Paediatric Resp Examination Flashcards
appearance/behaviour
alertness
cyanosis: bluish discolouration of the skin
shortness of breath
pallor: pale colour of the skin, may suggest anaemia or poor perfusion
weight
syndromic features
sounds
cough with wheeze: asthma, viral-induced wheeze
productive cough: lower respiratory tract infection
narking cough: croup, laryngomalacia
dry cough: allergies, tuberculosis
hoarse voice: laryngitis
hot potato voice: peritonsillar abscess
acute stridor: croup, foreign body, bacterial tracheitis, epiglottitis
chronic stridor: laryngomalacia, subglottic stenosis
hot potato voice:
peritonsillar abscess
acute stridor
croup, foreign body, bacterial tracheitis, epiglottitis
chronic stridor
laryngomalacia, subglottic stenosis
if a child is taking ppancreatic enzymes it is because they have
cystic fibrosis
if a child has a tremor they may have
may be caused by beta 2 agonist eg. salbutamol
what are some signs to look for on examination of the hands
colour
tremour
eczema
finger clubbing
finger clubbing
may be relevant in a paediatric respiratory examination as a sign of bronchiectasis, cystic fibrosis and primary ciliary dyskinesia
loss of schamroth’s window
pulse
assess radial pulse (or femoral pulse in babies)
hearing loss is associated with
primary ciliary dyskinesia
inspection of the nose
deviated nasal septum: may contribute to breathing difficulties
nasal polyps: associated with atopy and cystic fibrosis
inspection of the mouth
central cyanosis - bluish discolouration of the lips and/or tongue associated with hypoxaemia (e.g. persistent pulmonary hypertension, bronchospasm, lower respiratory tract infection)
cleft palate
inspection of the throat
tonsillar hypertrophy - may indicate history of recurrent tonsillitis and airway obstruction
causes of tracheal deviation
trachea deviates away from pneumothorax and large pleural effusions
trachea deviates towards lobar collapse and pneumonectomy
inspection of the anterior chest
- scars suggestive of previous thoracic surgery
- pectus excavatum: caved in, sunken appearance of the chest
- pectus carinatum: protrusion of the sternum and ribs
- asymmetry of the chest wall movement: may indicate underlying pneumothorax or consolidation
- harrison’s sulcus: associated with poorly controlled asthma
- chest hyper expansion: associated with asthma and chronic respiratory obstruction
normal resp rate
asymmetry between inspiratory and expiratory phases
the expiratory phase is often prolonged in asthma exacerbations
signs of increased work of breathing
general signs:
- difficulty speaking or feeding
recession:
- tracheal tug
- supraclavicular recession
- intercostal recession
- subcostal recession
use of accessory muscles
- nasal flaring
- abdominal breathing
- head bobbing (secondary to sternocleidomastoid contractions)
thoracic scars - median sternotomy scar
located in the midline of the thorax
this surgical approach is used for cardiac valve replacement and pulmonary artery banding
thoracic scars - right thoracotomy scar
located between the lateral border of the sternum and the mid-axillary line at the 4th or 5th intercostal space on the right. This surgical approach is used to perform pulmonary artery banding and a Blalock–Taussig shunt.
thoracic scars - left thoracotomy scar
located between the lateral border of the sternum and the mid-axillary line at the 4th or 5th intercostal space on the left. This surgical approach is used to perform pulmonary artery banding, patent ductus arteriosus ligation, a Blalock–Taussig shunt and coarctation of the aorta repair.
thoracic scars - infraclavicular scar
located in the infraclavicular region (on either side). This surgical approach is used for pacemaker insertion.
thoracic scars - left mid-axillary scars
this surgical approach is used for the insertion of a subcutaneous implantable cardioverter-defibrillator (ICD).
palpating the apex beat
place fingers horizontally across the chest
typically located in the 5th intercostal space in the midclavicular line
causes of displaced apex beat
leftward displacement: cardiomegaly, right pleural effusion, right tension pneumothorax
rightward displacement: dextrocardia, diaphragmatic hernia, left pleural effusion, left tension pneumothorax
assessing chest expansion
place hands on the chests chest inferior to the nipples
wrap fingers around either side of the chest
bring thumbs together in the midline so that they touch
observe if your thumbs move out symmetrically
causes of reduced chest expansion
lung collapse, pneumonia and restrictive lung disease
types of percussion notes
resonant - normal finding
dullness - suggests increased tissue density
stony dullness - caused by underlying pleural effusion
hyper-resonance: the opposite of dullness, suggestive of decreased tissue density (e.g. pneumothorax)
quality of breath sounds
vesicular - the normal quality of breath sounds in healthy individuals
bronchial - harsh sounding inspiration and expiration, associated with consolidation.
volume of breath sounds
quiet sounds - reduced air entry into that region of the lung (eg. pleural effusion, pneumothorax)
wheeze
wheeze: a continuous, source, whistling sound produced in the respiratory airways during breathing. often associated with asthma and bronchiectasis
stridor
a high-pitched extra thoracic breath sound resulting from turbulent airflow through narrowed upper airways. stridor has a wide range of causes, including foreign body inhalation (acute) and subglottic stenosis (chronic).
coarse crackles
discontinuous, brief, popping lung sounds typically associated with pneumonia, bronchiectasis and pulmonary oedema
fine end-inspiratory crackles
often describes as sounding similar to the noic generated with seperated velcro
find end-inspiratory crackles are associated wth pulmonary fibrosis
increased vocal resonance over an area suggests
increased tissue density
eg. consolidation, tumour, lobar collapse
decreased vocal resonance over an area suggests
presence of fluid or air outside of the lung eg. pleural effusion, pneumothorax
further tests or investigations that may be recommended
cardiovascular examination
inhaler technique assessment
full set of vital signs
peak expiratory flow rate
sputum sample
plot height and weight on a flow chart
venous blood gas
chest x-ray
syndromes that may impact the respiratory system
DiGeorge syndrome - chromosomal
downs syndrome - chromosomal
fetal alcohol spectrum disorder - lung hypoplasia and altered surfactant production
marfan syndrome - pneumothorax and chest wall deformities
pierre robin sequence
stickler syndrome - connective tissue disorder
treacher collins syndrome - underdevelopment of the facial bones
