Resp MedEd Flashcards
How would you explain the resp exam to a patient?
Check of your lungs and breathing which will involve me having a look at you hands, arms, face neck and leg and a closer look at your chest. Then a quick listen and feel of your chest and back
What items do you look for around the bed?
- Oxygen: how much and how
- Sputum pot: amount and colour
- Medicines: inhalers and diuretics
- Peak flow meters
- Cigarettes
- Anything attached to patient, ECG, fluids, IV lines
- Mobility aids
What are the different types of oxygen device?
- venturi mask
- non-rebreathing mask
- nasal cannulae
- Look for CPAP or Bipap
What are you looking at on the patient at the end of bed?
- Cyanosis
- SOB
- Cough
- Wheeze
- Stridor
- Cachexia
Why may the patient be cyanotic?
- poor circulation (peripheral vasoconstriction secondary to hypovolaemia)
- inadequate oxygenation of blood (right to left cardiac shunting)
What are signs of SOB?
- nasal flaring
- pursed lips
- use of accessory muscles
- intercostal muscle recession
- tripod position
What could SOB suggest?
- asthma
- pulmonary oedema
- pulmonary fibrosis
- lung cancer
- COPD
What could a productive cough be suggestive of?
- pneumonia
- bronchiectasis
- COPD
- CF
What could a dry cough suggest?
- asthma
2. interstitial lung disease
What is a wheeze often associated with?
- asthma
- COPD
- bronchiectasis
What could be a cause of stridor?
- foreign body (acute)
2. subglottic stenosis (chronic)
What could pallor suggest?
- underlying aneamia (haemorrhage or chronic disease)
2. poor perfusion (congestive heart failure)
When may there be oedema?
right ventricular failure
What is pulmonary oedema associated with?
secondary to left ventricular failure
What is cachexia associated with?
- lung cancer
2. end stage COPD
What general things do you look for in the hands?
- Colour
- Tar staining
- Skin changes
- Joint swelling or deformity
What would cyanosis of the hands suggest?
underlying hypoxaemia
What would bruising and thinning of skin of hands suggest?
long term steroid use e.g. COPD, asthma, ILD
Why is joint swelling relevant?
RA can have resp manifestations e.g. pleural effusions / pulmonary fibrosis
What are respiratory causes of clubbing?
- Lung cancer
- Interstitial lung disease
- Cystic fibrosis
- Bronchiectasis
NOT COPD
What are the special things to look for on the hands?
- finger clubbing
- fine tremor
- asterixis
- temp
When might there be a fine tremor?
beta-2-agonist use (e.g. salbutamol
Why might there be asterixis?
- CO2 retention (T2 resp failure)
- Uraemia
- Hepatic encephalopathy
What would cool hands suggest?
poor peripheral perfusion
What would excessively warm and sweaty hands suggest?
CO2 retention
What do you do on the arms?
- heart rate
- resp rate
- offer BP
What are the 2 pulse abnormalities?
- bounding pulse
2. pulsus paradoxus
When might there be a bounding pulse?
- underlying CO2 retention (e.g. type 2 respiratory failure)
- anaemia
What is pulsus paradoxus?
pulse wave volume decreases significantly during the inspiratory phase
When would there be pulsus paradoxus?
- late sign of cardiac tamponade
- severe acute asthma
- severe exacerbations of COPD
When may you have bradypnoea?
opiate overdose
When may you have tachypneoa?
acute asthma
What does a raised JVP indicate?
venous hypertension
What are resp causes of raised JVP?
pulmonary hypertension
When does pulmonary hypertension happen?
- Right sided heart failure
- COPD
- ILD
What would clear sputum suggest?
COPD + bronchiectasis with no current infection
What would yellow sputum suggest?
acute lower resp tract infection + asthma
What would green sputum suggest?
current infection either new or acute exacerbation of a chronic condition
What would red/rusty brown sputum suggest?
pneumococcal pneumonia
What would a mucus plug suggest?
asthma
What would blood in sputum suggest?
- Lung cancer (streaks)
- PE with pleurtic chest pain
- Bronchiectasis
What would pink frothy sputum suggest?
acute pulmonary oedema (seen in LHF)
What would thenar/hypothenar wasting suggest?
pancoasts tumour
What do you look for on palmar side of hands?
- thenar/hypothenar wasting
- temperature
- between fingers for tar staining
What do you look for on dorsal side of hands?
- cap refill
- clubbing
- dorsal guttering
- thin skin / brusing
What does dorsal guttering mean?
- TB and cancer
2. ulnar nerve palsy
What is pulse alternans?
alternating strong and weak pulse
When might there be pulse alternans?
LHF causing pulmonary oedema
What are LHF signs?
- tired
- fatigue
- breathlessness
- PND/orthopnoea
What are RHF signs?
- peripheral oedema
2. elevated JVP
