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Clinical > Respiratory > Flashcards

Respiratory Flashcards

1
Q

How do you set up for a resp exam? (6)

A

WIPPPE:

  • Wash hands
  • Introduce yourself and identify patient
  • Permission (gain from patient after explaining exam)
  • Position (45 degrees for CVS/resp)
  • Pain (check if patient has any pain)
  • Exposure (adequately expose patient)
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2
Q

What are the two patient identifiers? (2)

A
  • Name

- DOB

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3
Q

What are the end of bed observations that can be made in a resp exam? (7)

A
  • Oxygen mass
  • Walking aids
  • Drip stand
  • Nebuliser
  • Urinary catheter
  • Snacks
  • Sputum pots
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4
Q

What features of a patient can be seen from their general appearance relevant to a resp exam? (9)

A
  • In pain?
  • Unwell?
  • Breathless?
  • Breathing observations?
  • Cyanosis?
  • Age?
  • Scars?
  • O2 sats?
  • Cachexia?
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5
Q

What breathing observations can be made from a patient from their general appearance relevant to a resp exam? (8)

A
  • Using accessory muscles of respiration?
  • Leaning forward and using arms in breathing to brace chest? Tripod position?
  • Pursed lips?
  • Intercostal muscle recession?
  • Nasal flaring?
  • Cough? Dry/productive?
  • Wheeze (expiratory)?
  • Stridor (inspiratory?
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6
Q

What resp conditions do young patients tend to get? (2)

A
  • Asthma

- Cystic fibrosis (CF)

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7
Q

What resp conditions do older patients tend to get? (3)

A
  • COPD
  • Interstitial lung disease (ILD)
  • Malignancy
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8
Q

What does O2 around the bed indicate? (2)

A
  • ILD

- COPD

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9
Q

What do inhalers/nebulisers around the bed indicate? (2)

A
  • Asthma

- COPD

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10
Q

What do sputum pots around the bed indicate? (2)

A
  • COPD

- Bronchiectasis

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11
Q

What does cachexia indicate in a resp exam? (3)

A
  • Malignancy
  • Cystic fibrosis
  • COPD
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12
Q

What does a dry cough indicate? (2)

A
  • Asthma: younger

- ILD: older

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13
Q

What does a productive cough indicate in older patients? (2)

A
  • Bronchiectasis

- COPD

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14
Q

What does a productive cough indicate in younger patients?

A

Cystic fibrosis

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15
Q

What does an expiratory wheeze indicate? (3)

A
  • Asthma
  • COPD
  • Bronchiectasis
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16
Q

What does an inspiratory stridor indicate?

A

Upper airway obstruction

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17
Q

What is the order of a resp exam? (23)

A
  • General observation
  • Hands
  • Pulse
  • Temp
  • Resp rate
  • Tremors
  • Face
  • Mouth
  • Eyes
  • JVP
  • Trachea + cricosternal distance
  • Thorax inspection
  • Apex beat palpation
  • Heave
  • Expansion
  • Percussion
  • Auscultation
  • Vocal resonance
  • Repeat for posterior chest
  • Lymph nodes
  • Sacral oedema
  • Legs and calves
  • Investigations
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18
Q

What are looked for in hands in a resp exams? (5)

A
  • Tar staining
  • Clubbing
  • Peripheral cyanosis
  • Rhematological disease - joint swelling/tenderness
  • Bruising/thinning of skin
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19
Q

What are the resp causes of clubbing? (5)

A
  • Bronchial carcinoma
  • Empyema/abscess (chronic lung suppination)
  • Bronchiectasis (chronic lung suppination)
  • Cystic fibrosis (chronic lung suppination)
  • Fibrosing alveolitis
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20
Q

Why are signs of a rhematological disease checked for in a resp exam? (2)

A
  • Pleural effusion association

- Pulmonary fibrosis association

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21
Q

What is bruising/thinning of skin associated with? Give 3 examples

A

Long term steroid use e.g in ILD/asthma/COPD

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22
Q

What does a reduced temperature suggest? (2)

A
  • Peripheral vasoconstriction

- Poor perfusion

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23
Q

What is assessed in pulse palpation? (2)

A
  • Rate

- Rhythm

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24
Q

When is a resp rate of up to 20 still normal?

A

Patients with anxiety

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25
Q

How is resp rate counted?

A

Breaths in 15 secs x 4

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26
Q

What two types of tremor are assessed for?

