Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Skills > Respiratory Exam > Flashcards

Respiratory Exam Flashcards

1
Q

Two components of a respiratory exam

A
  1. Extra pulmonary portion

2. Pulmonary portion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Extrapulmonary examination- areas of examination

A

1) Detection of cyanosis
2) Clubbing of fingers
3) Trachea
4) Accessory respiratory muscles
5) Lymph nodes
6) Ears
7) Noses
8) Sinuses
9) Mouth/throat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Meaning of cyanosis

A

-bluish coloured skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of cyanosis

A
  • central

- peripheral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cause of peripheral cyanosis

A
  • usually normal

- related to constriction of vessels in the extremities (ex due to cold)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cause of central cyanosis

A

Low oxygen in blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Sign of central cyanosis

A

Lips and face?? really thought the lips were not included -want to look orally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Haemoglobin in blood to see cyanosis

A

-must be 5gm/dl of deoxygenated haemoglobin present to see cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clubbing of fingers -in which patients do see

A
  • chronically hypoxemic patients (but also in patients with normal O2 levels)
  • congenital heart disease
  • lung cancer
  • lung absces
  • empyema
  • cystic fibrosis
  • gi causes (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Recognizing clubbing

A

Curving of the fingernails
Softening of the nail bed
Loss of angle between the nail and dorsum of the finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Shifting of trachea with age

A

May be shifted slightly to the right in older people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pathological shifting of the trachea

A

1) Pushed to the opposite side by a large pneumothorax or pleural effusion
2) Drawn towards the side of extensive atelectasis
3) Thyroid enlargement may shift it either way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examination of trachea

A

Patients head in mild flexion by the one or two finger method
Compare distance from lateral tracheal wall to the bony medial border of the suprasternal notch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Accessory respiratory muscles-when do see

A

Normally not seen unless the patient is very short of breath

in a patient with obstructive lung disease -seeing this correlated with FEV1 <30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Accessory resp muscles -which is the most evident in the dyspnoeic patient

A

-sternocleidomastoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lymph nodes -which to palpitate

A

1) Occipital
2) Pre and post auricular nodes
3) Sub-mandibular nodes
4) Anterior and posterior cervical nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lymph nodes -what to note

A
  • soft, tender, mobile nodes = associated with infection

- firm/hard “matted down” nodes -signify malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lymph node in neck most frequently involved wiht lung cancer

A

Supraclavicular nodes (node may feel like a hard pea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ears examination

A
  • examine auricle of ear
  • check behind ear for nodes
  • check the lobule and helix for infected piercings from earrings
  • using ototscope look at auditory canal - note wax and other foreign bodies
  • look for redness/swelling of otittis externa
  • assess tympanic membrane for perforations, redness and bulging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Nose

A

1) examine the nose looking for foreign bodies
2) assess health of mucosa (redness, swellling, bleeding/scabbing of Little’s area
3) Assess for deviation of the septum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Sinuses

A

1) Press up on the frontal sinues from under the bony brows

2) Press up on maxillary sinuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mouth/throat

A
  • examine the teeth, gingiva, tongue and pharynx

- note presence/absence of tonsils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

4 components of pulmonary exam

A

1) Inspection
2) Palpation
3) Percussion
4) Auscultation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Inspection

A

1) observe patient for extrapulmonary signs - cyanosis, dyspnoea, accessory muscles
2) antero-posterior diamter
3) Deformities
4) Thoracic and/or abdominal breathing - is it symmetrical/regular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Where see antero-posterior diameter changes

A

With severe obstructive lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Deformities seen

A

1) Kyphosis (increase in thoracic convexity)
2) Scoliosis (lateral curve of spine)
3) Kyphoscoliosis (combined kyphosis and scoliosis)
4) Pectus excavatum -severe retraction f sternum
5) Pectus carinatum - anterior protrusion of the sternum

27
Q

Palpation of chest wall

A
  • feel for masses and tenderness in the ribs and carilage

- feel for nodes in the axillae

28
Q

Chest wall exercusion

A
  • feel for decreased movement

- with a breath lung begins to move later and move less than the normal one

29
Q

Chest wall exercusions movement of

a) lower lobe
b) upper and middle lobes

A

a) lower lobe - lateral movement

b) upper & middle lobe - anterior movement

30
Q

Methods assessment of lower lobes

A
  • place palms on posterolateral chest with fingers apart
  • patient takes deep breath in
  • watch movement of your thumbs

OR

  • place fingers tightly in the interspaces
  • Try to restrict the movement of the chest
  • Have patient inhale and feel any variation in thoracic excursion
31
Q

Upper lobe and middle lobe -method of assessment

A

Place hands lightly over anterior chest between clavicle and coastal margin
Have patient inhale
-feel chest move anteriorly

32
Q

Modified hoovers sign

A

-Normally the lateral ribs flare and the costal margin widens with a deep inspiration
-If the lungs are over-inflated with a low flat diaphragm the lateral chest wall may be drawn inwards with inspiration
Very common in patients with severe COPD

