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Yr 3 examinations > resp exam > Flashcards

resp exam Flashcards

1
Q

introduction

A

wash hands - vocalise this in exam

introduce yourself

confirm DOB and name

explain exam

gain consent

expose the pts chest - chaperone

position at 45degrees

ask pain

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2
Q

general inspection

A

look at age

comfortable/in distress

cyanosis

coughing

adjuncts

chest wall - scars, asymettry or abnormalities, cachexia

auditory at bedside - wheezy, stridor

stable, alert, breathless

medicine

nebulisors

oxygen

inhalers

sputum pots

cigarettes

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3
Q

significance of age

A

elderly - chronic disease/malignancy (COPD/interstial lung disease)

young - asthma/CF

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4
Q

what are you looking for when you see if a pt is in comfortable/in distress

A

accessory muscles

nasal flare

tripod position - clasp hand around thighs to aid breathing

pursed lips - COPD, pul fibrosis = keep more distant bronchioles open by keeping lung pressure high in severe airway obstruction/ephysema = easier breathing

can pt speak in full sentences, is speech normal (obstruction, recurrent laryngeal nerve palsy)

hoarse voice - malignancy/acid reflux

prolongued expiratory phase - asthma/copd

clicks - bronchiectasis

gurgling - airway secretions

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5
Q

use of accessory muscles

A

COPD

pleural effusion

pneumothorax

severe asthma

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6
Q

describe cyanosis

A

blue tinge around mouth and fingers

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7
Q

significance of cough

A

productive cough = infection/bronchiectasis/COPD/CF in youth

dry - asthma/ILD/malignancy

bovine

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8
Q

what are adjuncts

A

is pt on oxygen (ILD/COPD)

inhalers present/nebulisers - asthma/COPD

sputum pots - pneumonia/bronchiectasis

monitoring devices

medicine

mobility aids

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9
Q

barrel chest

A

suggest COPD

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10
Q

cachexia

A

suggests malignacy if old /CF if young

emphysema

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11
Q

what is stridor

A

inspiratory noise caused by obstruction eg mediastinal masses, bronchial carcinoma, retrosternal thyroid

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12
Q

suggestion from lateral thoracotomy

A

pneumonectomy - lung removed eg malignancy

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13
Q

examination of the hands

A

tar stains - smoking

clubbing

peripheral cyanosis - sat <85%

joint swelling

skin change

tremor

thenar/hypothenar muscle wasting

temperature

cap refill

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14
Q

what is tar staining

A

brown stain around nails

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15
Q

causes and appearance of clubbing

A

bronchiectasis/malignancy/interstitial lung disease/idiopathic pulmonary fibrosis/CF/sarcoidosis/TB

nails are white/grey

shamrocks window - if present = no clubbing

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16
Q

significance of joint swellings

A

rheumatoid arthritus associated with pleural effusion +/- pulmonary fibrosis

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17
Q

significance of skin changes

A

thin skin = long term steroid use

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18
Q

significance of tremor

A

asterixis (CO2 retention in type 2 resp failure) - outstretched hand, wait 30sec

beta agonsit fine tremor - out stretch arms - in asthma/COPD

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19
Q

significance of muscle wasting

A

pancoast tumour press on SNS = wastage

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20
Q

significance of temp change

A

reduced temp = poor perfusion

sweaty, warm, clammy = CO2 retention

21
Q

examination of arms

A

pulse - reg/irreg and rate - tachy might suggest hypoxia in severe asthma or COPD, PE, infection. Bounding = CO2 retention

resp rate

BP

22
Q

sig of RR

A

12-19 normal

>20 tachypnoea - fever, severe lung disease, hyperventilation

>30 worrying - pneumonia or anxiety/panic attack

bradypnoea occurs in opiod toxicity = resp depression, sedation

23
Q

significance of BP

A

need for CURB-65 score

in pneumothorax hypotension might indicate a tension pneumothorax

24
Q

examination of neck

A

carotid pulse - is it bounding

JVP raised in fluid overload/pul hypertension - use hepatojugular reflex test - increased in cor pulmonale

assess trachea deviation - central in health

lymph nodes - anterior and posterior triangles, supraclavicular region, axillary region

tracheal tug

notch-cricoid distance (<3 fingers = lungs hyperinflation)

25
Q

what does trachea deviation suggest

A

away from tension pneumothorax/large pleural effusion/haemothorax

trachea deviates towards lobar collapse/pneumonectomy

26
Q

what does lymphadenopathy suggest

A

infective/malignant pathology

pneumonia

TB

sarcoidosis

27
Q

examination of head

A

conjunctival pallor - anaemia or chronic disease

central cyanosis - blue tinge of lips and under tongue

mucus membranes - see if dehydrated

pursed lips

ptosis, myosis, anhidrosis = horner’s syndrome via pancoasts tumour (sometimes lower eyelid is elevated)

are they dry/fluid overloaded

cushingoid (steroid use)

plethoric - CO2 retention

telangiectasia/microstomia (systemic sclerosis)

butterfly rash (SLE)

lupus pernio (sarcoid)

lupus vulgaris (TB)