A
  • Fine tremor

- Flapping tremor

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27
Q

How is fine tremor assessed?

A

Ask patients to hold out arms outstretched

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28
Q

What is a fine tremor associated with?

A

Beta agonist medications

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29
Q

How is flapping tremor assessed?

A

Cock wrists back

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30
Q

What is flapping tremor associated with?

A
  • CO2 retention - type 2 resp failure e.g COPD
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31
Q

What signs are checked for in the face in a resp exam? (3)

A
  • Central cyanosis on lips/under tongue
  • Pursed lip on expiration
  • Dusky appearance and swelling
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32
Q

What does a dusky appearance and swelling in the face indicate? And how (2)

A

SVP compression

  • Mediastinal tumour
  • Puenmothorax
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33
Q

What signs are checked for in the eyes in a resp exam? (2)

A
  • Conjunctival pallor

- Horner’s syndrome

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34
Q

What does Horner’s syndrome look like in the eyes? (3)

A
  • Unilateral miosis (pupil constriction)
  • Ptosis (falling of upper eyelid)
  • Enophthalmos (posterior eyeball placement in orbit)
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35
Q

What are the signs of Horner’s syndrome in the face?

A

Anhidrosis (inability to sweat) on affected side

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36
Q

What does a raised JVP indicate in resp? (4)

A
  • Cor pulmonale
  • SVC obstruction
  • Acute: tension pneumothorax
  • Acute: PE
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37
Q

How is the trachea palpated? (6)

A
  • Warn
  • Relaxed neck musculature: chin downwards
  • Place 3 fingers gently
  • Into sternal notch
  • Central: trachea under middle finger
  • Compare space between trachea and sternocleidomastoid on each side: difference = deviation
38
Q

What does the trachea deviate away from? (2)

A
  • Pnuemothorax

- Large pleural effusion

39
Q

What does the trachea deviate towards? (2)

A
  • Lobar collapse

- Pueumonectomy (surgical lung part removal)

40
Q

What scars are inspected for on the chest? (2)

A
  • Small mid axillary scars

- Horizontal postero-lateral scars (on back)

41
Q

What do horizontal postero-lateral scars indicate?

A

Thoracotomy from e.g. lobectomy/pneumonectomy

42
Q

What do small mid axillary scars indicate?

A

Chest drains

43
Q

What surgeries does asymmetry of the chest wall indicate? And why? (2)

A
  • Pneumonectomy: cancer

- Thoracoplasty : rib removed for TB

44
Q

What is inspected for in the chest wall? (4)

A
  • Scars
  • Asymmetry
  • Shape
  • Intercostal recession due to rapid inspiration
45
Q

What conditions cause intercostal recession due to rapid inspiration? (2)

A
  • Acute infection

- Asthma

46
Q

What does a displaced apex beat indicate in a resp exam?

A

Mediastinal mass

47
Q

What does an absent apex beat indicate in a resp exam? (2)

A
  • Large pleural effusion

- Pneumothorax

48
Q

What are the two ways an apex beat can be changed in a resp exam? (2)

A
  • Displaced?
  • Absent?
  • Difficult to feel/hear?
49
Q

What might make the apex beat difficult to feel/hear in a resp exam?

A

Hyperinflation due to COPD

50
Q

What is felt for on the chest? (2)

A
  • Apex beat

- Right ventricular heave

51
Q

What deformities can be seen in chest wall shape?

A
  • Barrel chest
  • Pectus excavatum
  • Pectus carinatum
52
Q

What does barrel chest indicate?

A

Hyperinflation due to COPD

53
Q

What is pectus excavatum?

A

Genetic caved in chest, deformity of anterior thoracic wall

54
Q

What are the dangers of pectus excavaum? (2)

A
  • Can lead to difficulty of lung expansion

- Compression can squeeze heart

55
Q

What is pectus carinatum?

A

“Pigeon chest”

Genetic chest jutting out due to unusual rib and sternum protrusion growth

56
Q

What can pectus carinatum cause?

A

Shortness of breath esp on exertion

57
Q

How is chest expansion assessed? (7)

A
  • Cup hands
  • Fingers spread
  • Around upper anterior chest
  • Press finger tips into mid axillary line
  • Bring thumbs together in midline touching
  • See how much thumbs move as patient breathes in: should move apart equally
  • Look for asymmetry
58
Q

Where should chest expansion be assessed? (3)

A
  • Upper anterior chest
  • Lower anterior chest
  • On back
59
Q

What is asymmetry of chest expansion?

