Respiratory Flashcards
Differentials from age?
Young - asthma, CF
Old - COPD, interstitial lung disease, malignancy
General inspection signs? (5,4)
General - Age group, cyanosis, pallor, oedema, cachexia
Breathing - SoB, cough, wheeze, stridor
Objects/equipment of relevance?
O2 delivery devices, sputum pot, ECG leads, medications, catheters, IV access
Cigarettes/vaping
Medical charts
Hands clinical signs?
Colour - cyanosis
Tar staining
Skin changes (thinning/bruising = long-term steroids)
Joint swelling/deformity (RA-associated resp issues)
Clubbing
Clubbing implications?
Interstitial lung disease
Bronchiectasis
Cystic fibrosis
Lung cancer
Fine tremor implication?
Overuse of beta-2-agonist therapy (salbutamol)
Asterixis (flapping tremor) implication?
CO2 retention (type 2 resp failure)
Uraemia, hepatic encephalopathy
Hand temperature signs?
Cool = poor peripheral perfusion
Excessively warm + sweaty = CO2 retention
2 main pulse abnormalities in resp exam?
Bounding pulse - underlying CO2 retention
Pulsus paradoxus - severe acute asthma, severe exacerbation of COPD, late cardiac tamponade (so quite unlikely in exam!)
Asymmetries in respiratory rate inspiration/expiration?
EXPIRATORY phase prolonged relative to inspiration in asthma and COPD
Respiratory causes of raised JVP?
VENOUS HYPERTENSION = pulmonary hypertension causing right-sided heart failure due to COPD or interstitial lung disease
Plethoric complexion/congested red-faced appearance, respiratory causes?
Polycythaemia (e.g. in COPD)
CO2 retention (type 2 resp failure)
Respiratory eye signs?
Conjunctival pallor
Ptosis, mitosis, enophthalmos = HORNER’S indicating sympathetic trunk damage due to lung cancer affecting lung apex (Pancoast tumour)
4 main chest scars + location + indication?
Median sternotomy (thorax midline - cardiac valve replacement, coronary artery bypass grafts)
Axillary thoracotomy (4th/5th ICS in axilla between posterior pec major + anterior lat dorsi - chest drain insertion)
Posterolateral thoracotomy (between scapula + mid-spinal line, extends to axillary line - lobectomy, pneumonectomy, oesophageal surgery)
Infraclavicular (infraclavicular region either side - pacemaker insertion)
Radiotherapy-associated skin changes?
Dry skin, scale, thickened skin, depigmentation, telangiectasia
Chest wall deformities + implications?
Asymmetry - pneumonectomy, thoracoplasty
Pectus excavatum/carinatum
Hyperexpansion (barrel chest) - asthma, COPD (chronic lung disease)
Causes of tracheal deviation + direction?
Deviates AWAY - tension pneumothorax, large pleural effusion
Deviates TOWARD - lobar collapse, pneumonectomy
Decreased (<3 fingers) cricosternal distance = ?
Lung hyperinflation e.g. asthma, COPD
Respiratory causes of displaced apex beat?
Right ventricular hypertrophy (pulmonary hypertension, COPD, interstitial lung disease)
Large pleural effusion
Tension pneumothorax
Respiratory causes of reduced chest expansion?
Symmetrical - pulmonary fibrosis reducing lung elasticity (overall chest expansion reduced)
Asymmetrical - pneumothorax, pneumonia and pleural effusion
Types of percussion note + implication?
Resonant - normal
Dullness - increased tissue density (cardiac dullness, consolidation, tumour, lobar collapse)
Stony dullness - pleural effusion
Hyper-resonance - decreased tissue density (pneumothorax)
Tactile vocal fremitus + vocal resonance abnormalities?
Increased vibration OR volume = increased tissue density (consolidation, tumour, lobar collapse)
Decreased vibration OR volume = presence of fluid/air outside the lung (pleural effusion, pneumothorax)
Various breath sounds + implications?
Vesicular breathing - normal
Bronchial breathing - harsh-sounding (consolidation), insp/exp are equal with a pause in between
Quiet breath sounds = reduced air entry (e.g. pleural effusion, pneumothorax)
Wheeze (asthma, COPD, bronchiectasis), stridor (subglottic stenosis), coarse crackles (popping, sounds like rice crispies = pneumonia, bronchiectasis, pulmonary oedema), fine end-inspiratory crackles (velcro = pulmonary fibrosis)
Respiratory causes of lymphadenopathy?
Lung cancer + mets
TB
Sarcoid
Sacral/pedal oedema cause?
Congestive heart failure
Further assessments and investigations for respiratory examination?
At the bedside - full set of obs (inc. O2 sats, temp, BP), sputum sample, peak flow assessment, ABG if indicated
Imaging - CXR (?CT ok for fibrosis)
Cardiovascular examination and full history
