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Resp exam Flashcards

1
Q

General Inspection - patient wellbeing - what are you looking for? (6)

A
  1. Well/Unwell
  2. Alert
  3. Comfortable
  4. Breathless
  5. Cachexic
  6. Cushingoid
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2
Q

What are the causes of Cachexia in resp?

A

Malignancy

Emphysema

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3
Q

What are the causes of cushingoid in resp?

A

Steroid use

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4
Q

General Inspection - general breathing - what are you looking for? (2)

A
  1. Use of accessory muscles

2. Pursed lip breathing

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5
Q

What are the causes of use of accessory muscles in resp?

A
  1. COPD
  2. Pleural effusion
  3. Pneumothorax
  4. Severe asthma
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6
Q

What is the benefit of pursed lip breathing and in which conditions tend to cause this?

A

Prevents bronchial wall collapse by keeping airway pressure high in:

  1. severe airway obstruction
  2. emphysema
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7
Q

General Inspection - noises - what are you looking for? (7)

A
  1. Speech abnormalities
  2. Stridor
  3. Wheeze
  4. Cough
  5. Prolonged expiratory phase
  6. Clicks
  7. Gurgling
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8
Q

What are the resp causes of speech abnormalities? (1)

A

Recurrent laryngeal nerve palsy

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9
Q

What are the resp causes of stridor? (3)

A

Large airway obstruction

e. g.
1. Mediastinal masses
2. Bronchial carcinoma
3. Retrosternal thyroid

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10
Q

What 3 ways can you describe a cough?

A

Dry
Productive
Bovine

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11
Q

What is a bovine cough?

A

A non- explosive cough of someone unable to close their glottis

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12
Q

What causes a prolonged expiratory phase in resp?

A
  1. Asthma

2. COPD

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13
Q

What causes clicks in the resp exam?

A

Bronchiectasis

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14
Q

What causes gurgling in the resp exam?

A

Airway secretions

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15
Q

General Inspection - around the bed - what are you looking for? (4)

A
  1. Oxygen
  2. Medication
  3. Sputum pots
  4. Cigarettes
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16
Q

Give examples of resp medication you might see arounf the bed (2)

A
  1. Inhalers

2. Nebulisers

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17
Q

What should you do if you see a sputum pot?

A

Look at the sputum

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18
Q

Hands - tremor - what are the two types and what causes each (2)

A 
Fine tremor - beta-2 agonist 
Flapping tremor (asterixis) - CO2 retention
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19
Q

Hands- what can peripheral cyanosis indicate? (2)

A

Hypoxia or Hypoperfusion

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20
Q

Describe the hands of someone with CO2 retention? (3)

A
  1. Sweaty
  2. Clammy
  3. Warm
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21
Q

In what resp condition might you detect small muscle wasting in the hands?

A

Pancoast tumour

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22
Q

In resp, what causes clubbing of the nails? (4)

A
  1. Idiopathic pulmonary fibrosis
  2. Lung cancer
  3. Cystic Fibrosis
  4. Bronchiectasis
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23
Q

What causes tar stained fingers?

A

Smoking

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24
Q

Pulse - what respiratory conditions cause tachycardia? (3)

A
  1. Hypoxia in severe asthma or COPD
  2. Pulmonary embolism
  3. Infection
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25
Q

Pulse - What causes a bounding pulse in resp?

A

CO2 retention

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26
Q

What in resp causes tachypnoea? (5)

A
  1. Lung disease
  2. Infection
  3. Hyperventilation
  4. Fever
  5. Pulmonary Embolism
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27
Q

What causes bradypnoea? (1)

A

Central nervous system depression

28
Q

Head and Neck - Face - what are you looking for? (6)

A
  1. Cushingoid
  2. Plethoric
  3. Telangiectasia/microstomia
  4. Butterfly rash
  5. Lupus pernio
  6. Lupus vulgaris
29
Q

What in resp can cause a plethoric face? (3)

A
  1. Secondary Polycythaemia
  2. Cushing’s syndrome
  3. Superior Vena Cava Obstruction if facial swelling
30
Q

What might telangiectasia and microstomia indicate?

A

Systemic sclerosis

31
Q

What is microstomia?

