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respiratory > examinations > Flashcards

examinations Flashcards

1
Q

in a resp exam how would you start examination?

A

Introduction:
- Wash hands
- Introduce yourself – name/ role
- Confirm patient details – name/ DoB
- Explain procedure: today I have been asked to perform a resp examination, do you understand what this will involve
- Chaperone?
- Check understanding and gain consent

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2
Q

how would you prepare a patient for a resp exam after gaining consent?

A
  • Ask patient to undress down to waist behind curtain – can keep bra on, offer blanket
    Ask for chaperone
  • Adjust head of head to 45 degree angel (OSCEs important!)
  • Ask patient to expose their lower legs – knee down
  • Ask the patient if they have any pain before proceeding
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3
Q

what do you look for within inspection of resp exam?

A

age, accessory muscle use, lip pursing, sputum pots, cachexia, breathing sounds, nasal flaring (paeds), body position, catheter, breathing devices, meds, cyanosis/ pallor

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4
Q

why is age important within inspection of resp exam?

A

ideas of what conditions ot expect

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5
Q

what would accessory muscle use/ lip pursing suggest?

A

resp distress
intercostal recession

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6
Q

what do the different colours suggests within sputum pots?

A

green - bacterial
red - blood clots (lung cancer), capillaries (excess coughing), TB

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7
Q

what would a high pitched/ resonance wheeze indicate?

A

COPD/ lung cancer

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8
Q

what would an audible stridor be caused from?

A

resp emergency - obstructions
foreign body - narrowing of upper airways

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9
Q

what does cyanosis indicate?

A

lack of perfusion

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10
Q

what does pallor suggest?

A

anaemia

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11
Q

what is tripod breathing?

A

sitting up but forwards - optimising resp conditions if patient is struggling

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12
Q

what would a lower fluid output show?

A

pulmonary embolism

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13
Q

what do you look for in hands in resp exam?

A

clubbing, tar staining, fine tremour, pulse and resp rate, peripheral cyanosis/ temp
oxygen sats, asterixis, joint swelling

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14
Q

what does clubbing suggest?

A

asbestos, abscess, bronchiectasis, bronchial carcinoma, CF, emphysema (lack of oxygen) , fibrosing alveolitis (ABCDEF) - interstitial lung disease

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15
Q

what does a fine tremor in hands suggest?

A

excess salbutamol use

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16
Q

what is asterixis?

A

hands in resp exam
flapping tremour - hands stretched out and palms flexed - termour will appear

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17
Q

what can joint swelling show in hands section of resp exam?

A

RA

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18
Q

what do you look for within the face of a resp exam?

A

conjuctival pallor, central cyanosis in mouth, oral candidias, horners syndrome, erthymatous face

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19
Q

what would conjunctival pallor indicate?

A

anaemia

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20
Q

what would central cyanosis in the mouth indicate?

A

hypoxaemia

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21
Q

why may an asthmatic have oral candidias?

A

steroid inhaler use

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22
Q

what causes horners sydrome?

A

lung cancer at the apex of the lung - pancost tumour

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23
Q

what are common features of horners sydrome?

A

miosis - constricting pupils
ptosis - dropping eyelids
anhidrosis - sweating of the face

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24
Q

why could a patient have erythematous face?

A

polycythaemia, CO2 retnetion seen in COPD

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25
Q

would do you look for at the neck within a resp exam?

A

JVP, heptajugular reflex, trachea deviation, cricosternal distance, neck lymph nodes

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26
Q

what would a raised JVP indicate?

A

cor pulmonale - right sided HF secondary to lung or pulmonary arterial disease
>3cm is a concern

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27
Q

when would you do a hepatojuglar reflex?

A

in a healthy individual
>4cm is a concern

28
Q

how do you assess trachea deviation?

A

chin relaxed down - find lateral borders using three fingers

29
Q

how do you measure crico-sterno distance ?

A

using three fingers (or patients own if difference in size) from sternal angel to start of cartilage

30
Q

what would an extended cricosternal distance show?

A

hyperinflation eg COPD

31
Q

how do you assess patients neck lymph nodes

A

stand behind sat down patient and feel along neck
small pea like shape - inflamed

32
Q

what do you assess within the chest section of resp exam?