A

One of thumbs moving less - reduced expansion on that side

60
Q

What can reduced chest expansion on one side indicate? (2)

A
  • Lung collapse

- Pneumonia

61
Q

What are the resp causes right sided heart failure causing right ventricular heave be secondary to? (2)

A

Chronic hypoxic lung diseases:

  • COPD
  • ILD
62
Q

Describe good percussion technique (4)

A
  • Middle finger of non-dominant hand
  • Along an intercostal space - Tap with flexed index/ middle finger of dominant hand
  • On middle finger middle phalanx non dominant hand
63
Q

What areas should be percussed side to side anteriorly? (4)

A
  • Supraclavicular (lung apices)
  • Infraclavicular
  • Chest wall (3-4 locations bilaterally)
  • Axilla
64
Q

What is the normal percussion note?

A

Resonant

65
Q

Posterior lung ausculation (3)

A
  • 4 rows
  • Around borders of scapula
  • Then borders of back
66
Q

Cricosternal distance? (2)

A
  • Distance between suprasternal notch and cricid cartilage

- Healthy: 3-4 patient fingers

67
Q

What does reduced cricosternal distance suggest?

A

Lung hyperinflation

68
Q

What does a dull percussion note suggest? Give 4 examples

A

Increased tissue density

  • Consolidation
  • Fluid
  • Tumour
  • Collapse
69
Q

What does a stony dull percussion note suggest?

A

Pleural effusion

70
Q

What does a hyperresonant note suggest? Give an example

A

Decreased tissue density

Puenmothorax

71
Q

What insructions should be given to a patient for auscultation?

A

Deep breaths in out through mouth

72
Q

What position should the patient be in for auscultation of the back? (3)

A
  • Lean forward
  • Hunched over
  • Cross arms
73
Q

Describe vesicular breath sounds (4) Where should they be heard?

A
  • Lower pitch
  • Shorter expiration
  • No pause between inspiration and expiration
    THORAX
74
Q

Describe bronchial breath sounds (4) Where should they be heard normally? (4)

A
  • Higher pitch
  • Louder/harsher
  • Inspiration and expiration equal
  • Pause between inspiration and expiration
    TRACHEA
75
Q

What are bronchial breath sounds over the thorax associated with?

A

Consolidation

76
Q

What should be assessed in auscultation? (3)

A
  • Quality: vesicular/bronchial?
  • Volume: reduced?
  • Added sounds: Stridor? wheeze? Coarse/fine crackles?
77
Q

What do reduced breath sounds suggest? (3)

A
  • Consolidation
  • Collapse
  • Pleural effusion
78
Q

When is a wheeze heard? And what conditions is it associated with? (2)

A

Expiration

  • Asthma
  • COPD
79
Q

What are coarse crackles associated with? (3) Inspiratory vs expiratory

A
  • Puenmonia (inspiratory)
  • Fluid overload (inspiratory) (e.g oedema/HF)
  • Bronchiectasis (expiratory and inspiratory)
80
Q

What are fine crackles associated with?

A

Pulmonary fibrosis

81
Q

What are crackles that don’t clear after a cough associated with?

A

Bronchiectasis

82
Q

What should you do if you hear crackles?

A

Ask patient to cough

83
Q

How is vocal resonance assessed?

A

Ask patient to say 99

84
Q

What does increased vocal resonance suggest? Give 3 examples

A

Increased tissue density

  • Consolidation
  • Tumour
  • Lobal collapse
85
Q

What does decreased vocal resonance suggest?

A

Fluid outside the lung - pleural effusion

86
Q

What does lymphadenopathy indicate in resp exam? (3)

A
  • Lung cancer
  • TB
  • Sarcoidosis
87
Q

Why is sacral oedema relevant to a resp exam?

A

Fluid overload in cor pulmonale

88
Q

What should be inspected for in the legs in a resp exam? (3)

A
  • Pitting oedema
  • Calves: DVT
  • Erythema nodosum: Sacroidosis
89
Q

Further investigations? (5)

A
  • Peak flow
  • O2 sats
  • Chest x ray
  • ABG
  • Cardio exam
90
Q

What should be assessed with crackles? (3)

A
  • Fine/coarse?
  • Change with breath?
  • Change with cough?
91
Q

Reduced chest expansion? (5)

A
  • Fibrosis
  • Consolidation
  • Effusion
  • Collapse
  • Pneumothorax.

Clinical (21 decks)

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