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Year 2 Clinical skills > Resp > Flashcards

Resp Flashcards

1
Q

Tracheal Displacement towards the side of lung lesion

A

Upper lobe collapse
Upper lobe fibrosis
Pneumonectomy

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2
Q

tracheal deviation away lesion

A

Extensive pleural effusion
Tension pneumothorax
Chest Expansion

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3
Q

chest expansion on healthy individuals

A

least 5 cm

bilateral

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4
Q

why would unilateral decreased expansion occur?

A

Pneumothorax
Pleural effusion
Collapsed lung
Consolidation

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5
Q

what does percussion of lung sound like?

A

hollow, drum-like sound as it is over air-filled space

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6
Q

Hyper-resonant

A

Pneumothorax
Hollow bowels,
COPD

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7
Q

hyporesonant

A

Fluid filled such as pleural effusion you will hear a hypo-resonant (low) note such as muffled sound sometimes commented as “stoney dull”. With solid tissue such as a lung tumour, consolidation or collapse of the lung or normal liver you will hear also a flat/dull note

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8
Q

what are normal breath sounds

A

air turbulence in the airways

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9
Q

Bronchial sounds

A

harsh sounding
associated with consolidation
high pitched
inspiration and expiration are equal and there is a pause between

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10
Q

vesicular sound

A

The lung tissue filters the sounds of air turbulence, which results in the low pitch vesicular sound
normal breath sounds

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11
Q

what does vesicular sound like?

A

Soft, low pitched, and rustling in quality
Inspiratory phase lasts longer than the expiratory phase
Intensity of inspiration is greater than that of expiration
Inspiration is higher pitch than expiration
No pause between inspiration and expiration §

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12
Q

normal resp rate?

A

12-20

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13
Q

reduction in intensity of vesicular breath sound due to?

A

pneumothorax, pleural effusion, airway obstruction

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14
Q

what do we mean by reduction in intensity of sound?

A

reduced if there is poor sound generation in the airways or poor sound transmission through the tissues

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15
Q

decrease in the tactile vocal fremitus?

A

decrease in density; air in pneumothorax

increase in the distance between the chest wall and the lung- pleural effusion; fluid

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16
Q

increase in density- increased tactile vocal fremitus

A

consolidation in pneumonia, or tumour tissue in cancer

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17
Q 
Submental nodes 
Submandibular nodes 
Preauricular/parotid nodes 
Postauricular nodes
Occipital nodes 
Superior deep cervical nodes 
Inferior deep cervical nodes 
Supraclavicular nodes
A

–inferior to the chin
–inferior to the angle of the mandible
–anterior to the ear (technically the preauricular and parotid nodes are two separate sets of nodes, but because of their close proximity, they are usually palpated at the same time.)
- posterior to the ear
- base of the occipital
-superior part of the sternocleidomastoid
- inferior part of the sternocleidomastoid
- superior to the clavicle

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18
Q

Respiratory causes of cervical lymph node lymphadenopathy

A

Lung cancer metastasising to the lymph nodes
Tuberculosis
Sarcoidosis
Respiratory tract infection

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19
Q

lung examination?

A 
Position and exposure: Patient lying at 45 degrees, exposed from the waist upwards
Inspection: General inspection
Palpation: Tracheal position
Anterior chest expansion
Anterior chest percussion
Anterior chest auscultation
Anterior tactile vocal fremitus
Position: Patient leaning forwards
Posterior chest expansion
Posterior chest percussion
Posterior chest auscultation
Posterior tactile vocal fremitus
Position: Patient sitting across couch
Cervical lymph node palpation
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20
Q

pleural effusion
symptoms
clinical signs

A 
is the build-up of excess fluid between the layers of the pleura outside the lung
symptoms: 
Breathlessness
Cough
Pleuritic chest pain
examination signs : reduced chest movement, stony dull percussion note
tracheal deviation away
reduced/ absent sounds when auscultating
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21
Q

t3

A

level of medial part of spine of scapula

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22
Q

t7

A

inferior angle of scapula

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23
Q

l4

A

highest point of iliac crest

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24
Q

s2

A

level of posterior superior iliac spine

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25
Q

surface mark the trachea

A

The trachea can be surface marked on the surface of the anterior thorax, between the boundaries of the inferior margin of the cricoid cartilage and the sternal angle”

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26
Q

how can breathing rate be described?

