Resp exam findings Flashcards
Which signassesses finger clubbing?
Schamroth’s window
What can cause a fine tremor?
Beta-2-agonist use
What is asterixis?
flapping tremor
What ca cause asterixis?
CO2 retention (eg. from conditions that cause type 2 resp failure like COPD)
What is raised JVP evidence of?
venous hypertension
(can be due to pulmonary hypertension, congestive heart failure, tricuspid regurgitation and constrictive pericarditis )
What is conjunctival pallor suggestive of?
anaemia
Name 3 eye signs of Horner’s syndrome and what causes it
miosis, ptosis, enophthalmos
sympathetic trunk damaged (eg. by lung cancer at apex of lung)
What is oral candidiasis associated with?
steroid inhaler use (local immunosuppression)
Describe oral candidiasis
white slough, easily wiped away to reveal erythematous mucosa
Median sternotomy scar procedures
cardiac valve replacement
coronary artery bypass grafts (CABG)
Axillary thoracotomy scar procedures
insertion of chest drains
Posterolateral thoracotomy scar procedures
lobectomy
pneumonectomy
oesophageal surgery
Infraclavicular scar procedures
pacemaker insertion
Name some radiotherapy-associated skin changes
xerosis(dry skin)
telangiectasia
scale
hyperkeratosis
depigmentation
What is chest wall asymmetry associated with?
pneumonectomy
thoracoplasty (eg. TB)
What is pectus excavatum?
caved-in or sunken appearance of the chest
What is pectus carinatum?
protrusion of the sternum/ribs
Describe hyperexpansion of the chest (‘barrel chest’)
chest wall appears wider and taller than normal
What is ‘barrel chest’ associated with?
chronic lung diseases eg. asthma, COPD
What does the trachea deviate away from?
tension pneumothorax
large pleural effusions
What does the trachea deviate towards?
lobar collapse
pneumonectomy
What causes a reduced cricosternal distance?
underlying lung hyperinflation (eg. asthma, COPD)
What can cause a displaced apex beat?
right ventricular hypertrophy (eg. pulmonary hypertension, COPD, ILD)
large pleural effusion
tension pneumothorax
What can cause symmetrical reduced chest expansion?
pulmonary fibrosis (due to reduced lung elasticity)
What can cause asymmetrical reduced chest expansion?
pneumothorax
pneumonia
pleural effusion
What can cause resonant percussion of chest?
normal finding
What can cause dullness on percussion of the chest?
increased tissue density (eg. cardiac dullness, consolidation, tumour, lobar collapse)
What can cause stony dullness on percussion of the chest?
pleural effusion
What can cause hyper-resonance on percussion of the chest?
decreased tissue density (eg. pneumothorax)
What can cause increased vibrations during tactile vocal fremitus?
increased tissue density (eg. consolidation, tumour, lobar collapse)
What can cause decreased vibrations during tactile vocal fremitus?
presence of fluid/air outside of the lung (eg. pleural effusion, pneumothorax)
What do vesicular breath sounds indicate?
healthy lung
Describe bronchial breath sounds
What do they indicate?
harsh-sounding, inspiration and expiration equal with a pause in between
associated with consolidation
What do quiet breath sounds indicate?
reduced air entry into that region (eg. pneumothorax, pleural effusion)
What is a wheeze? Which conditions can it be heard in?
continuous, coarse, whistling sound
asthma, COPD, bronchiectasis
What is stridor? Which conditions can it be heard in?
high-pitched extra-thoracic breath sound from turbulent airflow through narrowed upper airways
foreign body inhalation, subglottic stenosis
What do coarse crackles sound like? Which conditions are they heard in?
brief, popping lung sounds
pneumonia, bronchiectasis, pulmonary oedema
What do fine end-inspiratory crackles sound like? Which conditions are they heard in?
separating velcro sound
pulmonary fibrosis
What is pitting sacral and pedal oedema suggestive of?
congestive heart failure
What signs can be seen on calves that are suggestive of a DVT?
swelling
increased temperature
erythema
visible superficial veins
What is erythema nododum associated with?
sarcoidosis
What further investigations/assessments might you offer to do/order after a respiratory examination?
Check oxygen saturation and apply supplemental oxygen if indicated
Check other vital signs (temperature, BP)
Take a sputum sample
Perform peak flow assessment
Request a CXR
Take an ABG
Perform full cardiovascular exam (eg. if suspecting cor pulmonale)