A

inspection, palpitation, percussion, auscultation - quality of sounds, expansion

33
Q

what do you do within the inspection part of chest resp exam?

A

scars and deformities

34
Q

what would chest scars mean?

A

surgeries - CABG, VR, posterolateral/ thoracotomy

35
Q

what would an asymmetric chest be a sign of?

A

pneumonectomy

36
Q

what would a barrel chest - hyper expansion be casued be?

A

emphysema - COPD

37
Q

what would right ventricular heave show?

A

visible or palpable - large pleural effusions

38
Q

how do you assess chest expansion?

A

but thumbs iv V shape across midline and when patient breaths in and out - do they move same distance etc

39
Q

what does symmetrically reduced chest expansion show?

A

idiopathic pulmonary fibrosis

40
Q

what would unilaterally reduced chest expansion show?

A

pneumothorax

41
Q

how would you check percussion of chest?

A

non dominant hand on chest wall, middle finger pressed against chest wall and briskly strike finger
supraclavicular, chest wall x4 bilaterally, and to axilla

42
Q

what would air sound like when percussing?

A

loud high pitched, high resonance

43
Q

what would a solid structure sound like durng percussion?

A

dull low pitched

44
Q

what would a hyper-resonant percussion suggest?

A

pneumothorax

45
Q

what do you assess when hearing sounds during auscultation?

A

volume of sound
quality (normal vs not)
added sounds

46
Q

when would the volume of auscultation be quieter?

A

pneumothorax/ pleural effusion - liquid/ air blocking normal movements

47
Q

what type of sounds can be added and essentially abnormal?

A

wheeze, coarse, stridor, crackles

48
Q

what would a wheeze indicate?

A

bronchoconstriction

49
Q

what would coarse - brief crackles indicate?

A

pneumonia

50
Q

what do crackles represent within ausculatation?

A

interstitial lung disease

51
Q

what you check for on legs section within resp exam?

A

pitting oedema
signs of DVT

52
Q

how would you conclude and finish a resp exam?

A
  • Thank patient
  • Cover them up with blanket/ sheet – allow time to for them to redress
  • Wash hands
  • Summarise findings
  • Suggest further assessments and investigations (usually 3) eg sputum sample, peak expiratory flow rate, CXR, ECG
53
Q

what is arterial blood gases used for?

A

diagnostic tool
- Used in emergency, intensivist, anaesthesiology and pulmonary medicine
- Alveolar-arterial oxygen gradient is useful measure of lung gas exchange – can be abnormal in patients with ventilation-perfusion mismatch

54
Q

is ABG quicker than FBC for electrolyte counts?

A

yes - takes minutes whereas FBC can take an hour

55
Q

what is the main focus of ABG?

A

Respiratory gas exchange, acid- base balance

56
Q

how can lactic acid build up?

A

Insufficient O2 delivery to mitochondria leads to anaerobic respiration which produces less ATP and lots of lactic acid

57
Q

what is type I resp failure?

A
  • Type I: low oxygen cell death due to hypoxia. Aetiology: shunt (pneumonia), diffusional (COVID), V/Q mismatch (PE), ventilation (coma) and altitude.
  • MORE SEVERE
58
Q

what is type II resp failure?

A
  • Type II: high carbon dioxide and can have lower oxygen as a result – cell death due to acidaemia
59
Q

what is the partial pressure of oxygen in room air?

A

21kPa - like the gas % of air

60
Q

what type of oxygen should you use when measuring ABG and why?

A

room air
venturis - know percentage by colour so can compare

61
Q

how much oxygen does a rebreather oxygen mask give?

A

percentage is unknown but allows for continuous rapid oxygen - 15L - good in emergency medicine

62
Q

why is having unnecessary high FiO2 bad?

A

can causing wasting in lungs and respiratory depression - no need to breathe

63
Q

in COPD patients do they respond to CO2 like normal physiology?

A

no as used to chronic CO2 exposure - more likely to respond to hypoxaemia

64
Q

what is optimal pH?

A

7.35-7.45

65
Q

what can acidaemia cause?

A

myocardial suppression/ arrhythmias, cell death, enzyme dysfunction, excitable tissue, hyperkalaemia

66
Q

what can alkalaemia cause?

A

enzyme dysfunction, poor oxygen uptake by tissues, cell death

respiratory (10 decks)

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