A

normal 12-20
bradypnea- less than 12
tachypnea- more than 20

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27
Q

pattern of breathing?

A

Normal/deep/shallow/use of accessory muscles/pursed lip breathing

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28
Q

why wouold you ask to breath through mouth?

A

Breathing deeply through the mouth rather than nose allows you to hear the inspiratory + expiratory sounds better.

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29
Q

surface marking of R. Lung

A

The apex of the right lung is 1 inch above the medial 3rd of the clavicle. The right lung then extends down to the right sternoclavicular joint, to the manubriosternal joint at the 2nd costal cartilage (CC), to the 4th CC at the sternal border, to the 6th CC at the sternal border, to the 6th rib at the MCL to the 8th rib at the MAL and finally to the 10th rib at the scapular line

30
Q

surafce marking of left lung

A

: “The apex of the left lung is 1 inch above the medial 3rd of the clavicle. The left lung then extends down to the left sternoclavicular joint, to the manubriosternal joint at the 2nd costal cartilage (CC), to the 4th CC at the sternal border, to the 5th CC 2-3cm from the sternal border due to the cardiac notch, to the 6th CC at the sternal border, to the 6th rib at the MCL to the 8th rib at the MAL and finally to the 10th rib at the scapular line.”

31
Q

Describe and demonstrate the surface markings of the oblique fissure

A

“The middle and lower lobe of the right lung are separated by the oblique fissure which curves between the 6th CC anteriorly to the vertebral level T3 posteriorly.”

32
Q

Describe and demonstrate the surface markings of horizontal fissures of right lung

A

“The horizontal fissure runs upwards from the 4th CC at the sternal border to meet the oblique fissure at the MAL, separating the upper and middle lobe

33
Q

Describe and demonstrate the surface markings of the oblique fissure
left

A

“The upper and lower lobe of the left lung are separated by the oblique fissure which curves between the 6th CC anteriorly to the vertebral level T3 posteriorly

34
Q

Describe and demonstrate the surface marking of the inferior margin of parietal pleura
right/left are the same

A

“The surface markings of the inferior margins of the parietal pleural of the right/left lung are down from the 6th CC at the sternal border, to the 8th rib at the MCL, to the 10th rib at the MAL, to the 12th rib at the scapular line, to the transverse process of L1”

35
Q

Describe and demonstrate the surface marking of the inferior margin of the visceral pleura of right/left lung

A

The surface markings of the inferior margins of the visceral pleural of the right/left lung are down from the 6th CC at the sternal border, to the 6th rib at the MCL, to the 8th rib at the MAL, to the 10th rib at the scapular line

36
Q

insertion of chest drain

A

“The triangle of safety for insertion of a chest drain is bound by the base of the axilla superiorly, the lateral border of the Pec Major anteriorly, the 5th ICS inferiorly and the lateral border of the Lat Dorsi posteriorly. The needle should be inserted in the 2nd-5th ICS above the upper border of the rib to avoid the neurovascular bundle and should be pointed up and medially

37
Q

DESCRIBE MEDIASTINAL PLEURA RIGHT LUNG

A

“The surface marking of the mediastinal pleura of the right lung is the portion of parietal pleura that adheres to the mediastinum on the right hand side. This goes from 1 inch above the medial 3rd of the right clavicle down to the 6th CC at the sternal border.”

38
Q

DESCRIBE MEDIASTINAL PLEURA LEFT LUNG – remember cardiac notch

A

“The surface marking of the mediastinal pleura of the left lung is the portion of parietal pleura that adheres to the mediastinum on the left hand side. This goes from 1 inch above the medial 3rd of the left clavicle to the 4th CC at the sternal border, and then curves out to the 5th CC deviated from the midline by 2-3cm due to the cardiac notch and then curves down to the 6th CC at the sternal border.”

