Resp Exam Flashcards
Peripheral cyanosis
Hypoxaemia (O2 says <85%)
Clubbing
Lung cancer Pulmonary fibrosis Bronchiectasis Cystic fibrosis Tuberculosis Abscess Empyema
Tar staining on fingers
Smoking
Temperature
Cold- poor peripheral perfusion
Warm with dilated veins- CO2 retention
Flapping tremor (asterisks)
Ask patient to hold hands in front of them extended at the wrist for 30s
CO2 retention
Fine tremor
Overuse of beta agonists (salbutamol)
Tachycardia ‘bounding’ pulse
CO2 retention
Pulses paradoxus
Pulse wave volume decreases significantly during inspiration
Severe acute asthma/COPD (also cardiac tamponade)
Mucosal pallor of conjunctivae
Anaemia
Jaundice of sclera
Anaemia
Horner’s syndrome
Ptosis
Miosis and enophthalmos
Caused by compression of the sympathetic chain in chest cavity (Pancoast tumour, sarcoidosis, fibrosis)
Red sclera
Anterior uveitis (TB, sarcoidosis)
Central cyanosis
Hypoxaemia
Oral candidiasis
Inhaled steroid use or immunosuppressants
JVP
Increased in pulmonary hypertension (e.g. COPD, interstitial lung disease)
Tracheal deviation- away
Pneumothorax
Large pleural effusions
Tracheal deviation- towards
Lung collapse
Pneumonectomy
Scars in chest
Chest drain in MAL
Thoracotomies
Chest wall deformities
Scoliosis
Kyphosis
Barrel chest (hyperinflation; COPD)
Pectus carinatum/excavatum
Resp effort and breathing pattern
Prolonged expiration phase- asthma/COPD exacerbations
Asymmetry of chest movement
Pneumonectomy or thoracoplasty
Symmetrical decreased chest expansion
Pulmonary fibrosis
Asymmetrical decreased chest expansion
Pneumothorax
Pneumonia
Pleural effusion
Normal percussion sound
Resonant
percussion dullness
Over areas of increased density
Consolidation, collapse, pulmonary oedema, abscess
Stony dullness on percussion
Pleural effusion
Hyper-resonance on percussion
Areas of decreased density
Pneumothorax, emphysema bullae, COPD
Bronchial breathing
Caused by increased density of matter in peripheral lung allowing sound from the larynx to the stethoscope unchanged, hollow/blowing quality Consolidation Lung abscess at chest wall Dense fibrosis Squashed lung above pleural effusion
Reduce volume breath sounds- Locally
Effusion Tumour Pneumothorax Pneumonia Lung collapse
Reduce breath sounds volume globally
COPD
Asthma
Polymorphic wheeze on expiration
Asthma
COPD
Monomorphic wheeze on expiration
Foreign body
Carcinoma
Stridor
High pitched extra-thoracic breath sounds
Upper airway obstruction
Crackles
Crepitations, rales
On inspiration
Coarse crackles
Early inspiration
Fluid
Infection
Fine crackles
Later in inspiration
Fluid
Fibrosis
Rub
At height of inspiration- inflamed pleural surfaces rubbing against one another
Hyper-resonance on vocal resonance
Consolidation
Collapse
Decreased resonance on vocal resonance
Fluid
Air (plural effusion, pneumothorax)
Legs
Sacral oedema
Pedal oedema
DVT
Erythema nodosum e.g. sarcoidosis
Extra tests
Obs Cardio exam Peak flow Sputum MC+S ABG CXR
