Respiratory Exam Flashcards
How does type of cough guide differential?
Productive: COPD, CF, Pneumonia, Bronchiectasis
Dry: Asthma + interstitial lung disease
3 conditions a/w WHEEZE
COPD
Asthma
Bronchiectasis
(LRT pathology)
2 causes of stridor
Inhaled foreign object
Subglottic stenosis
URT pathology
List 6 signs of respiratory distress
Tachypnoea
Nasal flaring
Tracheal tug (pulling of thyroid cartilage towards sternal notch in insp). Descent of trachea with insp limiting airflow.
Use of access muscles
Intercostal, subcostal, sternal recession
Pulsus paradoxus
What is indicated by cachexia?
Malignancy
End stage lung disease e.g. COPD
4 respiratory causes of clubbing
Chronic hypoxia in lung cancer (esp. Squamous cell carcinoma)
Interstitial lung disease
CF
Bronchiectasis
What may cause a plethoric complexion of the face?
Polycythaemia secondary to COPD
CO2 retention in T2 respiratory failure
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 respiratory pathology can cause a raised JVP?
Pulmonary HTN due to COPD/ ILD can cause cor pulmonale leading to raised JVP
5 radiotherapy associated skin changes that may be seen in respiratory exams
Xerosis (dry skin)
Scale
Hyperkeratosis (thickened skin)
Depigmentation
Telangiectasia
Describe what causes deviation of the trachea away and towards a pathology
Towards: Lobar collapse, Pneumonectomy, Pulmonary fibrosis
Away: Tension pneumothorax, Large pleural effusion
What does this indicate?
Lung volume reduction surgery
What is seen here?
Healed chest drain incision
What is seen here? What does this indicate?
Posterolateral thoracotomy
Lobectomy
Pneumonectomy
What is seen here? What does this indicate?
Clamshell/ bilateral anterolateral thoracotomy / transverse sternotomy
Lung transplantation
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?
Protrusion of sternum + ribs
= pigeon chest
Chronic resp 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 is indicated by dullness to percussion?
Increased tissue density:
cardiac dullness
consolidation
tumour
lobar collapse
What is indicated to stony dullness on percussion?
Pleural effusion
What is indicated by hyper-resonance on percussion?
Decreased tissue density- pneumothorax
Bronchial breath sounds
Harsh, pause in-between inspiration + expiration
a/w consolidation
What is suggested by quiet breath sounds?
Reduced air entry into that region of the lung e.g. pleural effusion, PTX
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
PTX
List 4 respiratory causes of lymphadenopathy
Lung cancer
URTI
Tuberculosis
Sarcoidosis
If you hear crepitations what should you do?
Ask patient to cough
Note whether creps clear after coughing
Ask patient to lean forward
Note whether creps clear on leaning forward
