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Year 3 - OSCE Resp > Resp Exam > Flashcards

Resp Exam Flashcards

1
Q

What paraphernalia are you looking for when inspecting from the side of a bed?

A 
Inhalers
Sputum pots
Immunosuppressants 
Nebulisers 
Peak flow charts 
Thoracotomy scars
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2
Q

What would immunosuppressants suggest?

A

Pulmonary fibrosis

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3
Q

What would sputum pots suggest?

A

Bronchiectasis

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4
Q

What is bronchiectasis?

A

Chronic infection of bronchi leading to chronic dilation of the lungs

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5
Q

What are you inspecting for on the patient?

A 
Pigeon chest
Pectus excavatum 
Scoliosis
Kyphosis
Barrel chest 
Wheeze
Stridor 
Cyanosis
SOB
Cough
Cachexia
Use of accessory muscles 
Cushingoid appearance (steroid use)
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6
Q

What is stridor and what is it caused by?

A

High pitched wheezing

Obstruction

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7
Q

What are you looking out for on the hands? (ask patient to hold hands out)

A 
Cyanosis 
Thinning of skin (steroid use) 
Tar staining
Clubbing 
Wasting of small muscles
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8
Q

What do you call the test that specifically looks for the presence of clubbing?

A

Schamroth’s window test

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9
Q

What are the respiratory causes of clubbing?

A 
Suppurative conditions (ones that produce pus) 
Fibrosis / interstitial lung disease 
Lung cancer
Sarcoidosis 
TB
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10
Q

What do you test for on the arms?

A

Temperature (compare temp on both sides)

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11
Q

What else do you test for in the arms?

A

CO2 retention

Salbutamol use

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12
Q

Tremor of the hands would suggest?

A

Salbutamol use / b2 agonist use

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13
Q

CO2 retention flap is called

A

Asterixis

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14
Q

Explain a positive asterixis sign

A

Hypercapnia is often caused by hypoventilation; not enough o2 to brain

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15
Q

Rate and rhythm of radial pulse and respiratory rate

What is the normal respiratory rate per min?

A

12-20 breaths per minute

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16
Q

What could a raised JVP suggest?

A

Cor pulmonale

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17
Q

Briefly explain cor pulmonale

A

Cor (heart) pulmonale (lungs)
Pulmonary hypertension causes right ventricular hypertrophy as the heart finds it difficult to pump against the increased blood pressure, but this can lead to heart failure due to the narrowing of the space

?diastolic heart failure?

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18
Q

What are you looking for on the face?

A 
Cushingoid appearance 
Central cyanosis
Conjunctival pallor 
Plethora (redness of face)
Facial swelling
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19
Q

What would redness of the face indicate?

A

Polycythemia; can lead to respiratory distress

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20
Q

What would facial swelling indicate?

A

Lung cancer obstructing superior vena cava

or superior vena cava syndrome

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21
Q

What are you looking for on the mouth?

A

Central cyanosis
Angular stomatitis
Dental hygiene
Dehydration

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22
Q

What are you looking for when examining the trachea?

A

Distance from sternum - should be 2finger lengths

Deviation

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23
Q

Describe when you would see a reduced distance between the trachea and the sternum and state the name of this

A

Tracheal tug - reduced if pt has a hyperexpanded (barrel chest)

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24
Q

Give the name of a condition where patients often have tracheal tug

A

COPD

25
Q

Explain barrel chest in patients with COPD / emphysema

A

Emphysema - damage to alveolar walls so air can’t get out, therefore lungs are chronically overinflated, resulting in a barrel chest

26
Q

The trachea deviates towards which direction with a collapsed lung?

A

Towards the collapsed lung (less holding it away)

27
Q

The trachea deviates towards which direction with a pneumothorax or pleural effusion?

A

Away from the the lung with air or fluid

28
Q

What do you call normal breath sounds?

A

Vesicular breathing

29
Q

What kind of sound would suggest upper airway obstruction?

A

Stridor

30
Q

What conditions sound wheezey?

A

Asthma and COPD

sometimes viral wheezes

31
Q

In what condition(s) can you hear COARSE crackles?

A

Pneumonia

Pulmonary oedema

32
Q

In what condition(s) can you hear FINE crackles?

A 
Pulmonary fibrosis
Bronchitis
Pneumonia
CHF
Atelectasis (lung collapse)
33
Q

If there is increased vocal resonance (when the patient says ‘99’), what could this suggest?

A

Consolidation
Lobar collapse
Tumour

34
Q

If there is decreased vocal resonance (when the patient says ‘99’), what could this suggest?

A

Pleural effusion

35
Q

Give three causes of lymphadenopathy

A

Tumour
Infection
Sarcoidosis

36
Q

Give two causes of reduced chest expansion

A

Lung cancer

Pneumonia

37
Q

What are the four sounds during percussion?

A

Resonant
Hyper-resonant
Dull
Stony dull

38
Q

What might dull percussion suggest?

A

Consolidation or collapse

dull - solid

39
Q

What might stony dullness percussion suggest?

A

Pleural effusion

stony dull - fluid

40
Q

What might hyper-resonant percussion suggest?

A

Pneumothorax

hyper resonant - air

41
Q

Which condition does not caues clubbing?

A

COPD

42
Q

Most common cause of CO2 retention?

A

COPD

43
Q

If the patient has warm hands, what may this suggest?

A

Hypercapnia (co2 retention)

44
Q

Poor capillary refill may suggest?

A

Sepsis

45
Q

What is pulsus paradoxus

A

Pulse volume decreases when patient breathes in

Sign of severe asthma or COPD

46
Q

What is pulsus paradoxus and when is it seen?

A

Pulse volume decreases when patient breathes in

Sign of severe asthma or COPD

47
Q

PLethoric complexion

A

Invades sympathetic plexus

48
Q

If the chest bulges out, what’s it called?

A

Pectus carinatum

49
Q

Chest inspection

A 
Are the patients in respiratory distress?
Shape of chest 
-asymmetry
Hyperexpansion (barrel chest)
Pectus carinatum 
Pectus excavatum

Scars:
Thoracotomy scar
Median sternotomy scar

Chest drains

50
Q

Chest inspection

A 
Are the patients in respiratory distress?
Shape of chest 
-asymmetry
Hyperexpansion (barrel chest)
Pectus carinatum 
Pectus excavatum

Scars:
Thoracotomy scar
Median sternotomy scar

Chest drains
Dry skin
Hyperkeratosis
Telangiectasia

51
Q

List 3 causes of apex beat displacement

A

Right ventricular hypertrophy
Large pleural effusion
Tension pneumothorax

52
Q

Reduced chest expansion

A

Pulmonary fibrosis

53
Q

Asymmetrical chest expansion

A

Pneumonia
Pleural effusion
Pneumothorax

54
Q

Pleural rub - what does it sound like and causes

A

Someone walking on snow

Mesothelioma
Systemic disease like lupus or RA

55
Q

After auscultation of the front what do you examine?

A 
Lymph nodes
Inspect for kyphosis and scoliosis
Palpate chest expansion 
Percuss
Auscultate

Sacral oedema
Peripheral oedema

56
Q

Explain how a malignant lymph node would feel

A

Rubbery
Hard
Fixed

57
Q

Explain three causes of a lymph node enlargement

A

Sarcoidosis
TB
Lung cancer
Upper respiratory track infection

58
Q

List some examinations to do at the end of the resp exam

A

SPOT X

Sputum
Peak flow
Oxygen
Temperature
X ray 
ABC
Spirometry
Bronchoscopy

Year 3 - OSCE Resp (6 decks)

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