39
Q

wheeze

A

asthma, bronchiectasis, copd

40
Q

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).

41
Q

crackles

A

discontinuous, brief, popping lung sounds

pneumonia, bronchiectasis and pulmonary oedema.

42
Q

pulmonary fibrosis crackles?

A

Fine end-inspiratory crackles

43
Q

DVT > PE

A

swelling in legs
visible superficial veins
w SOB
secondary to PE

44
Q

Bradypneoa causes?

A

use of sedative

opiods

45
Q

tachypneoa cause

A

compensation for DKA
sepsis
PE

46
Q

Finger clubbing?

causes

A

lung cancer, interstitial lung disease, cystic fibrosis and bronchiectasis.

47
Q

Ask the patient to place the nails of their index fingers back to back.
In a healthy individual, you should be able to observe a small diamond-shaped window (known as Schamroth’s window

what is this assessing?

A

finger clubbing

47
Q

Ask the patient to place the nails of their index fingers back to back.
In a healthy individual, you should be able to observe a small diamond-shaped window (known as Schamroth’s window

what is this assessing?

A

finger clubbing

48
Q

what can salbutamol use cause in a resp examination?

A

fine tremor because it is a beta-2-agonist

49
Q

astrexis

A

cock hands back 30s
palms face away
observe for a tremor

50
Q

causes of atrexis

A

hepatic encephalapthy
c02 retention secondary to type 2 resp failure > COPD
uraemia

51
Q

excessively warm and sweaty hands?

A

C02 retention

52
Q

heart rate

when do you measure pulse for full 60s ?

A

rate and rhythm

irregular rhythm to improve accuracy

52
Q

heart rate

when do you measure pulse for full 60s ?

A

rate and rhythm

irregular rhythm to improve accuracy

53
Q

Bounding pulse:

A

can be associated with underlying CO2 retention (e.g. type 2 respiratory failure).

54
Q

Resp rate

the expiratory phase is often prolonged

A

in asthma exacerbations and in patients with COPD).

55
Q

bradypnoea

A

opiate overdose
hypothyroidism
head injury
exhaustion in severe airway obstruction

56
Q

tachynpoea

A 
airway obstruction - copd / asthma 
pneumonia 
pulmonary fibrosis 
PE
pneumothorax
cardiac failure
57
Q

oral candiasis

caused by ?

A

decreased immune suppression > thrush
inhaled corticosteroids
amoxicilin

58
Q

dilated veins?

A

hypercapnia

59
Q

what common resp condition does not cause clubbing?

A

COPD

60
Q

kind of scars ?

A

lateral thoractomy

61
Q

pectus excavatus

A

connective tissue disease

Marfans syndrome

62
Q

pectus carinatum

A

protruded chest

63
Q

what can we tell when JVP is raised

A
  • If a patient is hypervolaemic the JVP will appear raised due to
  • ## increased venous pressure within the right atrium causing a higher than normal column of blood within the IJV
64
Q

is JVP palpable

A

no must be carotid artery

65
Q

causes of raised JVP

A

Right-sided heart failure
Tricuspid regurgitation - infective endocarditis
Constrictive pericarditis

66
Q

fine crackles?

A

pulmonary fibrosis

67
Q

tension pneumothorax management

A

cardiac arrest call
immediate needle decompression - large bore cannula into pleural space 2 intercostal space MCL 4/5 MAL - hiss of air

high flow oxygen - aim 100% sats

chest drain and admit

68
Q

sob pneumothorax >2cm

A

needle aspiration - cannula

if unsuccesful chest drain - correct clotting first

69
Q

pleural effusion investigation and management

A

uss
pleural aspirate- 21g needle and 50ml syringe
pH, protein, lactate dehydrogenase

contrast CT to look for a cause
treat the cause

pleurodesis
aspiration

Year 2 Clinical skills (6 decks)

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