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SAM > Examination of the respiratory system > Flashcards

Examination of the respiratory system Flashcards

1
Q

Exam of the resp system: History

A 
Signs
Vaccination 
Deworming 
Medications 
Type of housing/ environment 
Health of other animals 
Age (old=tumours, young=infections)
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2
Q

Signs

A 
Get the exact complaint, duration and progression
Nasal discharge 
Coughing 
Abnormal breathing sounds 
Abnormal vocalization
Dyspnoea
Sneezing 
Stridor 
Epistaxis
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3
Q

General impression

A 
Level of consciousness 
Behaviour 
Posture 
Locomotion
Nutritional condition
Grooming state 
Abnormal sounds 
Abnormal resp
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4
Q

Nose and paranasal sinuses: exam methods

A

Inspection- internal and external
Palpation
Percussion
Smelling

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5
Q

Nose and paranasal sinuses: further exams

A 
Nasal discharge- cytology, bacto, mycology, para 
X-ray
Endoscopy and rhinoscopy!
Diagnostic punction
Biopsy
Diagnostic rhinotomy 
CT
MRI
Nasogastric tubing
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6
Q

Parameters to examine

A 
Shape/form of nose 
Occurrence of Nasal stridor 
Expired air 
Any discharge 
Nasal plane 
Nostrils and mucus membranes 
Palate and nasopharynx 
Paranasal and frontal sinuses
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7
Q

Occurrence of nasal stridor: normal

A

Faint during expiration- more pronounced in brachycephalic

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8
Q

Occurrence of nasal stridor: abnormal

A 
Stridor 
Sneezing 
Reverse sneezing 
Snoring 
Singulation 
Purring 
Groaning 
Howling
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9
Q

Causes of abnormal stridor

A

Can be during insp or exp or both
Localization: one-sided, on both sides, from pharynx or larynx etc
Narrowed air passages

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10
Q

Nasal stridor:

A

Sniffling sound

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11
Q

Pharyngeal stridor

A

Snoring sound

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12
Q

Laryngeal

A

Soft “sawing”

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13
Q

Collapsed trachea

A

Expiratory!!

Tooting sound

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14
Q

Larynx paralysis

A

Inspiratory stridor

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15
Q

Narrow trachea/bronchus

A

Mixed stridor

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16
Q

Expired air

A

Strength- lung capacity
Temp- will increase with fever, will decrease with hypovolaemic shock
Symmetry- both nostrils
Odour

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17
Q

Nasal discharge

A 
Continuity (frequency)
Symmetry
Quantity
Quality/ consistency
Colour
Odour
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18
Q

Nasal discharge: continuity

A

Permanent vs periodic

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19
Q

Nasal discharge: side

A

Unilateral is possible until the choana bilateral is after

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20
Q

Nasal discharge: quality/ consistency

A 
Watery
Mucous 
Mucopurulent 
Haemorrhagic
Foamy
Food particles
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21
Q

Nasal plane

A

Surface- intact
Colour
Moisture

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22
Q

Nostrils and mucus membranes

A 
Shape
Width
Movability of nasal alae (very in horse)
Symmetry
Internal exam of the mucus membranes
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23
Q

Paranasal and frontal sinuses

A 
Inspection 
Palpation
Percussion
Endoscopy 
X-ray, CT, MRI

*all the sinuses

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24
Q

Examples of diseases infecting the nose and paranasal sinuses

A 
Distemper- hyperkeratosis of nasal plane and foot pads
Rhinitis/ nasal discharge
Canine leishmaniosis
Discoid lupus erythematosus
Sinusitis
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25
Q

Physio findings of nose and paranasal sinuses

A

Temp same as surroundings
Palpation not painful
Percussion sound is sharp, bone-like
Faint, regular noise during expiration
Nostrils have regular shape and symmetrica width
Nasal alae don’t move during insp and exp
Percussion sound of paranasal sinuses is sharp, bone-like
Nasal plane is moist, intact, pigmented and no discharge
Soft and hard-palate are intact, moist and are pinkish-red
Mucus membrane of nose is light pink, smooth, shiny and intact

