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Z Year3 Clinical Examinations > Resp MedEd 2 > Flashcards

Resp MedEd 2 Flashcards

1
Q

What do you look for in the face?

A

plethoric complexion

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2
Q

When might you have a plethoric complexion?

A
  1. polycythaemia (e.g. COPD)

2. CO2 retention (e.g. T2 resp failure)

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3
Q

What do you look for in the eyes?

A
  1. conjunctival pallor

2. ptosis miosis and enophthalmos

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4
Q

Why do you ask about conjuctival pallor?

A

underlying anaemia

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5
Q

Why do you ask about ptosis, miosis and enophthalmos?

A

horners syndrome

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6
Q

Why is horner’s syndrome relevant for resp?

A

sympathetic trunk is damaged by pathology such as lung cancer affecting the apex of the lung (e.g. Pancoast tumour)

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7
Q

What are you looking for in the mouth?

A
  1. central cyanosis

2. candidiasis

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8
Q

Why may there be central cyanosis?

A

hypoxaemia

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9
Q

Why might someone have oral candidiasis?

A

steroid inhaler use (due to local immunosuppression)

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10
Q

What Scars on the chest do you look for?

A
  1. median sternotomy scar
  2. axillary thoracotomy scar
  3. posteriolateral thoractotomy scar
  4. infraclavicular scar
  5. radiotherapy associated skin changes
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11
Q

Why may there be a median sternotomy scar?

A
  1. cardiac valve replacement

2. CABG

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12
Q

When might there be an axillary throacotomy scar?

A

insertion of chest drains

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13
Q

When might there be a posterolateral thoracotomy scar?

A
  1. lobectomy
  2. pneumonectomy
  3. oesophageal surgery
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14
Q

Why may there be a infraclavicular scar?

A

pacemaker insertion

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15
Q

What are some radiotherapy-assoicated skin changes?

A
  1. xerosis (dry skin)
  2. scale
  3. hyperkeratosis (thickened skin)
  4. depigmentation
  5. telangiectasia
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16
Q

What are examples of chest wall deformities?

A
  1. asymmetry
  2. pectus excavatum
  3. pectus carinatum
  4. hyperexpansion (barrel chest)
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17
Q

Why might there be asymmetry?

A
  1. pneumonectomy (e.g. lung cancer)

2. thoracoplasty (e.g. tuberculosis).

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18
Q

What is pectus excavatum?

A

caved-in or sunken appearance of the chest

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19
Q

What is pectus carinatum?

A

protrusion of the sternum and ribs

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20
Q

What is hyperexpansion / barrel chest usually due to?

A
  • chest wider and taller than normal

- chronic lung diseases such as asthma and COPD

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21
Q

When is the trachea deviated away?

A
  1. tension pneumothroax

2. large pleural effusion

22
Q

When is a trachea deviated towards?

A
  1. lobar collapse

2. pneumonectomy

23
Q

What are the respiratory causes of a displaced apex beat?

A
  1. Right ventricular hypertrophy (e.g. pulmonary hypertension, COPD, interstitial lung disease)
  2. Large pleural effusion
  3. tension pneumothorax
24
Q

What are the respiratory causes of a symmetrically reduced chest expansion?

A

pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion.

25
Q

What are the respiratory causes of an asymmetrically reduced chest expansion?

A
  1. pneumothorax
  2. pneumonia
  3. pleural effusion
26
Q

What would a resonant percussion note suggest?

A

normal finding

27
Q

What would dullness on percussion suggest?

A

increased tissue density

  1. cardiac dullness
  2. consolidation
  3. tumour
  4. lobar collapse
28
Q

What would stony dullness on percussion suggest?

A

pleural effusion

29
Q

What would hyper-resonance on percussion suggest?

A
  • decreased tissue density

1. pneumothorax

30
Q

What would increased vibration in tactile vocal fremitus suggest?

A
  • increased density
    1. consolidation
    2. tumour
    3. lobar collapse
31
Q

What would decreased vibration in tactile vocal fremitus suggest?

A
  • presence of fluid or air outside of the lung
    1. pleural effusion
    2. pneumothorax
32
Q

What would vesicular breath sounds suggest?

A

normal

33
Q

What are bronchial breath sounds?

A

harsh-sounding (similar to auscultating over the trachea), inspiration and expiration are equal and there is a pause between

34
Q

What are bronchial breath sounds associated with?

A

consolidation

35
Q

What would quiet breath sounds suggest?

A
  • reduced air entry into that region of the lung
    1. pleural effusion
    2. pneumothorax
  • presenting your findings, state ‘reduced breath sounds’, rather than ‘reduced air entry’.
36
Q

What are examples of added sounds?

A
  1. wheeze
  2. stridor
  3. coarse crackles
  4. fine end-inspiratory crackles
37
Q

What does wheeze sound like?

A

continuous, coarse, whistling sound produced in the respiratory airways during breathing

38
Q

What is a wheeze associated with?

A
  1. asthma
  2. COPD
  3. bronchiectasis
39
Q

What is a stridor breath sound?

A

high-pitched extra-thoracic breath sound resulting from turbulent airflow through narrowed upper airways

40
Q

What are causes of stridor breath sound?

A
  1. foreign body inhalation (acute)

2. . subglottic stenosis (chronic)

41
Q

What do coarse crackles sound like?

A

discontinuous, brief, popping lung sounds

42
Q

What are coarse crackles usually associated with?

A
  1. pneumonia
  2. bronchiectasis
  3. pulmonary oedema
43
Q

What are fine end-inspiratory crackles?

A

sounding similar to the noise generated when separating velcro

44
Q

When might you hear fine end-inspiratory crackles?

A

pulmonary fibrosis

45
Q

What are the respiratory causes of lymphadenopathy?

A
  1. lung cancer with metastases
  2. tuberculosis
  3. sarcoidosis
46
Q

What is the name of the different lymph nodes?

A
  1. Submental
  2. Submandibular
  3. Pre-auricular
  4. Post-auricular
  5. Superficial cervical
  6. Deep cervical
  7. Posterior cervical
  8. Supraclavicular – left supraclavicular region is where Virchow’s node may be noted (associated with upper gastrointestinal malignancy)
47
Q

How could you see respiratory distress?

A

flared nostril and pursed lip breathing

48
Q

Why might there be an abnormal cricosternal distance?

A

distance of fewer than 3 fingers suggests underlying lung hyperinflation

  1. asthma
  2. COPD
49
Q

Why might there be an abnormal cricosternal distance?

A

distance of fewer than 3 fingers suggests underlying lung hyperinflation

  1. asthma
  2. COPD
50
Q

How could you see DVT on legs?

A
  1. Inspect: red and swollen
  2. Palpate: tender and hot
  3. Watch their face for pain
51
Q

What would erythema nodosum on the legs suggest?

A

sarcoidosis

Z Year3 Clinical Examinations (33 decks)

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