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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
What would you look for in the neck during a respiratory examination?
1. JVP (elevated in PE, RHF) 2. Trachea 3. Lymph nodes
26
How would you assess the trachea in a patient?
1. Position 2. Cricosternal distance 3. Tug on inspiration
27
What is a normal cricosternal distance?
2-4 fingers, reduced in COPD hyperinflation
28
What do tender lymph nodes mean? And non-tender?
``` Tender = infection Non-tender = suspicious of malignancy ```
29
How would you inspect a patient in a respiratory examination?
1. A-P diameter (increased in COPD) 2. Scars 3. Deformity of chest and spine 4. Intercostal indrawing
30
What scars could you see in a respiratory exam?
Lobectomy Pneumonectomy Chest drains
31
What are significant chest and spine deformities in a respiratory exam?
Pectus excavatum Pectus carinatum (asthma) Scoliosis
32
What is intercostal indrawing a sign of?
COPD (hyperinflation)
33
How would you palpate a patient in a respiratory examination?
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
How would you percuss a patient in a respiratory examination?
Start in supraclavicular fossae and work down 8-10 places Compare side to side including axilla Map out any abnormalities
35
How would you describe a percussion note?
Resonant, stony, dull
36
How would you auscultate a patient in a respiratory examination? (with D!)
Start in supraclavicular fossae and work down 8-10 places Make sure patients is breathing through mouth 2. Vocal resonance 3. Whispering pectoriloquy
37
How can vocal resonance change?
More resonance in consolidation Less resonance in collapse, effusion and pneumothorax
38
How can whispering pectoriloquy change?
Loud conduction of whispered voice due to consolidation
39
What are vesicular versus bronchial breath sounds?
Vesicular: inspiration longer than expiration (soft!) Bronchial: expiration (loud!) longer than inspiration
40
What are wheeze and crepitations a sign of?
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
How would you examine the back of a patient (inspect, palpate etc)
Pt sitting on side of the bedded arms crossed in front to separate scapulae
42
What would you look for in the back and ankles during a respiratory examination?
Back: sacral oedema for RHF Ankles: peripheral oedema for RHF
43
What investigations would you consider after a respiratory exam?
Peak flow, CXR, ABG
44
How would you present your findings of a respiratory exam?
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
What are the findings of consolidation?
No mediastinal shift Dull percussion Bronchial or decreased breath sounds Increased vocal resonance
46
What are the findings of collapse?
Mediastinal shift towards Dull percussion Decreased or absent breath sounds Decreased or absent vocal resonance
47
What are the findings of effusion?
Mediastinal shift away if big Stony dull percussion Decreased or absent breath sounds Decreased or absent vocal resonance
48
What are the findings of pneumonectomy?
Mediastinal shift towards Dull percussion Absent breath sounds Absent vocal resonance
49
What are the findings of pneumothorax?
Mediastinal shift away if tension Hyper resonant percussion Decreased or absent breath sounds Decreased or absent vocal resonance
50
What are signs of hyperinflation?
``` Reduced cricosternal distance Increased AP diameter Intercostal indrawing Apex beat not palpable Hyper-resonant percussion note ```
51
What are causes of fine bibasal crepitations? And coarse?
Fine: pulmonary oedema, interstitial lung disease Coarse: bronchiectesis, cystic fibrosis, bibasal pneumonia
52
What are causes of a transudate effusion?
LVG Volume overload Hypoalbuminaemia Meig's syndrome
53
What are causes of a exudate effusion?
Pneumonia TB PE Mesothelioma
54
What are causes of interstitial lung disease?
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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