Respiratory Flashcards
Clubbing may be congenital true or false
True
Central cyanosis is examined by looking at the tongue for bluish discolouration.
True or false
True
Peripheral cyanosis gives a bluish discolouration of the distal parts of body like fingers, toes and lips. Peripheral cyanosis is usually due to increased oxygen extraction with a slow moving circulation. It is seen in cold weather or in Raynaud’s phenomenon or peripheral vascular disease. Central cyanosis gives rise to peripheral cyanosis but not vice versa.
True or false
True
Pigeon shaped chest is seen in which condition
Pectus carinatum
The sternum is depressed in which condition
Pectus excavatum
Pursed lip breathing is a sign of severe airway obstruction.
If on lying flat the patient becomes breathless or pre-existing breathlessness worsens, a condition called
orthopnoea, then one should think of pulmonary oedema or bilateral diaphragmatic paralysis.
True or false
True
The normal chest expansion measured with a tape measure at the level of the nipple is about 5cm or more.
True or false
True
Now palpate for the position of the trachea with the middle finger as well as the index and ring fingers. Feel for the trachea in the supra-sternal notch with the middle finger of the right hand. The ring and index fingers help to confirm if the trachea is deviated to one or the other side
True or false
True
Index,middle,ring
Tactile fremitus is palpable over normal lung and remains palpable or increased over consolidated lung but is reduced over an effusion. When one finds reduced percussion note for which the reason is not clear then a reduction in tactile fremitus favours a pleural effusion or thickening.
True or false
True
If sound heard after percussion is dull what does it mean
Consolidated lung or long collapse
Stony dull if there’s fluid
Example in pleural effusion
In consolidated pneumonia sound is higher if it’s ? And sound is lower if?
Higher- air
Lower-fluid
Stridor is a harsh, often musical note heard at the mouth marked on inspiration and denoting major airway obstruction.
Sound heard over a normal lung is vesicular true or false
True
Wheeze are the sounds heard with the naked ear and the same sounds heard with a stethoscope are called rhonchi. Wheeze is musical sounds produced by airway walls oscillating between the open and nearly closed position.
Always suspect stridor if the inspiratory noise of wheeze is louder than the expiratory sound
True or false
True
Crackles or rakes are heard when and when are coarse and fine crackles found
Heard in consolidation of lungs in pneumonia
Secretions in the terminal bronchi and alveoli give rise to coarse crackles. Pulmonary oedema gives rise to fine crackles.
Pleural rub is heard in both inspiration and expiration and it disappears when fluid collects between the two surfaces of the pleura.
True or false
True
What are you looking for in auscultation
Air entry. Is this reduced / absent or increased.
- Type of breath sounds. Is this vesicular or bronchial
- Presence or absence of adventitious sounds – crackles, rhonchi / wheeze and rub.
Tachypnea,hyperventilation,bradypnea,normal or eupnea, have which breathing patterns
Tachyons- 20bpm
Brady-less than 12bpm
Hyperventilation-rapid,deep respiration less greater than 20 bpm
Eupnea-regular,comfortable at 12-20bpm
What did the emergent therapeutic procedure for pneumothorax
Treatment of tension pneumothorax is immediate needle decompression by inserting a large-bore (eg, 14- or 16-gauge) needle into the 2nd intercostal space in the midclavicular line. Air will usually gush out.
What’s re the accessory muscle of respiration
Accessory muscles of respiration include the sternocleidomastoid, scalene, trapezius, internal intercostal, and abdominal muscles
Differentials for chest pain
Pericarditis
Pulmonary embolism
Myocardial infarction
Aortic dissection
Cardiac: myocardial infarction, unstable angina, acute pericarditis, coronary spasm, hypertrophic cardiomyopathy, anaemia, myocarditis, aortic dissection and pulmonary hypertension;
- Pulmonary: pulmonary embolism, pneumonia, pleuritis and pneumothorax;
- Gastrointestinal: oesophageal reflux/spasm, oesophageal rupture and biliary colic;
Musculoskeletal: fractured rib, costochondritis (an inflammation of the costal cartilage of the anterior chest wall, characterised by pain and tenderness), chest wall trauma and Herpes zoster;
- Miscellaneous: anxiety/panic attacks, depression, cocaine use and lymphoma, for example.
What causes increased tactile frematus and decreased tactile frematus
dense or consolidated or collapse of lung or presence of solid mass or inflamed lung tissue (as occurs in pneumonia)
it’s decreased in asthma meaning the lung is filled w air(as occurs in pneumothorax)or fluid in the pleural spaces(as occurs in pleural effusion)or decrease in lung tissue density (as occurs in COPD)
An estimated 4.1 percent of people who have diabetes experience palmar erythema. Autoimmune diseases: More than 60 percent of people who have rheumatoid arthritis experience palmar erythema. Thyroid disease: About 18 percent of people with too much thyroid hormone have palmar erythema and liver cirrhosis
True or false
True
Kyphosis may cause a deformity such as a humpback or hunchback or give patients a pitched-forward appearance. Abnormal kyphosis is more commonly found in the thoracic or thoracolumbar (chest area/middle back)
True or false
True
What’s re the respiratory causes of clubbing
Pulmonary TB Emphysema Bronchiectasis Chronic fibrosing alveolitis Severe chronic cyanosis
What is lung consolidation
Lung consolidation occurs when the air that usually fills the small airways in your lungs is replaced with something else. Depending on the cause, the air may be replaced with: a fluid, such as pus, blood, or water.
Name five diseases associated with splinter hemorrhage
subacute infective endocarditis, scleroderma, trichinosis, systemic lupus erythematosus (SLE), rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome, haematological malignancy, and trauma.
What causes leuconychia striata or muehrcke’s nails
appearance of Muehrcke’s lines is associated specifically with marked hypoalbuminemia (serum albumin ≤ 2.2 g/dL) indicating decreased protein synthesis, which may occur during periods of metabolic stress (e.g. systemic infection, trauma, AIDS, chemotherapy), or in hypoalbuminemic states such as the nephrotic .
Osler’s nodes and Janeway lesions are seen in
Endocarditis
Oslers nodes are found where on the body
the pulp of the terminal phalanx of the finger.
Shifting fullness is done by auscultation true or false
False
the fluid wave test or fluid thrill test is a test for ascites (free fluid in the abdominal cavity). It is performed by having the patient (or a colleague) push their hands down on the midline of the abdomen. The examiner then taps one flank, while feeling on the other flank for the tap. True or false
True
Presence of radio radial delay suggests
Aortic dissection
Aprtic coarctation
Subclavian stenosis
Example of conditions that causes crackles,wheezing,rhonchi
Conditions such as pneumonia or left-sided heart failure may cause this buildup.
Wheezing: Wheezing is a common symptom of conditions that narrow the small airways in the lungs, such as asthma and COPD.
Rhonchi: Rhonchi occur due to conditions that block airflow through the large airways, including the bronchi. There may also be inflammation and fluid in these airways. Conditions such as acute bronchitis and COPD may cause rhonchi,pneumonia,cystic firbiosis ,bronchiectasis as well
Stridor: Stridor occurs in people with an upper airway blockage. A blockage may occur if a person breathes in a foreign object, chemical, or other harmful substance. A traumatic neck or chest injury involving the upper airway could result in a blockage too. Stridor can also be a symptom of inflammatory conditions, such as tonsillitis, epiglottitis, or croup (laryngotracheitis