A

A small sized mouth

32
Q

Why is systemic sclerosis relevant to resp?

A

If severe can cause SOB and pulmonary hypertension

33
Q

What is the significance a butterfly rash in resp?

A

It can indicate SLE

34
Q

What are the pulmonary signs of SLE? (3)

A

Pleuritic chest pain
Coughing
SOB

35
Q

What can lupus pernio indicate?

36
Q

What the resp symptoms of sarcoid? (4)

A

Persistent dry cough
Wheezing
SOB
Chest pain

37
Q

What does lupus vulgaris indicate?

38
Q

Head and Neck - Eyes - what are you looking for? (2)

A
  1. Conjunctival Pallor

2. Horner’s syndrome

39
Q

What does conjunctival pallor indicate?

A

Anaemia of chronic disease

40
Q

What is the triad of Horner’s syndrome?

A
  1. Ptosis
  2. Miosis
  3. Anhydrosis
41
Q

What tumour is Horner’s syndrome associated with?

A

Pancoast tumour

42
Q

Head and Neck - Mouth - what are you looking for? (1)

A

Central cyanosis under tongue

43
Q

What does central cyanosis under tongue indicate?

44
Q

Head and Neck - Neck - what are you looking for? (3)

A

JVP height
Tracheal deviation
Cricosternal distance

45
Q

In what resp condition is JVP elevated?

A

Cor Pulmonale

46
Q

What is Cor Pulmonale?

A

When a disorder of the lungs (pulmonary HTN) causes right sided heart dysfunction leading to RHF

47
Q

Which 2 conditions cause deviated trachea and state which side each causes the trachea to move

A

Tension Pneumothorax and large pleural effusion- trachea is deviated away from the lesion
Collapsed lung and pneumonectomy- trachea is deviated towards the lesion

48
Q

What does a cricosternal distance of less than 3 fingers indicate?

A

Hyperinflated lungs

49
Q

What is pulsus parodoxicus?

A

When the pulse wave volume decreases significantly during the inspiratory phase

50
Q

What are causes of pulsus paradoxus?

A
  1. late sign of cardiac tamponade,

2. severe acute asthma and 3. severe exacerbations of COPD

51
Q

What is a normal Resp rate?

A

12-20 breaths per min

52
Q

What are the causes of a displaced apex beat?

A
  1. RV hypertrophy e.g. Pulmonary HTN, COPD, interstitial lung disease
  2. Large pleural effusion
  3. Tension pneumothorax
53
Q

What causes symmetrical reduced chest expansion?

A

pulmonary fibrosis (reduced lung elasticity

54
Q

What causes asymmetrical reduced chest expansion?

A

Pneumothorax
Pleural effusion
Pneumonia

55
Q

What can dull percussion indicate?

A

Consolidation
Tumour
Lobar collaspe
Pleural effusion (stony dullness)

56
Q

What can hyper-resonance indicate?

A

Decreased tissue density e.g. pneumothorax

57
Q

When you auscultate the lungs, what are you assessing?

A

Quality of breath sounds
Volume of breath sounds
Added sounds

58
Q

What are the 2 types of quality of breath sounds?

A

Vesicular

Bronchial

59
Q

What are bronchial breath sounds ?

A

Harsh-sounding

Inspiration and expiration are equal and there is a pause between

60
Q

What is bronchial breath sounds associated with?

A

Consolidation

61
Q

What can caused quiet breath sounds?

A

Reduced air entry (however present it as reduced breath sounds)

  • pneumothorax
  • pleural effusion
62
Q

Describe coarse crackles

A

Discontinous, brief, popping lung sounds

63
Q

Describe fine crackles

A

Sounds like separating velcro

64
Q

What causes coarse crackles?

A

Pneumonia
Bronchiectasis
Pulmonary oedema

65
Q

What crackles do you get in pulmonary fibrosis?

A

Fine end-inspiratory crackles

66
Q

What are respiratory causes of lymphadenopathy?

A

Lung cancer with mets
TB
Sarcoidosis

67
Q

How do you complete a resp exam?

A 
Bedside: 
CV examination (cor pulmonale)  
Basic obs 
Sputum sample
PEFR 
Bloods: ABG 
Imaging: CXR

Year 6 (18 decks)

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