33
Q

Tactile fremitus

A

Vibrations from a patients voice detected by examiners hand on patients chest

34
Q

Method of assessing tactile fremitus

A

-use palms or fingers or ulnar border of hand
-compare sies
Posteriorly:
-upper 1/3 (upper lobe)
-middle 1/3 (superior segment of lower lobe)
-lower 1/3 (basal segments)
a) medial to mid scapular line
b) lateral to mid scapular line
-axillae
Anteriorly
-place hand in area between clavicle and rib margin

35
Q

In which disorders is tactile fremitus increased

A

-where lung is more dense –> consolidation of pneumonia or atelectasis

36
Q

In which disorders is tactile fremitus absent

A

Pneumothorax

Pleural effusion which decreases the transmision of vibrations

37
Q

Techique for percussion -position of patient

A

Patient should be sitting up

When percussing posteriorly have patients cross arm across anterior of chest

38
Q

Locations to percuss

A
  • same as tactile fremitus

- percuss about 3x at each site comparing side for side

39
Q

5 types of percussion note and meaning

A

1) Normal resonance - normal lung
2) Dullness- over consolidation/similar to note over liver
3) Flat - over large pleural effusion / similar to note over thigh
4) hyper-resonance - over large pneumothorax
5) Tympanic -a hollow sound - as over stomach bubble

40
Q

percussion of the diaphragm - location

A

Level of 9th posterior rib in mid scapular line

May be 1-2 cm higher on right

41
Q

Assessing diaphragmatic exercusions

A

Compare position and maximum expiration and inspiration
Normal exercuion 5–7 cm
(only do so if suspect diaphragmatic weakness)

42
Q

Stridor

A

The sound of partial upper airway obstruction

Heard in inspiration

43
Q

Things to hear without a stethoscope

A

1) Hoarse voice
2) Stridor
3) Wheeze
4) Normal breathing > 1 m away at rest

44
Q

Using the stethoscope to assess breath sounds

A
  • patient take deep breaths with mouth open

- compare equivalent sites ver each lung in same areas as tactile fremitus and percussion

45
Q

Types of breath sounds

A
  1. Normal/vesicular breathing - inspiratory phase 3x expiratory phase
    - abnormal if these sounds not present
  2. Bronchial breath sounds - high pitched and loud, inspiratory = expiratory phase
    - gap between inspiration and expiration
    - heard over consolidation (i.e. pneumonia)
  3. Broncho-vesicular sounds
    - a little louder than vesicular
    - heard over the right upper lobe anteriorly or between the scapulae
  4. Tubular breath sounds -very harsh, normally heard over the trachea or sometimes over consolidation
46
Q

Crackles

A

Due to opening of small airways o secretions

Sounds like velcro coming apart

47
Q

Types of crackles

A
  • coarse
  • fine
  • early
  • late
  • continuous
48
Q

Causes of early crackles

A
  • bronchiectasis

- asthma (occasionally)

49
Q

Causes of late crackles

A
  • pulmonary fibrosis

- congestive heart failure

50
Q

Causes of continuous crackles

A

Pneumonia

51
Q

Wheezes

A

a continuous sound in expiration

52
Q

Causes of wheezes

A
  • bronchospasm
  • secretions
  • airway collapse or obstruction
53
Q

Pleural rub

A
  • due to inflamed surface of the pleura rubbing against each other
  • present in inspiration & expiration
  • sounds like squeaky door
  • dissapears with fluid formation
54
Q

Causes of pleural rub

A

Pleuritis usually due to pneumonia or pulmonary infarct

55
Q

If lung cancer is suspected what should do

A

Feel for

  • supraclavicular nodes
  • bony tenderness
56
Q

If sarcoid is suspected what should do

A

Feel for all lymph nodes

57
Q

Normal lung

a) Tracheal shift
b) percussion
c) breath sounds
d) fremitus
e) adventitious sounds

A

a) none
b) N
c) N
d) N
e) O

58
Q

Consolidation

a) Tracheal shift
b) percussion
c) breath sounds
d) fremitus
e) adventitious sounds

A

a) none
b) dull
c) bronchial
d) increased
e) crackles

59
Q

Pleural effusion

a) Tracheal shift
b) percussion
c) breath sounds
d) fremitus
e) adventitious sounds

A

1) to opposite side
2) dull/flat
3) decrease
4) absent
5) O

60
Q

Pneumothorax

a) Tracheal shift
b) percussion
c) breath sounds
d) fremitus
e) adventitious sounds

A

1) to opposite side
2) hyper resonant
3) Decreased
4) Absent
5) O

61
Q

Atelectasis

a) Tracheal shift
b) percussion
c) breath sounds
d) fremitus
e) adventitious sounds

A

1) To same side
2) Dull
3) Decreased
4) Increased/decreased
5) crackles

62
Q

Asthma

a) Tracheal shift
b) percussion
c) breath sounds
d) fremitus
e) adventitious sounds

A

1) none
2) N
3) N or decreased
4) n
5) Wheezes

63
Q

Emphysema

a) Tracheal shift
b) percussion
c) breath sounds
d) fremitus
e) adventitious sounds

A

1) None
2) Hyper resonant
3) Decreased
4) Decreased
5) variable

Clinical Skills (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions