Resp Flashcards
MRC dyspneoa
1 - strenuous exercise 2 - hurry/uphill 3 - slower, stop 15mins/1 mile 4 - 100yds/few mins level ground 5 - dressing/housebound
Sputum colours
Clear = mucoid
COPD BRONCHIECT
Yellow = mucopurulent
LRTI asthma
Green = prurulent
LRTI COPD
Rusty = pneumococcal pneumonia
Pink/frothy = acute PULMONARY OEDEMA
Haemoptysis
Streaks ie infection forceful cough
PE
Large Ca Bronchiectasis ie CF Cavitation Vasculitis
Stridor
Large airway compression
INSPIRATATORY = Extrathoracic
EXPIRATORY = intrathoracic
Both ?inlet
Meds
Worse asthma - b blockers NSAIDS
Cough ACE IPF - MTX/cytotoxic, amiodarone, nitro, IVDU VTE - oestrogen Effusion - amiodarone, nitro RR - opioids, benzos
Bedside
Demenor
BMI
Confused/distressed
Chest wall
O2, Nebs, Medication
Resp rate/pattern ie effort or noise
Pulse BP
Chest inspection
Shape
Hyperinflation ie barrel chest
Small vol/high resp rate ie IPF
Breathing Prolonged exp/pursed lip breathing ie COPD/asthma PF - doorstop ACCESSORY MUSCLE USE ie forceful insp Increased sternal mvt ie 5cm Traps and scalenes ie shoulders elevated
Chest wall
Kyphoscoliosis
TB/pleurectomy ? Scars
Pectus carinatum = severe obstructive lung disease in childhood
Pectus excavatum = congenital
Scars
Thoracotomy = lat/post
Drains = AXILLAE
Resp rate
N 12-15
20+
Skin general
SC mets
Sarcoid = erythema nodosum
DVT legs!
Resp hands
Temp Peripheral cyanosis Nicotine stains Small muscle/interossei wasting ie T1/apical tumour ?Yellow nail syndrome
Clubbing ie ca, IPF, chronic supperative
Wrist pain
Tremor
Fine - b agonists
Asterixis - CO2 retention
Pulse
Resp neck
JVP
Raised if pulm hypertension, tension pneumonia, large PE
SVC obstruction
Accessory muscles
Tracheal deviation
Away=acute
Tension pneumo
Towards = chronic
UL fibrosis/ collapse
Lobectomy
Chrichosternal distance ie notch to cricoid - first ridge N = three fingers REDUCED hyperinflation Tracheal tug = AA Resp effort/mvt
LYMPH NODES!
?vocal fremitus
Resp face
Conjunctiva
Tongue
Pupils
Central cyanosis
Anaemia
SVC obstruction = dusky, generalised swelling, sub conjunctival oedema ie upper m tumour invasion
Horners synd = unilat ptosis/ pupil constriction
Tumour at root of neck affecting sympathetic nerves to eye
Palpation
CHEST EXPANSION 1x front 2x back
Palpate
APEX BEAT impalp if hyperinflation ie masked by lingual
HEAVES rt side pulm hypertension
EXPANSION ie upper and lower
COPD - paradoxical inward mvt insp
Hoovers sign = diaphragm contracts
? Surgical emphysema
Percussion
Sequence/ compare DIRECT ON CLAVICLES
Posterior - arms forward/folded ie reduce obstruction
N dull over precordium, lost in COPD
Increased resonance ie pneumothorax
Dull ie consolidation
stony dull = effusion
Auscultation resp
Deep breaths ie 5l VC
Vesicular= n most sound turbulence from large airways
Consolidation/fibrosis/top of effusion = thick and stiff, increased sound conduction, bronchial breathing ie high pitched/blowing
Collapse = reduced a/e
Pneumothorax/effusion - none! But pn
Inc apices, use bell if v thin!
VOCAL RESONANCE
Consolidation ie whispering petriloquy
