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Z Year3 Clinical Examinations > Resp MedEd > Flashcards

Resp MedEd Flashcards

1
Q

How would you explain the resp exam to a patient?

A

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

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2
Q

What items do you look for around the bed?

A
  1. Oxygen: how much and how
  2. Sputum pot: amount and colour
  3. Medicines: inhalers and diuretics
  4. Peak flow meters
  5. Cigarettes
  6. Anything attached to patient, ECG, fluids, IV lines
  7. Mobility aids
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3
Q

What are the different types of oxygen device?

A
  1. venturi mask
  2. non-rebreathing mask
  3. nasal cannulae
  4. Look for CPAP or Bipap
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4
Q

What are you looking at on the patient at the end of bed?

A
  1. Cyanosis
  2. SOB
  3. Cough
  4. Wheeze
  5. Stridor
  6. Cachexia
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5
Q

Why may the patient be cyanotic?

A
  1. poor circulation (peripheral vasoconstriction secondary to hypovolaemia)
  2. inadequate oxygenation of blood (right to left cardiac shunting)
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6
Q

What are signs of SOB?

A
  1. nasal flaring
  2. pursed lips
  3. use of accessory muscles
  4. intercostal muscle recession
  5. tripod position
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7
Q

What could SOB suggest?

A
  1. asthma
  2. pulmonary oedema
  3. pulmonary fibrosis
  4. lung cancer
  5. COPD
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8
Q

What could a productive cough be suggestive of?

A
  1. pneumonia
  2. bronchiectasis
  3. COPD
  4. CF
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9
Q

What could a dry cough suggest?

A
  1. asthma

2. interstitial lung disease

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10
Q

What is a wheeze often associated with?

A
  1. asthma
  2. COPD
  3. bronchiectasis
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11
Q

What could be a cause of stridor?

A
  1. foreign body (acute)

2. subglottic stenosis (chronic)

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12
Q

What could pallor suggest?

A
  1. underlying aneamia (haemorrhage or chronic disease)

2. poor perfusion (congestive heart failure)

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13
Q

When may there be oedema?

A

right ventricular failure

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14
Q

What is pulmonary oedema associated with?

A

secondary to left ventricular failure

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15
Q

What is cachexia associated with?

A
  1. lung cancer

2. end stage COPD

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16
Q

What general things do you look for in the hands?

A
  1. Colour
  2. Tar staining
  3. Skin changes
  4. Joint swelling or deformity
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17
Q

What would cyanosis of the hands suggest?

A

underlying hypoxaemia

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18
Q

What would bruising and thinning of skin of hands suggest?

A

long term steroid use e.g. COPD, asthma, ILD

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19
Q

Why is joint swelling relevant?

A

RA can have resp manifestations e.g. pleural effusions / pulmonary fibrosis

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20
Q

What are respiratory causes of clubbing?

A
  1. Lung cancer
  2. Interstitial lung disease
  3. Cystic fibrosis
  4. Bronchiectasis
    NOT COPD
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21
Q

What are the special things to look for on the hands?

A
  1. finger clubbing
  2. fine tremor
  3. asterixis
  4. temp
22
Q

When might there be a fine tremor?

A

beta-2-agonist use (e.g. salbutamol

23
Q

Why might there be asterixis?

A
  1. CO2 retention (T2 resp failure)
  2. Uraemia
  3. Hepatic encephalopathy
24
Q

What would cool hands suggest?

A

poor peripheral perfusion

25
Q

What would excessively warm and sweaty hands suggest?

A

CO2 retention

26
Q

What do you do on the arms?

A
  1. heart rate
  2. resp rate
  3. offer BP
27
Q

What are the 2 pulse abnormalities?

A
  1. bounding pulse

2. pulsus paradoxus

28
Q

When might there be a bounding pulse?

A
  1. underlying CO2 retention (e.g. type 2 respiratory failure)
  2. anaemia
29
Q

What is pulsus paradoxus?

A

pulse wave volume decreases significantly during the inspiratory phase

30
Q

When would there be pulsus paradoxus?

A
  1. late sign of cardiac tamponade
  2. severe acute asthma
  3. severe exacerbations of COPD
31
Q

When may you have bradypnoea?

A

opiate overdose

32
Q

When may you have tachypneoa?

A

acute asthma

33
Q

What does a raised JVP indicate?

A

venous hypertension

34
Q

What are resp causes of raised JVP?

A

pulmonary hypertension

35
Q

When does pulmonary hypertension happen?

A
  1. Right sided heart failure
  2. COPD
  3. ILD
36
Q

What would clear sputum suggest?

A

COPD + bronchiectasis with no current infection

37
Q

What would yellow sputum suggest?

A

acute lower resp tract infection + asthma

38
Q

What would green sputum suggest?

A

current infection either new or acute exacerbation of a chronic condition

39
Q

What would red/rusty brown sputum suggest?

A

pneumococcal pneumonia

40
Q

What would a mucus plug suggest?

A

asthma

41
Q

What would blood in sputum suggest?

A
  1. Lung cancer (streaks)
  2. PE with pleurtic chest pain
  3. Bronchiectasis
42
Q

What would pink frothy sputum suggest?

A

acute pulmonary oedema (seen in LHF)

43
Q

What would thenar/hypothenar wasting suggest?

A

pancoasts tumour

44
Q

What do you look for on palmar side of hands?

A
  1. thenar/hypothenar wasting
  2. temperature
  3. between fingers for tar staining
45
Q

What do you look for on dorsal side of hands?

A
  1. cap refill
  2. clubbing
  3. dorsal guttering
  4. thin skin / brusing
46
Q

What does dorsal guttering mean?

A
  1. TB and cancer

2. ulnar nerve palsy

47
Q

What is pulse alternans?

A

alternating strong and weak pulse

48
Q

When might there be pulse alternans?

A

LHF causing pulmonary oedema

49
Q

What are LHF signs?

A
  1. tired
  2. fatigue
  3. breathlessness
  4. PND/orthopnoea
50
Q

What are RHF signs?

A
  1. peripheral oedema

2. elevated JVP

Z Year3 Clinical Examinations (33 decks)

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