Resp History and Examination Flashcards
Resp causes of clubbing?
Lung cancer (usually not small cell) Mesothelioma CF Bronchiectasis Fibrosing alveolitis/IPF Empyema Sarcoidosis
Define a wheeze
musical sound produced as the result of continuous oscillation of opposing airway walls where airways are narrowed.
causes of an inspiratory wheeze?
this implies severe airway narrowing
usually result of tumours, foreign bodies or scarring
why do crackles/crepitations occur?
result of abrupt opening of the small airways during inspiration following their collapse on expiration
what do early inspiratory crackles suggest?
small airways disease e.g. bronchiolitis
what do mid-inspiratory crackles suggest?
pulmonary oedema
why might a patient complaining of SOB also complain of a tingling in their fingers and around their mouth?
if breathless, may be blowing off lots of CO2 so hypocapnic, which causes dizziness, light headedness, tinging and chest tightness.
causes of orthopnoea?
LV failure large pleural effusion morbid obesity massive ascites respiratory muscle weakness
why might pts get breathless on sitting up, and what is this called?
platypnoea
due to R to L shunting through a PFO, ASD or a large intrapulmonary shunt.
why might pts become breathless lying on 1 side?
trepopnoea
if unilateral lung disease, prefer to lie with healthy lung down
dilated cardiomyopathy, lie on R side
tumours compressing central airways or blood vessels
causes of breathlessness that wakes people from sleep?
asthma- tend to wake between 3 and 5 am, and also have wheezing.
LV failure
if suspecting asthma, what triggers should you consider asking about in the history?
dust, mould, (HDM- shaking bedding, hoovering?) smoke cold air perfumes fumes pets grass pollens- mowing the lawn, hayfever season drugs- aspirin, NSAIDs
causes of biphasic crackles (heard throughout inspiration and expiration)?
bronchiectasis- coarse crackles, gurgling quality, may change if secretions dislodged by coughing.
causes of late inspiratory crackles?
pulmonary fibrosis-fine crackles
pulmonary oedema-medium crackles
bronchial secretions in: COPD, pneumonia, lung abscess, tubercular lung cavities (coarse)
what is a tracheal tug and when is it found?
resting on the patient’s trachea, your fingers are moved inferiorly with each inspiration, this is found in severe hyperinflation.
