Respiratory Flashcards
Signs of pleural effusion on inspection (2)
Trachea and apex beat deviated to opposite side if large
Reduced chest expansion
Signs pleural effusion on auscultation (3)
Reduced vocal resonance
Reduced or absent breath sounds
May be bronchial breathing heard above effusion
Sign pleural effusion on percussion
Stony dull
2 broad causes of pleural effusion
Transudate
Exudate
What is exudate
At least one of light’s criteria
High protein - fluid protein: serum protein more than 0,5
High LDH- fluid LDH: serum LDH more than 0,6 or more than 2/3 normal upper limit LDH in serum.
= local problem eg malignancy, inflammation, pulmonary infarct , chemo and radiation
What is transudate
Transported fluid from elsewhere to pleural space
= systemic problem eg hf, hypoproteinaemia
causes transudative pulmonary effusion 3
Hypothyroid
Hypoalbuminaemia eg from cirrhosis, kidney failure
Cardiac failure
6 causes exudative pleural effusion
Malignancy: bronchial carcinoma, metastatic carcinoma…
TB
Pneumonia
Meigs syndrome -ovarian fibroma causing pleural effusion and ascites
Connective tissue disease-rheumatoid arthritis, SLE
Acute pancreatitis
Chemo /radiation
Pulmonary infarct
What is consolidation
Lobar pneumonia
Chest inspection findings of consolidation
Reduced chest wall movement (expansion)
Percussion signs of consolidation
Dull
Auscultation findings of consolidation (4)
Bronchial breathing Coarse crackles inspiratory Vocal resonance increased Reduced breath sounds. (Pleural rub may be present)
Symptoms of consolidation (6)
Dementia! Cough (painful and dry at first) Fever and rigors Pleuritic chest pain Dyspnoea Tachycardia
Diagnosis COPD?
Spirometry: post-bronchodilator FEV 1 / FvC <70%
What is emphysema
Increase in air spaces distal to terminal bronchioles (alveoli) (hyperinflation)
Inspection signs of COPD chest (4)
Barrel- shaped chest (hyperinflation)
Use of accessory muscles
Hoover’s sign
Reduced expansion
Lay term for emphysema patients
Pink (face) puffers (dyspnoea)
Face and neck signs copd (3)
emphysema
• Pink face
• Pursed -lip breathing
• tracheal tug
Chronic bronchitis
• central cyanosis later
Reduced cricosternal distance
Raised JvP
Complications of COPD (2)
Emphysema
•Hypercapnia - drowsy/ coma state. May be caused by oxygen supplements which further diminishes respiratory drive. Also lead to warm peripheries, bounding pulses, flapping tremor
Chronic bronchitis
• R ventricular failure
Chest percussion signs COPD (2)
Hyper-resonant
Emphysema: decreased liver dullness
Auscultation COPD signs (3)
Decreased breath sounds
Early inspiratory crackles
Chronic bronchitis: wheezes
Heart sounds loudest in epigastrum
Lay term for chronic bronchitis patients
Blue (cyanosis) bloaters (oedema from right ventricular failure)
What is Chronic bronchitis definition
Daily production of sputum for 3 months a year for at least 2 consecutive years. Subtype of COPD.
Symptoms of Chronic bronchitis (2)
Loose cough and sputum esp in morning
Oedema