Respiratory

Question 1

What pieces of information can you gather before undressing the infant

Answer 1

RR, colour, nasal flaring, use of accessory muscles
stridor

Question 2

what are you looking at on general inspection

Answer 2

general health
dysmorphic features
extras- oxygen supplementation, saturation monitor s, sputum pots, peak flow meters

Question 3

what are you looking for on inspection of the hands

Answer 3

clubbing

Question 4

what are you looking for in the face

Answer 4

cyanosis, traumatic petechia on the eyelids, face and neck following severe paroxysms of coughing

Question 5

what are you looking for on the neck

Answer 5

tracheal tug, swelling, lymph nodes, cystic hygroma, thyroid

Question 6

what are you looking for on inspection of the shape of the chest

Answer 6

undress the top half of the child looking for
shape (asymmetry or deformity)
pectus excavatum (sunken) or carinatum (prominence)
hyperinflation (barrel chest- chronic asthma, emphysema, CF)
harrisons sulcus (chronic airway obstruction ddx: left to right cardiac shunt)
rachitic rosary (swelling of the costochodral junctions- rickets)
absent clavicles
absent pectoralis (Polands syndrome
movement (full expiration then inspiration)

Question 7

what does intercostal recession mean

Answer 7

airway obstruction or decreased lung compliance

Question 8

subcostal recession means

Answer 8

airway obstruction or decreased lung compliance

Question 9

what does a right thoractomy scar mean

Answer 9

possible oesophageal surgery
BT shunt
lobectomy

Question 10

when counting the rate on breathing what else are you thinking about

Answer 10

nasal flaring
grunting on expiration (positive end exp pressure)
use of accessory muscles (sternocleidomastoids)
chest wall recession
see saw chest movement
difficulty with speaking or feeding

Question 11

what is the normal breathing rate for a neonate

Answer 11

30-60

Question 12

what is the normal breathing rate for an infant

Answer 12

20-40

Question 13

respiratory rate for 1-3 year old

Answer 13

20-30

Question 14

normal RR for a 4-10 year old

Answer 14

15-25

Question 15

if you are greater than 10 what is the normal respiratory rate

Answer 15

15-20

Question 16

in a young child when is palpation and percussion useful

Answer 16

degree of hyperinflation
upper liver border detection
to confirm consolidation, collapse, or effusion

Question 17

in an older child what are you feeling for on palpation of the mediastinum

Answer 17

trachea (single finger) and localisation of the apex beat

Question 18

steps of palpation in an older child

Answer 18

mediastinum position
chest expansion
tactile vocal fremitus

Question 19

if the apex and trachea are pushed away that means

Answer 19

there may be a pleural effusion or pneumothorax

Question 20

if the apex and trachea are pulled towards the effected side

Answer 20

it is either a collapse or fibrosis

Question 21

if only the trachea is shifted

Answer 21

then it is an upper lobe pathology

Question 22

when only the apex is shifted

Answer 22

think pectus excavatum, scoliosis, dextrocardia, cardiomegaly 9think cor pulmonale)

Question 23

what is normal chest expansion

Answer 23

4 cm and should be symmetrical

Question 24

how do you test for vocal fremitus

Answer 24

place hand on either side of the upper chest and ask the child to say 99 compare left and right anterior and posterior

Question 25

with increased vocal fremitus what is the pathology

Answer 25

consolidation

Question 26

with decreased vocal fremitus what is the underlying pathology

Answer 26

collapse, pleural thickening

Question 27

with absent vocal fremitus what does that mean

Answer 27

pleural effusion

Question 28

what does hyper-resonance mean pathology wise

Answer 28

pneumothorax or emphysema

Question 29

what does a dull percussion note mean

Answer 29

consolidation, collapse, pleural thickening, fibrosis

Question 30

what does stony dullness mean on percussion

Answer 30

pleural effusion

Question 31

the right lung has how many lobes

Answer 31

three (upper, middle and lower lobe)

Question 32

what re the three questions you should ask yourself while auscultating the lungs

Answer 32

are the breath sounds normal
are there added sounds
are these in inspiration, expiration or both

Question 33

what are the characteristics of normal breath sounds

Answer 33

low pitches rustle, increased intensity in inspiration, faded quickly in the first third of expiration

Question 34

what does bronchial breathing sound like

Answer 34

there is a pause between inspiration and expiration
the duration of inspiration and expiration is equal
and the quality and intensity is the same

Question 35

what does diminished or absent breath sounds mean

Answer 35

collapse, pleural effusion, pneumothorax, pleural thickening, emphysema, obstruction

Question 36

what does bronchial breathing mean

Answer 36

consolidation or fibrosis

Question 37

what causes prolonged expiration

Answer 37

asthma or emphysema (to prevent closure of alveoli

Question 38

what are wheezes due to

Answer 38

they are due to partial obstruction or narrowing of the bronchi or bronchioles
asthma or bronchiolitis (also has creps)

Question 39

what are crackles

Answer 39

the are non musical sounds generally heard during inspiration

Question 40

what do fine crackles indicate

Answer 40

they are normally found at the base of the lung
pulmonary edema
fibrosiing alveolitis

Question 41

what does coarse crackles indicate

Answer 41

bubbly secretions in the bronchioles
pneumonia
bronchiectasis

Question 42

what does a pleural rub indicate

Answer 42

leathery sound caused by movement of visceral pleura over parietal pleura when the surfaces are roughened by fibrous exudate (uncommon)

Question 43

what is a pneumothorax click?

Answer 43

rhythmical sound, synchronous with cardiac systole
caused by shallow left pneumothorax between the two layers overlying the heart