Respiratory Flashcards
What is often prolonged in asthma exacerbations + COPD?
Expiratory phase
Which respiratory conditions do you think of in older and younger patients?
Young: Asthma + CF
Old: COPD, interstitial lung disease, malignancy
Give 2 causes of cyanosis
Poor circulation (peripheral vasoconstriction due to hypovolaemia) Inadequate oxygenation of blood (Right to left shunting)
List 5 signs of shortness of breath
Nasal flaring Pursed lip breathing Use of accessory muscles Intercostal muscle recession Tripod position
How does type of cough guide differential?
Productive: COPD, CF, Pneumonia, Bronchiectasis
Dry: Asthma + interstitial lung disease
List 3 conditions associated with wheeze
COPD
Asthma
Bronchiectasis
Give 2 causes of stridor
Inhaled foreign object
Subglottic stenosis
What causes gurgling?
Respiratory secretions
What is indicated by cachexia?
Malignancy
End stage lung disease e.g. COPD
Give 2 causes of pallor
Anaemia (e.g. haemorrhage/chronic disease) Poor perfusion (e.g. congestive cardiac failure
What should you look for around the patient?
Oxygen delivery devices Sputum pot: volume, colour Other med equipment e.g. catheter, inhaler Vital signs Fluid balance Prescriptions Cigarettes/ vaping devices
What signs do you look for in the hands?
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
Give 4 respiratory causes of clubbing
Chronic hypoxia in lung cancer
Interstitial lung disease
CF
Bronchiectasis
What should you measure in the hands and arms?
Resting fine tremor: B2 agonist use BP Radial pulse CO2 retention flap Temperature Capillary refill: sepsis/ poor perfusion
What may cause a plethoric complexion of the face?
Polycythaemia secondary to COPD
CO2 retention in T2 respiratory failure
What should you look for in the eyes?
Conjunctival pallor: anaemia
Ptosis, miosis, anhydrous: Horners syndrome
What is the relevance of signs of horners syndrome to a respiratory exam?
Occurs when sympathetic trunk is damaged by pathology e.g. tumour in apex (pancoast tumour)
What should you look for in the mouth?
Central cyanosis: hypoxaemia
Oral candidiasis: steroid inhaler use
Hydration
What respiratory pathology can cause a raised JVP?
Pulmonary HTN due to COPD can cause cor pulmonale leading to raised JVP
Describe what causes deviation of the trachea away and towards a pathology
Towards: Lobar collapse, Pneumonectomy, Pulmonary fibrosis
Away: Tension pneumothorax, Large pleural effusion
List 5 types of chest wall scars
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
What skin changes may be seen on the chest wall of a patient that has undergone radiotherapy?
Xerosis (dry skin) Scales Hyperkeratosis (thickened skin) Depigmentation Telangiectasia.
Give 2 causes of an asymmetrical chest wall
Pneumonectomy (e.g. lung cancer)
Thoracoplasty (e.g. tuberculosis)
What is Pectus excavatum?
Caved-in/ sunken chest
What is Pectus carinatum? What causes this?
Protrusion of sternum + ribs
= “pigeon chest”
Chronic respiratory disease in childhood
What is hyper expansion of the chest? What is it also known as? Which conditions is this seen in?
Chest wall wider + taller
Barrel chest
Chronic lung diseases e.g. Asthma + COPD
What causes symmetrical reduced chest expansion? How?
Pulmonary fibrosis
Reduces lung elasticity, restricting overall chest expansion
Give 3 causes asymmetrical reduced chest expansion
Pneumothorax
Pneumonia
Pleural effusion
Give 3 causes of a displaced apex beat
RV hypertrophy
Large pleural effusion
Tension pneumothorax
What 4 sounds may be heard on chest percussion and what do each of these indicate?
Resonant: Normal
Dull: increased tissue density (cardiac dullness, consolidation, tumour, lobar collapse)
Stony dull: pleural effusion
Hyper-resonance: decreased tissue density (pneumothorax)
Describe vesicular and bronchial breath sounds
Vesicular: Normal
Bronchial: harsh, pause in-between inspiration + expiration. Associated with consolidation
What is suggested by quiet breath sounds?
Reduced air entry into that region of the lung e.g. pleural effusion, pneumothorax
Describe wheeze and what conditions it is associated with
Continuous, coarse, whistling sound, usually on expiration Asthma COPD Bronchiectasis LRT pathology
Describe stridor and what conditions it is associated with
high pitched extra-thoracic sound, results from turbulent airflow through narrowed upper airways, usually inspiratory
Foreign body inhalation + subglottic stenosis
URT pathology
Describe coarse crackles and what conditions they are associated with
Discontinuous, brief, popping lung sounds
Pneumonia
Bronchiectasis
Pulmonary oedema
Describe fine end-inspiratory crackles and what conditions they are associated with
“separating velcro”
High pitched
best heard at lung bases
Pulmonary fibrosis
Describe pleural rub and what conditions they are associated with
"walking on snow" inspiration + expiration Mesothelioma (asbestos exposure, RA + lupus) Pneumonia Pleurisy Pulmonary infarction
What is indicated by increased volume on vocal resonance?
Increased tissue density
Consolidation
Tumour
Lobar collapse
What is indicated by decreased volume on vocal resonance?
Fluid or air outside of the lung
Pleural effusion
Pneumothorax
List 4 respiratory causes of lymphadenopathy
Lung cancer
URTI
Tuberculosis
Sarcoidosis
What other areas may you check for signs?
Sacral + pedal oedema (congestive heart failure) Swollen calves (DVT) Erythema nodosum (sarcoidosis)
