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YR3: OSCE > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is often prolonged in asthma exacerbations + COPD?

A

Expiratory phase

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2
Q

Which respiratory conditions do you think of in older and younger patients?

A

Young: Asthma + CF
Old: COPD, interstitial lung disease, malignancy

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3
Q

Give 2 causes of cyanosis

A 
Poor circulation (peripheral vasoconstriction due to hypovolaemia)
Inadequate oxygenation of blood (Right to left shunting)
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4
Q

List 5 signs of shortness of breath

A 
Nasal flaring
Pursed lip breathing
Use of accessory muscles
Intercostal muscle recession
Tripod position
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5
Q

How does type of cough guide differential?

A

Productive: COPD, CF, Pneumonia, Bronchiectasis
Dry: Asthma + interstitial lung disease

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6
Q

List 3 conditions associated with wheeze

A

COPD
Asthma
Bronchiectasis

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7
Q

Give 2 causes of stridor

A

Inhaled foreign object

Subglottic stenosis

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8
Q

What causes gurgling?

A

Respiratory secretions

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9
Q

What is indicated by cachexia?

A

Malignancy

End stage lung disease e.g. COPD

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10
Q

Give 2 causes of pallor

A 
Anaemia (e.g. haemorrhage/chronic disease) 
Poor perfusion (e.g. congestive cardiac failure
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11
Q

What should you look for around the patient?

A 
Oxygen delivery devices
Sputum pot: volume, colour
Other med equipment e.g. catheter, inhaler
Vital signs
Fluid balance
Prescriptions
Cigarettes/ vaping devices
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12
Q

What signs do you look for in the hands?

A 
Tar staining: smoking
Cyanosis: hypoxaemia
Bruising + thinning: chronic steroid use
Joint swelling/ deformity: RA
Clubbing
Small muscle wasting at thenar eminence: malignancy at lung apex
Dilated veins: hypercapnia
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13
Q

Give 4 respiratory causes of clubbing

A

Chronic hypoxia in lung cancer
Interstitial lung disease
CF
Bronchiectasis

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14
Q

What should you measure in the hands and arms?

A 
Resting fine tremor: B2 agonist use
BP
Radial pulse 
CO2 retention flap 
Temperature
Capillary refill: sepsis/ poor perfusion
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15
Q

What may cause a plethoric complexion of the face?

A

Polycythaemia secondary to COPD

CO2 retention in T2 respiratory failure

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16
Q

What should you look for in the eyes?

A

Conjunctival pallor: anaemia

Ptosis, miosis, anhydrous: Horners syndrome

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17
Q

What is the relevance of signs of horners syndrome to a respiratory exam?

A

Occurs when sympathetic trunk is damaged by pathology e.g. tumour in apex (pancoast tumour)

18
Q

What should you look for in the mouth?

A

Central cyanosis: hypoxaemia
Oral candidiasis: steroid inhaler use
Hydration

19
Q

What respiratory pathology can cause a raised JVP?

A

Pulmonary HTN due to COPD can cause cor pulmonale leading to raised JVP

20
Q

Describe what causes deviation of the trachea away and towards a pathology

A

Towards: Lobar collapse, Pneumonectomy, Pulmonary fibrosis
Away: Tension pneumothorax, Large pleural effusion

21
Q

List 5 types of chest wall scars

A

Midline sternotomy:midline of thorax. Cardiac valve replacement + CABG.
Anterior thoracotomy: lung biopsy, pericardial surgery
Axillary thoracotomy: insertion of chest drains.
Posterolateral thoracotomy lobectomy, pneumonectomy + oesophageal surgery.
Clamshell/ bilateral subpectoral: lung transplantation

22
Q

What skin changes may be seen on the chest wall of a patient that has undergone radiotherapy?

A 
Xerosis (dry skin)
Scales
Hyperkeratosis (thickened skin)
Depigmentation
Telangiectasia.
23
Q

Give 2 causes of an asymmetrical chest wall

A

Pneumonectomy (e.g. lung cancer)

Thoracoplasty (e.g. tuberculosis)

24
Q

What is Pectus excavatum?

A

Caved-in/ sunken chest

25
Q

What is Pectus carinatum? What causes this?

A

Protrusion of sternum + ribs
= “pigeon chest”
Chronic respiratory disease in childhood

26
Q

What is hyper expansion of the chest? What is it also known as? Which conditions is this seen in?

A

Chest wall wider + taller
Barrel chest
Chronic lung diseases e.g. Asthma + COPD

27
Q

What causes symmetrical reduced chest expansion? How?

A

Pulmonary fibrosis

Reduces lung elasticity, restricting overall chest expansion

28
Q

Give 3 causes asymmetrical reduced chest expansion

A

Pneumothorax
Pneumonia
Pleural effusion

29
Q

Give 3 causes of a displaced apex beat

A

RV hypertrophy
Large pleural effusion
Tension pneumothorax

30
Q

What 4 sounds may be heard on chest percussion and what do each of these indicate?

A

Resonant: Normal
Dull: increased tissue density (cardiac dullness, consolidation, tumour, lobar collapse)
Stony dull: pleural effusion
Hyper-resonance: decreased tissue density (pneumothorax)

31
Q

Describe vesicular and bronchial breath sounds

A

Vesicular: Normal
Bronchial: harsh, pause in-between inspiration + expiration. Associated with consolidation

32
Q

What is suggested by quiet breath sounds?

A

Reduced air entry into that region of the lung e.g. pleural effusion, pneumothorax

33
Q

Describe wheeze and what conditions it is associated with

A 
Continuous, coarse, whistling sound, usually on expiration
Asthma
COPD
Bronchiectasis 
LRT pathology
34
Q

Describe stridor and what conditions it is associated with

A

high pitched extra-thoracic sound, results from turbulent airflow through narrowed upper airways, usually inspiratory
Foreign body inhalation + subglottic stenosis
URT pathology

35
Q

Describe coarse crackles and what conditions they are associated with

A

Discontinuous, brief, popping lung sounds
Pneumonia
Bronchiectasis
Pulmonary oedema

36
Q

Describe fine end-inspiratory crackles and what conditions they are associated with

A

“separating velcro”
High pitched
best heard at lung bases
Pulmonary fibrosis

37
Q

Describe pleural rub and what conditions they are associated with

A 
"walking on snow"
inspiration + expiration 
Mesothelioma (asbestos exposure, RA + lupus)
Pneumonia
Pleurisy 
Pulmonary infarction
38
Q

What is indicated by increased volume on vocal resonance?

A

Increased tissue density
Consolidation
Tumour
Lobar collapse

39
Q

What is indicated by decreased volume on vocal resonance?

A

Fluid or air outside of the lung
Pleural effusion
Pneumothorax

40
Q

List 4 respiratory causes of lymphadenopathy

A

Lung cancer
URTI
Tuberculosis
Sarcoidosis

41
Q

What other areas may you check for signs?

A 
Sacral + pedal oedema (congestive heart failure)
Swollen calves (DVT)
Erythema nodosum (sarcoidosis)

YR3: OSCE (6 decks)

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