should be central
24
Q

What conditions result in displacement of the trachea towards the lesion?

A
  • Lobar collapse
  • Pneumonectomy
  • Pulmonary fibrosis
25
Q

What conditions result in displacement of the trachea away from the lesion?

A
  • Large pleural effusion

- Tension pneumothorax

26
Q

When palpating the chest how can you tell the lungs are expanding equally?

A

The thumbs should move apart equally

27
Q

How should you percuss the chest?

A
  • Percuss anterior, posterior and lateral chest
  • Use middle finger / left hand
  • Apply firmly to patient’s chest
  • Strike it’s middle phalanx with the middle finger of right hand
  • Percuss over intercostal spaces
  • However percuss clavicles directly
  • Compare left and right
  • Listen to note produced
28
Q

What does a resonant note indicate when percussing the chest?

A

Air / normal lung

29
Q

What does a dull sound indicate when percussing the chest?

A
  • Collapse
  • Consolidation
  • Fibrosis
    (liquid or solid)
30
Q

What does a hyper resonant sound indicate when percussing the chest?

A
  • Emphysema
  • Large bullae
  • Pneumothorax
31
Q

What does a ‘stoney’ or very dull percussion note indicate?

A

Pleural effusion or haemothorax

32
Q

What is tactile vocal fremitus?

A
  • Vibration felt on the patient’s chest during low frequency vocalization.
  • Done using palm / ulnar border of the hand
  • Say ‘99/11’ / low frq noise
33
Q

What does increased fremitus indicate?

A
  • Consolidation or fibrosis
34
Q

What does decreased fremitus indicate?

A
  • Pleural effusion, pneumothorax or collapse
35
Q

What does auscultation involcve in a respiratory examination?

A
  • Use bell or diaphragm
  • Ask patient to breathe deeply in and out through mouth
  • Listen through full inspiration and full expiration
  • Compare side to side - anterior, posterior and lateral (similar to percussion sites)
  • Listen for breath sounds and added sounds
36
Q

What questions should you ask whilst listening to the chest?

A
  • Are any breath sounds present?
  • Are they vesicular in nature?
  • Are breath sounds equal on both sides?
  • Are there any bronchial breath sounds?
  • Are there any added sounds such as crackles, wheezes or pleural rubs?
37
Q

What should normal vesicular breath sounds sound like?

A
  • Inspiration longer and expiration
  • Low pitched, quiet, heard over most of lung fields
  • No gap between inspiration and expiration
38
Q

What can cause diminished vesicular breath sounds?

A 
- When lung is displaced by air e.g:
Obesity 
Pleural effusion 
Pneumothorax 
Collapse 
Hyperinflation - emphysema - in COPD
39
Q

What are bronchial breath sounds (abnormal)?

A
  • Noise which originates from larger airways
  • When damage to small airways / alveoli
  • Harsh in nature
  • Gap between inspiration and expiration
  • Expiratory component dominates
  • Find in consolidation - when alveoli and small airways fill with dense material )e.g pneumonia, infection on top of pleural effusion) or fibrosis
40
Q

What can fine late crackles indicate?

A

Cryptogenic fibrosing alveolitis

41
Q

What can cause crackles?

A
  • Pulmonary oedema
  • Pulmonary fibrosis
  • Bronchial secretions
  • COPD
  • Pneumonia
  • Lung abcess
  • TB
  • Bronchiolitis
  • Bronchiectasis
42
Q

What does pleural rub sound like?

A

low pitched, like ‘creaking leather’

43
Q

What can cause pleural rub?

A
  • PE
  • Pneumonia
  • Vasculitis
    May be associated with pleuritic pain (sharp on inspiration / coughing)
44
Q

What can cause ‘wheeze’?

A
  • Continous oscillation of opposing airway walls
  • Implies airway (small) narrowing
  • Generalised caused by asthma and COPD
  • Localised is caused by a lung tumour.
45
Q

What does a ‘wheeze’ sound like?

A
  • Musical quality, high pitched

- Louder in expiration

46
Q

What is the difference between tactile vocal resonance and tactile vocal fremitus?

A
  • Fremitus - feeling vibrations with hands

- Resonance - listening with stethoscope

47
Q

Where should you examine lymph nodes from?

A

The back

48
Q

What additional areas can you look at at the end of the respiratory exam

A
  • Ankle oedema
  • Sputum pot
  • Observation chart - pulse, BP, Temp, O2 saturation
  • Peak flow
  • Spirometry
49
Q

What can a spirometer be useful for diagnosing?

A

Confiriming COPD or diagnosing asthma

50
Q

What information about the patient do you need to consider when assessing the peak flow?

A

Age and height

Clinical 3001 (6 decks)

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