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OSCE - examinations > Respiratory exam > Flashcards

Respiratory exam Flashcards

1
Q

What would you look for at the end of the bed in a respiratory examination?

A
  1. General appearance - well/unwell/distressed/dyspnoeic
  2. Accessory muscle use and pursed-lip breathing
  3. Nutritional status and cachexia
  4. Oxygen, fluid and medications
  5. Look inside sputum pot
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2
Q

What is pursed-lip breathing a sign of?

A

Lower airway obstruction, often COPD

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3
Q

What is cachexia a sign of?

A

COPD and malignancy

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4
Q

What would you describe about sputum?

A

Purulence, colour, presence of blood

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5
Q

What would you look for in the hands during a respiratory examination?

A
  1. Peripheral cyanosis
  2. Temperature
  3. Dilated veins
  4. Tar staining and coal dust tattoos
  5. 1st web space wasting
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6
Q

What causes peripheral cyanosis?

A

PVD
Raynaud’s
CCF

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7
Q

What causes dilated veins?

A

Hypercapnia

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8
Q

What does mining increase the risk of?

A

Pneumoconiosis

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9
Q

What is 1st web space wasting a sign of?

A

Pancoast tumour, T1 lesion

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10
Q

What would you look for in the nails during a respiratory examination?

A
  1. Clubbing

2. Koilonychia

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11
Q

What are respiratory causes of clubbing?

A

Cancer, IDL, suppurative lung disease

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12
Q

Why is koilonychia important in a respiratory context?

A

Anaemia is a cause of shortness of breath

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13
Q

What would you look for in the wrists during a respiratory examination?

A
  1. Flapping tremor
  2. Physiological tremor
  3. Respiratory rate
  4. Heart rate and volume
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14
Q

What is a flapping tremor a sign of?

A

Respiratory failure (CO2 retention)
Liver failure (hepatic encephalopathy, acute liver disease)
Renal failure
Wilson’s disease

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15
Q

What is physiological tremor a sign of?

A

Beta2 agonist medication (salbutamol)

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16
Q

When is the volume of a radial pulse bounding?

A

Hypercapnia

And tachycardia in B2-agonist use

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17
Q

What would you look for in the face during a respiratory examination?

A

Cushingoid appearance

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18
Q

What is part of a Cushingoid appearance?

A

Moon face
Acne
Hirsute

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19
Q

What is a Cushingoid appearance a sign of?

A

Longterm steroid use

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20
Q

What would you look for in the eyes during a respiratory examination?

A

Conjunctival pallor for anaemia (SoB)

Horner’s (pancoast tumour)

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21
Q

What are the parts of Horner’s?

A

Ptosis - drooping of upper eyelid
Miosis - pupil constriction
Anhydrosis - no tears

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22
Q

What would you look for in the mouth during a respiratory examination?

A

Central cyanosis

Candida

23
Q

What can cause central cyanosis?

A

Hypoxic lung disease
Cardiac shunt
Abnormal Hb

24
Q

What can cause candida?

A

Steroid use

25
Q

What would you look for in the neck during a respiratory examination?

A
  1. JVP (elevated in PE, RHF)
  2. Trachea
  3. Lymph nodes
26
Q

How would you assess the trachea in a patient?

A
  1. Position
  2. Cricosternal distance
  3. Tug on inspiration
27
Q

What is a normal cricosternal distance?

A

2-4 fingers, reduced in COPD hyperinflation

28
Q

What do tender lymph nodes mean? And non-tender?

A 
Tender = infection
Non-tender = suspicious of malignancy
29
Q

How would you inspect a patient in a respiratory examination?

A
  1. A-P diameter (increased in COPD)
  2. Scars
  3. Deformity of chest and spine
  4. Intercostal indrawing
30
Q

What scars could you see in a respiratory exam?

A

Lobectomy
Pneumonectomy
Chest drains

31
Q

What are significant chest and spine deformities in a respiratory exam?

A

Pectus excavatum
Pectus carinatum (asthma)
Scoliosis

32
Q

What is intercostal indrawing a sign of?

A

COPD (hyperinflation)

33
Q

How would you palpate a patient in a respiratory examination?

