Respiratory 1 Flashcards
What are the main presenting symptoms in respiratory disease?
- cough
- sputum
- haemoptysis
- breathlessness
- wheeze
- chest pain
for each symptom, you need to know how symptoms have changed over time
What symptoms would make you consider malignancy and chronic infection?
- weight loss
- malaise
- fevers
Using ticks or crosses, what symptoms are present in lung cancer?
Using ticks or crosses, what symptoms are associated with chest infections/pneumonia?
Using ticks or crosses, which symptoms are associated with pulmonary embolism?
What respiratory conditions are more likely in younger/older people?
younger:
more likely to be asthma or cystic fibrosis
older:
more likely to be COPD, interstitial lung disease or malignancy
Upon general insepction, what signs should be noted in a patient undergoing a respiratory examination?
- age
- treatments or adjuncts around the bed
- does the patient look short of breath?
- are they able to speak in full sentences?
- scars
- cyanosis
- chest wall
- cachexia
- cough
- wheeze (expiratory)
- stridor (inspiratory)
What treatments or adjuncts are looked for around the bed?
oxygen:
- interstitial lung disease
- COPD
inhalers or nebulisers:
- asthma
- COPD
sputum pots:
- COPD
- bronchiectasis
What should you look for when assessing whethether a patient is short of breath?
- tripod position
- nasal flaring
- pursed lips
- use of accessory muscles
- intercostal muscle recession
How would cyanosis be recognised on general inspection?
What does this suggest?
bluish/purple discolouration
this suggests <85% oxygen saturation
When looking at the chest wall, what should be looked for?
- note any abnormalities or asymmertry
e. g. barrel chest in COPD
What is cachexia?
What conditions is it associated with?
a very thin patient with muscle wasting
this is present in malignancy, cystic fibrosis and COPD
What are the two types of cough?
What conditions do these suggest in older and younger patients?
productive:
- COPD in older patients
- CF in younger patients
dry:
- ILD in older patients
- asthma in younger patients
What does an expiratory wheeze suggest?
asthma, COPD, bronchiectasis
What does inspiratory stridor suggest?
upper airway obstruction
When inspecting the hands, what 5 aspects should be looked for?
- tar staining
- clubbing
- peripheral cyanosis
- features of rheumatological disease
- skin changes
What does tar staining on the fingers suggest?
this is present in smokers
they have an increased risk of COPD and lung cancer
What diseases are associated with clubbing?
- lung cancer
- interstitial lung disease
- bronchiectasis
Why should features of rheumatological disease be looked for on the hands?
rheumatological diseases can be associated with pleural effusions and pulmonary fibrosis
Why should skin changes in the hand be looked for?
bruising and thinning of the skin are associated with long-term steroid use
this is associated with ILD, asthma and COPD
When assessing the hands, after inspection what else should be looke d for?
- assess temperature
- palpate pulse
- assess respiratory rate
- pulsus paradoxus
- fine tremor
- flapping tremor
- asterixis
Why is temperature of the hands assessed?
low temperature suggests peripheral vasoconstriction / poor perfusion
How is pulse palpated in the hands?
it is assessed for rate and rhythm
What is normal adult respiratory rate?
12 - 20 breaths per minute
How is conjunctival pallor assessed?
What is it associated with?
ask the patient to lower their eyelid for inspection
pallor is associated with anaemia
How is jugular venous pressure assessed?
- ensure patient is positioned at 45o
- ask the patient to turn their head away from you
- observe the neck for the JVP (this is located inline with the sternocleidomastoid)
- measure the JVP (number of centimetres measured vertically from the sternal angle to the upper border of pulsation)
What scars are looked for upon close inspection of the thorax?
- small mid-axillary scars (e.g. chest drains)
- horizontal postero-lateral scars (thoractomy from e.g. lobectomy/pneumonectomy)
How is tracheal position assessed?
- ensure patient’s neck musculature is relaxed and their chin is slightly downwards
- dip index finger into the thorax beside the trachea
- gently apply pressure to locate trachea
- compare this space to the other side of the trachea using the same process
- a difference in the amount of space between the sides suggests deviation
How is apex beat assessed?
Why?
normal position is 5th intercostal space - mid-clavicular line
right ventricular heave is noted in cor-pulmonale
(right heart failure secondary to chronic hypoxic lung diseases such as COPD)
How is chest expansion assessed?
- place hands on the patient’s chest inferior to the nipples
- wrap your fingers around either side of the chest
- bring your thumbs together in the midline, so that they touch
- ask patient to take a deep breath
- observe movement of your thumbs - they should move apart eqqually
- if one thumb moves less than the other, this suggests reduced expansion on that side
What is the technique involved in percussion?
- place non-dominant hand on the chest wall
- middle finger should overlie the area you want to percuss (between ribs)
- with the dominant hand’s middle finger, strike the middle phalanx with the non-dominant hand’s middle finger
- the striking finger should be removed quickly, otherwise you may muffle resulting percussion note
What does a dull percussion note suggest?
increased tissue density
this is due to consolidation, fluid, tumour or collapse
In which areas are the lymph nodes palpated?
Why?
- anterior and posterior triangles
- supraclavicular region
- axillary region
Lymphadenopathy may indicate infective/malignant pathology
(lung cancer, tuberculosis, sarcoidosis)
