Resp MedEd 2 Flashcards
What do you look for in the face?
plethoric complexion
When might you have a plethoric complexion?
- polycythaemia (e.g. COPD)
2. CO2 retention (e.g. T2 resp failure)
What do you look for in the eyes?
- conjunctival pallor
2. ptosis miosis and enophthalmos
Why do you ask about conjuctival pallor?
underlying anaemia
Why do you ask about ptosis, miosis and enophthalmos?
horners syndrome
Why is horner’s syndrome relevant for resp?
sympathetic trunk is damaged by pathology such as lung cancer affecting the apex of the lung (e.g. Pancoast tumour)
What are you looking for in the mouth?
- central cyanosis
2. candidiasis
Why may there be central cyanosis?
hypoxaemia
Why might someone have oral candidiasis?
steroid inhaler use (due to local immunosuppression)
What Scars on the chest do you look for?
- median sternotomy scar
- axillary thoracotomy scar
- posteriolateral thoractotomy scar
- infraclavicular scar
- radiotherapy associated skin changes
Why may there be a median sternotomy scar?
- cardiac valve replacement
2. CABG
When might there be an axillary throacotomy scar?
insertion of chest drains
When might there be a posterolateral thoracotomy scar?
- lobectomy
- pneumonectomy
- oesophageal surgery
Why may there be a infraclavicular scar?
pacemaker insertion
What are some radiotherapy-assoicated skin changes?
- xerosis (dry skin)
- scale
- hyperkeratosis (thickened skin)
- depigmentation
- telangiectasia
What are examples of chest wall deformities?
- asymmetry
- pectus excavatum
- pectus carinatum
- hyperexpansion (barrel chest)
Why might there be asymmetry?
- pneumonectomy (e.g. lung cancer)
2. thoracoplasty (e.g. tuberculosis).
What is pectus excavatum?
caved-in or sunken appearance of the chest
What is pectus carinatum?
protrusion of the sternum and ribs
What is hyperexpansion / barrel chest usually due to?
- chest wider and taller than normal
- chronic lung diseases such as asthma and COPD
When is the trachea deviated away?
- tension pneumothroax
2. large pleural effusion
When is a trachea deviated towards?
- lobar collapse
2. pneumonectomy
What are the respiratory causes of a displaced apex beat?
- Right ventricular hypertrophy (e.g. pulmonary hypertension, COPD, interstitial lung disease)
- Large pleural effusion
- tension pneumothorax
What are the respiratory causes of a symmetrically reduced chest expansion?
pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion.
What are the respiratory causes of an asymmetrically reduced chest expansion?
- pneumothorax
- pneumonia
- pleural effusion
What would a resonant percussion note suggest?
normal finding
What would dullness on percussion suggest?
increased tissue density
- cardiac dullness
- consolidation
- tumour
- lobar collapse
What would stony dullness on percussion suggest?
pleural effusion
What would hyper-resonance on percussion suggest?
- decreased tissue density
1. pneumothorax
What would increased vibration in tactile vocal fremitus suggest?
- increased density
1. consolidation
2. tumour
3. lobar collapse
What would decreased vibration in tactile vocal fremitus suggest?
- presence of fluid or air outside of the lung
1. pleural effusion
2. pneumothorax
What would vesicular breath sounds suggest?
normal
What are bronchial breath sounds?
harsh-sounding (similar to auscultating over the trachea), inspiration and expiration are equal and there is a pause between
What are bronchial breath sounds associated with?
consolidation
What would quiet breath sounds suggest?
- 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’.
What are examples of added sounds?
- wheeze
- stridor
- coarse crackles
- fine end-inspiratory crackles
What does wheeze sound like?
continuous, coarse, whistling sound produced in the respiratory airways during breathing
What is a wheeze associated with?
- asthma
- COPD
- bronchiectasis
What is a stridor breath sound?
high-pitched extra-thoracic breath sound resulting from turbulent airflow through narrowed upper airways
What are causes of stridor breath sound?
- foreign body inhalation (acute)
2. . subglottic stenosis (chronic)
What do coarse crackles sound like?
discontinuous, brief, popping lung sounds
What are coarse crackles usually associated with?
- pneumonia
- bronchiectasis
- pulmonary oedema
What are fine end-inspiratory crackles?
sounding similar to the noise generated when separating velcro
When might you hear fine end-inspiratory crackles?
pulmonary fibrosis
What are the respiratory causes of lymphadenopathy?
- lung cancer with metastases
- tuberculosis
- sarcoidosis
What is the name of the different lymph nodes?
- Submental
- Submandibular
- Pre-auricular
- Post-auricular
- Superficial cervical
- Deep cervical
- Posterior cervical
- Supraclavicular – left supraclavicular region is where Virchow’s node may be noted (associated with upper gastrointestinal malignancy)
How could you see respiratory distress?
flared nostril and pursed lip breathing
Why might there be an abnormal cricosternal distance?
distance of fewer than 3 fingers suggests underlying lung hyperinflation
- asthma
- COPD
Why might there be an abnormal cricosternal distance?
distance of fewer than 3 fingers suggests underlying lung hyperinflation
- asthma
- COPD
How could you see DVT on legs?
- Inspect: red and swollen
- Palpate: tender and hot
- Watch their face for pain
What would erythema nodosum on the legs suggest?
sarcoidosis
