Respiratory Flashcards
Where can the middle lobe of the lung be examined?
Axilla and back
What angle should the patient be sitting at?
45 degrees
What should you look for in general inspection?
Colour of patient (are they cyanosed), obvious signs of weight loss, breathlessness (are they propped up?), any wasting of accessory muscles of breathing (COPD), pursing of lips, expiratory time.
Check surroundings for oxygen, inhalers, nebulisers, drips, sputum pots, medications, masks etc.
Respiratory causes of clubbing?
Empyema, bronchiectesis, non-small cell carcinoma, lung fibrosis, CF, abscesses, suppurative diseases.
Summarise what you are looking for in the hands?
Clubbing, cyanosis, tar staining, Duypetren’s contracture, asterixis, tremor (B2 agonists).
Check BP? Yes/no?
Yes, or say you would
Summarise what looking for in head/face?
Cyanosis (under side of tongue)
Check for lesions
Check eyes (anaemia, jaundice, xanthelasma) Horner’s sign
Arcus
Angular stomatits (anaemia)
Glossitis (sign of iron deficiency/pernicious anaemia)
Smell of breath (ketones)
Dental state
Thrush and leukoplakia
GENERAL SWELLING - SVC OBSTRUCTION AS RESULT OF LUNG CANCER
What is Horner’s sign?
Constricted pupils, droopy eyelid and reduced sweating. All on same side of face.
No sympathetic so pupil is always constricted
Common symptom of an upper lung tumour.
Summarise what looking for in neck?
Feel for inflamed lymph nodes - submandibular/submental LNs, then backwards to LNs anterior to SCM muscle, then along towards the clavicle up the back of the neck all the way up to the occipital nodes. Don’t forget to check lymph nodes in axilla.
Check JVP in respiratory exam?
Apparently not but say you would. Often raised in cor pulmonale.
Name neck lymph nodes?
Submental, submandibular, pretracheal, preauricular, upper, middle and lower cervical, postauricular, posterior triangle, supraclavicular.
Where else should you check lymph nodes?
Axilla
Where should you definitely look for scars?
On the back! And the axilla
What should you do before you check for tracheal deviation?
Tell patient it will feel a bit uncomfortable
How to check for tracheal deviation?
Put second and fourth fingers on heads of the two clavicles, leaving middle finger to feel the trachea.
Reasons for a displaced trachea?
Tension pneumothorax - shifts trachea away from side of pneumothorax.
Collapsed lobe of lung - shifts trachea towards side of collapse.
When is the JVP raised?
In right sided heart failure/states of fluid overload.
Define cor pulmonale?
Chronic hypoxia in COPD leads to pulmonary arterial vasoconstriction, pulmonary hypertension, right heart dilatation and peripheral oedema with elevation of the JVP.
Another state in which JVP is raised?
When intrathoracic pressure is raised i.e. tension pneumothorax or acute asthma.
What is the JVP like in SVC obstruction?
Raised and non-pulsatile, and abdomino-jugular reflex is absent.
What is normal respiratory rate?
12-13
How to check for chest expansion?
Ask patient to take a deep breath out then lay hands flat on upper part of the chest and ask them to take deep breaths - should feel both sides moving in and out equally.
For lower part extend hands around the sides of the chest.
Other thing in palpation?
Palpate apex beat.
Where do you percuss the clavicle?
Medial third.