28
Q

what do you look for on inspection of the chest

A

scars

skin changes

asymettry

deformities

radiotherapy tattoos

chest wall movements

breathing

29
Q

what do different scars indicate

A

small mid-axillary scars = chest drains for haemothorax or pneumothorax

horizontal postero-lateral scars - thoracotomy eg from lobectomy/pneumonectomy

pacemakers

30
Q

summarise skin changes

A

may indicate recent or previous radiotherapy - erthyma/thickened skin

31
Q

what does asymettry indicate

A

majory surgery

pneumonectomy - usually for cancer - there is reduced expansion on the side of the scar

thoracoplasty - rib removed to relax rib cage, previously used to treat TB

32
Q

summarise chest deformities

A

barrel chest = COPD or emphysema

pectus excavatum = sunken in chest eg in marfans

pectus carinatum = pointy chest eg i childhood asthma or rickets

thoracic kyphosis/scoliosis - can impact breathing, restricts chest movements

posture - ankylosing spondylitis (cause of pul fibrosis) = round back and head stooped forward

33
Q

describe chest wall movements

A

mainly upwards - emphysema

asymettrical - fibrosis, collapsed lung, pneumonectomy, pleural effusion, pneumothorax

34
Q

describe breathing

A

in-drawing of intercostal muscles (generalised is hyperinflation, localised is bronchial obstruction)

powerful expirations (asthma, chronic bronchitis)

hyperextended chest (COPD)

35
Q

palpation of chest

A

supramammary and inframammary chest expansion

  • when exhale put hands around the chest
  • ask pt to take deep breath
  • look at thumbs move from midline - look for unilateral reduction in expansion

cardiac

  • feel for cardiac apex (might not be felt in hyperexpansion of lungs/obesity)
  • RV heave and palpable P2 - pulmonary hypertensin
36
Q

what does asymettrical chest expansion indicate

A

pneumonectomy - reduced expansion on that side

lobar collapse

pneumonia

effusion

pneumothorax

37
Q

abnormalities in apex beat palpation

A

displaced apex in pneumonectomy/collapse towards the abnormality

away from abnormality in pleural effusion or pneumothorax

parasternal heave - RVH secondary to COPD/PE

38
Q

percussion technique

A

non-dominant hand on chest wall, middle finger over the lung space

dominant hand middle finger strikes middle phalanx of non-dominant middle finger

firm and brisk strikes

generates a resonant sound - normal

percuss apex of lungs first, then first rib, then 3 places on either side is sufficient down to axilla

39
Q

What could be found by percussion of apex

A

pancoasts tumour

40
Q

type of percussion note

A

resonant - normal

dullness - suggests increased tissue density - consildation, fluid, tumour, collapse

stony dullness - pleural effusion, its a more metallic sound

hyper-resonance - the opposite of dullness - suggestive of decreased tissue density, ie increased air space - pneumothorax, COPD, emphysema, bronchitis

41
Q

what are you assessing in auscultation

A

quality

volume

added sounds

vocal resonance

listen for loud P2 ie loud second hert sound over pul area - pul hypertension

42
Q

quality - auscultation

A

vesicular breath sounds = normal

bronchial (harsh, louder breathing) is abnormal in periphery (listen for trachea over normal bronchial breathing and compare) = consolidation in pneumonia

43
Q

volume in auscultation

A

quiet v loud breath sounds

quiet = reduced air entry - collapse, consolidation, effusion, lung removed, emphysema, pneumothorax

44
Q

added sounds on auscultation

A

wheeze = asthma/copd

coarse crackles = pneumonia, bronchiectasis, fluid overload, consolidation

fine crackles = pul fibrosis (if severe can be coarse crackles so need to look at the whole picture)

fine inspiritory crackles at bases - pul odema

pleural rub = pulmonary infarction, pneumonia, pleural malignancy

45
Q

vocal resonance

A

stethoscope on skin - say 99

reduced with fluid - effusion, pneumothorax

increased over increased density - tumour, pneumonia, lobar collapse, consolidation

46
Q

examination of the posterior thorax

A

inspect, palpate, percuss, auscultate

get pt to lean forward and cross arms - moves scapular out the way

look for sacral oedema - pt lying down a lot, fluid oeverload, congestive HF

tactile fremitus and vocal fremitus

47
Q

examine the legs

A

pitting oedema - fluid overload in cor pulmonale - press and hold the release

erythema nodosum - sarcoidosis/IBD/TB

check for DVT - tight tender calf, unilateral - squeeze calf muscle ask if painful, see if swollen/red

48
Q

to complete…

A

SPOTX:

sputum, peak flow, O2 sat, temperature, x-ray

full CVS exam

blood tests

CT

spirometry for obstructive/restrictive lung disease

49
Q

auscultation technique

A

pt breathes in and out deeply

compare sides starting in the supraclavicular area and ending in axillae

Yr 3 examinations (10 decks)

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