A
  1. Chest expansion at least 2 places
  2. Apex beat (mediastinal shifts due to collapse or tension)
  3. RV heave (RVH and possible cor pulmonale)
34
Q

How would you percuss a patient in a respiratory examination?

A

Start in supraclavicular fossae and work down 8-10 places
Compare side to side including axilla
Map out any abnormalities

35
Q

How would you describe a percussion note?

A

Resonant, stony, dull

36
Q

How would you auscultate a patient in a respiratory examination? (with D!)

A

Start in supraclavicular fossae and work down 8-10 places
Make sure patients is breathing through mouth

  1. Vocal resonance
  2. Whispering pectoriloquy
37
Q

How can vocal resonance change?

A

More resonance in consolidation

Less resonance in collapse, effusion and pneumothorax

38
Q

How can whispering pectoriloquy change?

A

Loud conduction of whispered voice due to consolidation

39
Q

What are vesicular versus bronchial breath sounds?

A

Vesicular: inspiration longer than expiration (soft!)

Bronchial: expiration (loud!) longer than inspiration

40
Q

What are wheeze and crepitations a sign of?

A

Wheeze: small airway obstruction (asthma, COPD)

Crepitations: fluid in airspaces: secretions, pus, oedema
- ask pt to cough and then listen again; normal secretions clear after cough

41
Q

How would you examine the back of a patient (inspect, palpate etc)

A

Pt sitting on side of the bedded arms crossed in front to separate scapulae

42
Q

What would you look for in the back and ankles during a respiratory examination?

A

Back: sacral oedema for RHF

Ankles: peripheral oedema for RHF

43
Q

What investigations would you consider after a respiratory exam?

A

Peak flow, CXR, ABG

44
Q

How would you present your findings of a respiratory exam?

A
  1. Patient was (dyspneic/comfortable) at rest breathing (air/O2) and (cyanosed/not cyanosed)
  2. The respiratory rate was X breaths per minute
  3. Comment on clubbing, lymphadenopathy and mediastinal shift
  4. List any other peripheral signs
  5. Comment on expansion, percussion, breath sounds, added sounds and vocal resonance
  6. Give differential diagnosis
  7. Comment on presence or absence of cor pulmonale if chronic lung disease like COPD or ILD
45
Q

What are the findings of consolidation?

A

No mediastinal shift
Dull percussion
Bronchial or decreased breath sounds
Increased vocal resonance

46
Q

What are the findings of collapse?

A

Mediastinal shift towards
Dull percussion
Decreased or absent breath sounds
Decreased or absent vocal resonance

47
Q

What are the findings of effusion?

A

Mediastinal shift away if big
Stony dull percussion
Decreased or absent breath sounds
Decreased or absent vocal resonance

48
Q

What are the findings of pneumonectomy?

A

Mediastinal shift towards
Dull percussion
Absent breath sounds
Absent vocal resonance

49
Q

What are the findings of pneumothorax?

A

Mediastinal shift away if tension
Hyper resonant percussion
Decreased or absent breath sounds
Decreased or absent vocal resonance

50
Q

What are signs of hyperinflation?

A 
Reduced cricosternal distance
Increased AP diameter 
Intercostal indrawing
Apex beat not palpable 
Hyper-resonant percussion note
51
Q

What are causes of fine bibasal crepitations? And coarse?

A

Fine: pulmonary oedema, interstitial lung disease

Coarse: bronchiectesis, cystic fibrosis, bibasal pneumonia

52
Q

What are causes of a transudate effusion?

A

LVG
Volume overload
Hypoalbuminaemia
Meig’s syndrome

53
Q

What are causes of a exudate effusion?

A

Pneumonia
TB
PE
Mesothelioma

54
Q

What are causes of interstitial lung disease?

A
  1. Idiopathic
  2. Due to inhaled antigen
  3. Dude to inhaled irritant (asbestos, coal, silicosis)
  4. Associated with systemic disease (SLE, RA, sarcoid)
  5. Iatrogenic (methotrexate, amiodarone, radiotherapy)

OSCE - examinations (13 decks)

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