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26
Q

Coughing: parameters to examine

A 
Origin 
Frequency
Strength
Tone 
Occurrence 
Duration
Secretion
Any pain
Depth 
Localization of origin
Quality of sputum- if productive vs non-productive
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27
Q

Location of coughing

A 
Larynx 
Trachea 
Bronchi
Lung emphysema, chronic bronchitis 
Pneumonia
Cardiac Disease
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28
Q

Coughing from larynx

A

gagging, tendency to vomit

Larynx paralysis- deep and long hoars

29
Q

Coughing from trachea

A

Tracheitis- bark like

Tracheal collapse: goose-honking cough

30
Q

Coughing from bronchi

A

Acute is like tracheitis

Chronic is wet! mucus and pus

31
Q

Cardiac disease

A

Wet, hacking cough

32
Q

How to stimulate coughing

A

Press the tracheal rings or press the thorax very rapidly during expiration

33
Q

Characteristics of an induced cough

A 
Medium held
Medium intensive 
Medium deep
Unsnapping 
Dry 
Sharp
Painless
Does not recur
34
Q

Larynx and pharynx examination methods

A

External: inspection, palpation, auscultation
Internal: inspection
Additional: X-ray, endoscopy, CT and MR

35
Q

Examination of the tonsils

A 
Shape size: half peanut 
Covered by semilunar fold
Colour 
Surface 
Symmetricity
36
Q

Examination of the trachea

A

External: inspection, palpation, auscultation

Additional

37
Q

What are the additional exams of the trachea

A

X-ray
Endoscopy
CT, MRI
Tracheal fluids- sampling and analysis- cytology etc…

38
Q

Examination of the thorax

A 
Inspection
Palpation
Auscultation
Percussion
Additional
39
Q

Inspection of thorax

A

Chest
Resp movements
Dyspnea

40
Q

Inspection of thorax: chest

A

Skin
Shape and size
Bilateral symmetry
Local deformities

41
Q

Inspection of thorax: resp movements

A

Frequency
Rhythm
Type
Depth

42
Q

Inspection of thorax: resp movements: rhythm

A 
Normal- insp is a bit longer 
Held insp- narrowing upper airways or abd P
Held exp- decreased lung elasticity
Shorter insp or expiration- usually pain
Assymetric- bronchus obstruction 
Intermittent
43
Q

Inspection of thorax: resp movements: Type

A

Normal is costo-abdominal
Costal- function of diaphragm lost or increased abdominal P
Abdominal: painful chest diseases, paralysis of intercostal muscles

44
Q

Inspection of thorax: Dyspnea types

A

Insp
Exp
Mixed

45
Q

Inspiratory dyspnea

A

Narrowed upper airways
Pneumothorax
Pleural effusion

Proloned insp
Extension of head and neck, dilated nostrils, sagging belly

46
Q

Expiratory dyspnea

A

Compression/ obstruction of lower airways
Microbronchitis
Fibrous pleuritis

Prolonged and laboured exp
Work of abd muscles more severe, extension of head and neck

47
Q

Mixed dyspnea

A

Decreased compliance
Pulmonary edema, emphysema
Neoplasm

Forced inspiration and expiration

48
Q

Inspection of thorax: Dyspnea paradoxical breathing

A

Normally: abdomen and chest move in and out together
Diaphragm moves downwards during insp and upwards during exp

During paradoxical- the diaphragm and abdominal wall moves opposite to expected
Chest movements are restricted

49
Q

Causes of paradoxical breathing

A

Pleural fluid
Pneumothorax
Diaphragm paralysis
Broken ribs

50
Q

Palpation of thorax

A

Temp- intercostal spaces from dors to ventral
Fremitus pectoalis- bronchitis, valve insufficiency
Pain
Deformities

