Respiratory Flashcards
Core Resp Exam?
IC HIUG DEP V
· O2
· End of bed - oxygenation, rate, respiratory cycle, accessory muscle use, recession
· Cough, quality of voice
Hands
· Cyanosis
· Clubbing
· Anaemia
· HPOA- hypertrophic osteoarthropathy (clubbing, arthritis, periostitis)
Arms
· Pulse, RR
· Respiratory cycle - prolonged expiratory phas
· Asterixis
Head
· General - structural (micrognathia/retrognathia), Cushingoid
· Eyes- anaemia
· Mouth - cyanosis, teeth, palate
ENT
· Nose - polyps
· Throat - tonsils
· Ears - leave to end
Neck
· Tracheal position
Chest
Inspection
· Scars
· Symmetric
· Deformity - pectus excavatum, (excavate) carinatum (out), Harrison’s sulcus
· Work of breathing
· Obvious scoliosis
Posterior –> Anterior chest
· Palpate
· Percuss
· Vocal resonance (say 99), tactile fremitus
· Auscultate breath sounds
Cardio
· Heaves, thrills
· Apex beat
· Palpate dextrocardia
· Heart sounds
Abdo
· Hepatosplenomegaly
· Liver ptosis ?floating liver
Legs
· Toe clubbing
Peripheral edema
CF - key signs?
Key signs
Inspection
· Long line or port, sputum cup, PEG
· Cough
· Cushingoid - steroids for ABPA
· Stigmata chronic liver disease
Hands
· Finger prick marks - diabetes
Head
· Polyps
Chest
· Bilateral crackles
· Pulmonary hypertension/cor pulmonale
· Must check apex beat - PCD key differential (situs invertus)
· Wheeze - ABPA
Abdo
· PEG
· Scars - meconium ileus, DIOS (distal intestinal obstruction syndrome)
· Hepatomegaly, liver ptosis
· Portal HTN
· Insulin injection sites
Lower limb
· Muscle bulk
Pubertal status
Screening Ix complications CF?
Track growth/development/puberty
· LFTs and coags - liver synthetic function, Abdo USS
· Micronutrients - FBE, Fe studies, ferritin, Vit b12, folate, zinc
· Fat soluble - ADEK
· HbA1c trends/OGTT
· Bones - Vit D, CMP, PTH, ALP, DEXA
Steatorrhea - stool fat globules, elastase for pancreatic insufficiency
Bronchiectasis DDx?
Bronchiectasis DDx
CF related
Non CF related
Immunodeficiency
· Febrile, focal chest findings, OM/sinusitis
· PCD + Kartageners - sinusitis, nasal polyps, dextrocardia and situs invertus
· Bronchiolitis obliteras
· Pulmonary interstitial fibrosis
Alpha 1 anti-trypsin
What is accepted terminology for breath sounds?
Normal breath or lung sounds
Bronchial breathing - harsh sounds like those heard over the trachea- hollow, tubular – indicative of consolidation
Crackles - fine or coarse
Stridor, wheeze, rhonchus (low pitched wheeze)
Pleural friction rub
Squawk (short inspiratory wheeze)
