Resp Exam Flashcards
What paraphernalia are you looking for when inspecting from the side of a bed?
Inhalers Sputum pots Immunosuppressants Nebulisers Peak flow charts Thoracotomy scars
What would immunosuppressants suggest?
Pulmonary fibrosis
What would sputum pots suggest?
Bronchiectasis
What is bronchiectasis?
Chronic infection of bronchi leading to chronic dilation of the lungs
What are you inspecting for on the patient?
Pigeon chest Pectus excavatum Scoliosis Kyphosis Barrel chest
Wheeze Stridor Cyanosis SOB Cough Cachexia Use of accessory muscles Cushingoid appearance (steroid use)
What is stridor and what is it caused by?
High pitched wheezing
Obstruction
What are you looking out for on the hands? (ask patient to hold hands out)
Cyanosis Thinning of skin (steroid use) Tar staining Clubbing Wasting of small muscles
What do you call the test that specifically looks for the presence of clubbing?
Schamroth’s window test
What are the respiratory causes of clubbing?
Suppurative conditions (ones that produce pus) Fibrosis / interstitial lung disease Lung cancer Sarcoidosis TB
What do you test for on the arms?
Temperature (compare temp on both sides)
What else do you test for in the arms?
CO2 retention
Salbutamol use
Tremor of the hands would suggest?
Salbutamol use / b2 agonist use
CO2 retention flap is called
Asterixis
Explain a positive asterixis sign
Hypercapnia is often caused by hypoventilation; not enough o2 to brain
Rate and rhythm of radial pulse and respiratory rate
What is the normal respiratory rate per min?
12-20 breaths per minute
What could a raised JVP suggest?
Cor pulmonale
Briefly explain cor pulmonale
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?
What are you looking for on the face?
Cushingoid appearance Central cyanosis Conjunctival pallor Plethora (redness of face) Facial swelling
What would redness of the face indicate?
Polycythemia; can lead to respiratory distress
What would facial swelling indicate?
Lung cancer obstructing superior vena cava
or superior vena cava syndrome
What are you looking for on the mouth?
Central cyanosis
Angular stomatitis
Dental hygiene
Dehydration
What are you looking for when examining the trachea?
Distance from sternum - should be 2finger lengths
Deviation
Describe when you would see a reduced distance between the trachea and the sternum and state the name of this
Tracheal tug - reduced if pt has a hyperexpanded (barrel chest)
Give the name of a condition where patients often have tracheal tug
COPD
Explain barrel chest in patients with COPD / emphysema
Emphysema - damage to alveolar walls so air can’t get out, therefore lungs are chronically overinflated, resulting in a barrel chest
The trachea deviates towards which direction with a collapsed lung?
Towards the collapsed lung (less holding it away)
The trachea deviates towards which direction with a pneumothorax or pleural effusion?
Away from the the lung with air or fluid
What do you call normal breath sounds?
Vesicular breathing
What kind of sound would suggest upper airway obstruction?
Stridor
What conditions sound wheezey?
Asthma and COPD
sometimes viral wheezes
In what condition(s) can you hear COARSE crackles?
Pneumonia
Pulmonary oedema
In what condition(s) can you hear FINE crackles?
Pulmonary fibrosis Bronchitis Pneumonia CHF Atelectasis (lung collapse)
If there is increased vocal resonance (when the patient says ‘99’), what could this suggest?
Consolidation
Lobar collapse
Tumour
If there is decreased vocal resonance (when the patient says ‘99’), what could this suggest?
Pleural effusion
Give three causes of lymphadenopathy
Tumour
Infection
Sarcoidosis
Give two causes of reduced chest expansion
Lung cancer
Pneumonia
What are the four sounds during percussion?
Resonant
Hyper-resonant
Dull
Stony dull
What might dull percussion suggest?
Consolidation or collapse
dull - solid
What might stony dullness percussion suggest?
Pleural effusion
stony dull - fluid
What might hyper-resonant percussion suggest?
Pneumothorax
hyper resonant - air
Which condition does not caues clubbing?
COPD
Most common cause of CO2 retention?
COPD
If the patient has warm hands, what may this suggest?
Hypercapnia (co2 retention)
Poor capillary refill may suggest?
Sepsis
What is pulsus paradoxus
Pulse volume decreases when patient breathes in
Sign of severe asthma or COPD
What is pulsus paradoxus and when is it seen?
Pulse volume decreases when patient breathes in
Sign of severe asthma or COPD
PLethoric complexion
Invades sympathetic plexus
If the chest bulges out, what’s it called?
Pectus carinatum
Chest inspection
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
Chest inspection
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
List 3 causes of apex beat displacement
Right ventricular hypertrophy
Large pleural effusion
Tension pneumothorax
Reduced chest expansion
Pulmonary fibrosis
Asymmetrical chest expansion
Pneumonia
Pleural effusion
Pneumothorax
Pleural rub - what does it sound like and causes
Someone walking on snow
Mesothelioma
Systemic disease like lupus or RA
After auscultation of the front what do you examine?
Lymph nodes Inspect for kyphosis and scoliosis Palpate chest expansion Percuss Auscultate
Sacral oedema
Peripheral oedema
Explain how a malignant lymph node would feel
Rubbery
Hard
Fixed
Explain three causes of a lymph node enlargement
Sarcoidosis
TB
Lung cancer
Upper respiratory track infection
List some examinations to do at the end of the resp exam
SPOT X
Sputum Peak flow Oxygen Temperature X ray ABC Spirometry Bronchoscopy
