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Physical Examinations > Respiratory exam > Flashcards

Respiratory exam Flashcards

1
Q

What signs are there of respiratory distress on general inspection?

A 
Tachypnoea (rapid breathing)
Nasal flaring
Tracheal tug
Accessory muscle
Intercostal, subcostal and sternal recession
Pulsus paradoxus
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2
Q

What is pulsus paradoxus?

A

Systolic pressure weakens by >10mmHg on inspiration

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3
Q

What is tracheal tug?

A

Pulling of thyroid cartilage towards sternal notch in inspiration.

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4
Q

Which are the accessory muscles?

A

Sternocleidomastoid
Platysma
Infrahyoid

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5
Q

What should you look for around the patient?

A 
O2
Nebulisers
Inhaler
Sputum pots (look!)
Cigarettes
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6
Q

When would you see paradoxical breathing?

A

Paralysed diaphragm

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7
Q

How does paradoxical breathing present?

A

Abdomen sucked in with inspiration.

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8
Q

On general inspection what do you look for?

A 
Cachetic?
Uncomfortable at rest. 
Pain
Cyanotic
Alert/drowsy
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9
Q

What might respiratory distress be due to? 4 things.

A

COPD
Pleural effusion
Pneumothorax
Severe asthma

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10
Q

On general inspection, what would you listen for?

A 
Speech
Stridor
Wheeze
Cough
Clicks
Gurgling
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11
Q

Abnormal speech due to?

A

Obstruction, recurrent laryngeal nerve palsy.

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12
Q

Causes of stridor?

A

Airway obstruction (broncial carcinoma, retrosternal thyroid)

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13
Q

How would you categorise a cough?

A

Dry, bovine (non-explosive, unable to close glottis), productive.

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14
Q

Causes of clubbing?

A

Idiopathic pulmonary fibrosis
Lung cancer
Sarcoidosis

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15
Q

What is Pancoast’s tumour?

A

A tumour at the pulmonary apex, invades the sympathetic plexus of the neck, brachial plexus, recurrent laryngeal nerve.

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16
Q

Why would intrinsic hand muscles waste?

A

T1 lesion/damage of brachial plexus due to Pancoast’s tumour.

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17
Q

How would an apical lung tumour invading sympathetic neck plexus present?

A

Ipsilateral Horner’s

18
Q

How would an apical lung tumour invading recurrent laryngeal nerve present?

A

Hoarse voice, bovine cough.

19
Q

How would an apical lung tumour invading brachial plexus present?

A

Wasting of intrinsic muscles of hand (and arm).

20
Q

Why do you check for hand tremor?

A

Beta agonist use

21
Q

What is asterixis?

A

Flap of the hands. CO2 retention (i.e too little co2 removed by the lungs).

22
Q

What would tender wrists indicate?

A

Hypertrophic pulmonary osteoarthropathy (ca)

23
Q

Bounding pulse indicates?

A

Co2 retention (leaping and forceful that quickly disappears).

24
Q

What is Horner’s syndrome?

A

Deficiency in sympathetic outflow - symptoms appear on the ipsilateral side as the site of the lesion.

25
Q

What are the symptoms of Horner’s syndrome?

A

Ptosis, miosis, anhydrosis.

26
Q

What distance of crico-sternal expansion is hyperexpansion?

A

> 3cm

27
Q

How would severe airflow limitation manifest?

A

Tracheal tug (with inspiration)

28
Q

What is Cor Pulmonale?

A

Enlargement and failure of the right ventricle due to increased pulmonary pressure/vascular resistance. Raised JVP.

29
Q

What might cause lymphadenopathy?

A

Cancer

TB

30
Q

Would a tension pneumothorax cause tracheal deviation away from or towards?

A

Away

31
Q

Why might the apex beat be impalpable?

A

Pleural effusion
COPD
Dextrocardia

32
Q

How far should the chest wall expand?

A

5cm or more

33
Q

What does increased consolidation imply (tactile vocal fremitus).

A

d

34
Q

Why should you palpate the left supraclavicular node (aka Virchow’s node?

A

It drains the thoracic duct. An elarged node indicates metastatic neoplasm e.g. lung or abdominal.

35
Q

What is an enlarged supraclavicular node called?

A

Troisier’s sign.

36
Q

What 5 things might cause a dull percussion note?

A 
Consolidation
Pleural effusion
Collapse
Fibrosis
Pleural thickening
37
Q

Where does liver dullness usually reach?

A

Up to the 5th rib, right mid-clavicular line

38
Q

What does it imply if you hear resonant percussion below the 5th rib, right mid-clavicular line?

A

Lung hyper-expansion.

COPD, asthma

39
Q

On percussion, what does hyper-resonance indicate?

A

Pneuothorax or hyperinflation (COPD)

40
Q

What might cause hyperinflation?

A

COPD, cystic fibrosis or asthma

41
Q

What is bronchial breathing and how does it sound?

A

Harsh. Gap between inspiration and expiration. Expiration may be high pitched.

Physical Examinations (2 decks)

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