51
Q

Auscultation of thorax, what are we trying to measure

A

Spontaneous or artificially induced sounds
Indirect= mediate
Direct= immediate

52
Q

Auscultation of thorax: normal sound

A

Blow-like, develops in upper airways
Stronger during insp
Resp sounds do not originate from alveoli or small bronchi

53
Q

Auscultation of thorax: exam order

A

Directly audible with ear: nose, larynx, trachea

Indirect: use stethoscope: larynx, trachea, thorax

54
Q

Brachycephalic airway syndrome

A

Elongated soft palate and laryngeal collapse, stenosis of nares— this all leads to dyspnoea

55
Q

Auscultation of thorax: Bronchial resp sound

A

Physio: above larynx and trachea

Blowing character and prolonged syllable ‘ch’
normal during inhalation in cow, dog, cat, sus
ALWAYS abnormal during exhalation
Best heard at anterior resp area over the larger bronchi close to the surface of the body

Abnormal when peribronchial lung tissue contains less air e.g bronchitis, pneumonia and pneuomothorax

56
Q

Auscultation of thorax: additional/adventitious resp sounds (rhonchi)

A 
NEVER physio
Need to describe 
place
strength
type
resp phase when heard 
if temp or permanent
57
Q

Classification of rhonchi

A

Non-musical and musical

58
Q

Non-musical rhonchi

A

Sudden arising and stopping
Because of areas infiltrated with fluid
Caused by abrupt opening of previously closed bronchi and the vibration of the small bronchial wall
Crepitation, crackling, rattling, stertor

Early insp: obstruction of bronchi >2mm in diameter
Bronchopneumonia, COPD

Late insp: compression of bronchi <2mm in diameter
Pulm edema, interstitial pneumonia

59
Q

Musical rhonchi

A

Continuous regarding the phase of the resp cycle
Obstructive lung disease- results in active expiration
Venturi effect: smaller diameter, quicker airflow
Walls vibrate between insp and exp

Whistling- higher monophon
Wheezing- lower monophon

60
Q

Types of musical rhonchi

A

During inspiration- extrathoracal
Caused by upper airway obstruction e.g laryngeal paralysis

During late insp- intrathoracal resonant sound- originates from bronchial compression caused by enlarged lung parenchyma

During expiration-intrathoracal resonant sound- from obstruction of bronchi and bronchiole e.g COPD

61
Q

Percussion- lung borders

A

Abnormal shift of lung borders
Elevation of caudoventral border
Altered percussion sound of the lung borders

62
Q

Abnormal shift of lung borders- causes

A

Caudal borders- backwards and downwards
Alveolar and interstitial lung emphysema

Decreased percussion area of lungs- caused by abdominal distension- ascites, pregnancy

63
Q

Elevation of caudoventral border causes

A

Increased cardiac dullness- cardiomegaly, pericardial effusion

64
Q

Altered percussion sounds within the lung borders

A

Relative dullness
Absolute dullness- thickened thoracic wall, pleural effusion
Tympanic- atelactic parenchyma around lung
Hollow/box sound- lung emphysema
Metallic- penumothorax

65
Q

Diernhofer triangle

A

Enlarged cardiac dullness

66
Q

Additional exams

A 
X-ray
US
Endoscopy- rigid or flexible endoscope 
BAL
Bronchial fluid ananlysis
Thoracocentesis
CT, MR
Lung function tests
Blood acid base analysis
67
Q

Rhincoscopy- indications and diseases

A

Sneezing, reverse sneezing
Nasal discharge
Epistaxis
Stridor

Diseases:
Rhinitis
Neoplasia
Foreign body

68
Q

Laryngoscopy/pharyngoscopy- indications and diseases

A

Laryngeal disfunction causing obstruction of the epiglottis – need to first rule out rabies!!!
Difficulty swallowing
Regurgitation

Diseases:
Foreign body
Elongated soft palate 
Tonsilitis/ laryngitis 
Laryngeal paralysis/ collapse
69
Q

Tracheo-bronchoscopy

A

Bronchopneumonia
Chronic bronchitis
Pulmonary parasites
Tracheal collapse

SAM (16 decks)

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