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Year 3 - History and Examination > Respiratory exam > Flashcards

Respiratory exam Flashcards

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1
Q

How would you explain and gain consent for a respiratory exam?

A
  • I’ve been asked to do an examination of your lungs today - it will involve having a look at your hands face and neck as well as having a feel and a listen to your lungs. You will have to be exposed from the waist up and the examiner will act as a chaperone today
  • would that be ok?
  • are you in any pain at all
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2
Q

What is the general layout of a resp exam?

A 
1) WIPE
INSPECT, PALPATE, PERCUSS, ASCULTATE
2) Gen inspection (pt and bedside)
3) hands
4) pulse and Resp rate
5) face
6) Neck : JVP raised?, feel for lymphadenopathy.
7) palpate axillary nodes
8) Chest inspection
9) Palpation chest 
10) percussion 
11) tactile vocal fremitus / resonance
12) auscultation
13) peripheral and sacral oedema
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3
Q

what do you look for on gen inspection of the patient and bedside in a resp exam?

A

1) Patient
- alert, comfortable and well at rest , doesn’t look in pain
- cachexic
- SOB / respiratoru distress
- position of patient
- cyanosed

2) Bedside
- oxygen mask
- inhaler
- nebuliser
- peak flow meter
- sputum pot
- spacer

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4
Q

What do you look for on inspection of the hands in a resp exam?

A
  • cap refill
  • tar staining
  • peripheral cyanosis

Nails:
- clubbing

TREMOR
CO2 FLAP

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5
Q

what could cause a fine tremor in a resp exam?

A
  • excessive use of beta agonists like salbutamol or theophylline bronchodilators
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6
Q

What do you look for on inspection of the face?

A

Eyes:
- conjuctival pallor (anaemia)

Horner’s syndrome:

  • ptosis
  • miosis (constricted pupil)

Lips

  • peripheral cyanosis
  • angular stomatitis

tongue - central cyanosis

mouth - oral thrush

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7
Q

what are the causes of hyperventilation?

A
  • anxiety
  • metabolic acidosis
  • toxins
  • head injury
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8
Q

What does hypoventilation indicate?

A
  • ventilatory failure
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9
Q

what does the pulse feel like in CO2 retainers?

A

Pulse will be large in volume (bounding) do to the vasodilatory effects of CO2 and tachycardic.

peripheries will be warm

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10
Q

what are the resp causes of a raised JVP?

A
  • Cor pulmonale
  • elevated intrathoracic pressures (acute sever asthma or tension pneumothorax)
  • SVC obstruction
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11
Q

What are the causes of clubbing (respiratory and other)

A
  • bronchial carcinoma
  • chronic suppurative lung disease e.g. cystic fibrosis, bronchiectasis
  • fibrosing alveolitis
  • cyanotic heart disease
  • infective endocarditis
  • liver cirrhosis
  • Inflammatory Bowel Disease
  • Idopathic
  • familial
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12
Q

How could you describe a palpable lymph node?

A
  • rubbery (hodgkin’s disease)
  • tender (tonsilitis)
  • matted together (TB and metastatic disease)
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13
Q

What do you look for on inspection of the chest in a resp exam?

A
  • scars (thoracotomy, sternocotomy)
  • chest wall deformities (kyphoscoliosis, barrell chest, pectus excavatum, pectus carinatum)
  • chest drain
  • dilated superficial veins due to SVC obstruction
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14
Q

What is barrel chest usually associated with

A
  • COPD (hyperinflation)

- kyphoscoliosis

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15
Q

What is pectus excavatum associated with?

A

pulmonary hypertension

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16
Q

What is thoracic kyphoscoliosis associated with?

A

May be idiopathic or secondary to childhood poiomyelitis.
Or spinal TB.

It causes decreased ventilatory capacity and increased work of breathing

17
Q

what is pectus carinatum associated with?

A

pectus carinatum aka pigeon chest.

sign of chronic resp disease since childhood.

18
Q

what do you palpate in a resp exam?

A
  • tracheal position (assess for any tracheal deviation)
  • palpate of apex beat
  • chest expansion (upper, middle and lower zones
19
Q

What are the diagnosis of an impalpable apex beat?

A
  • emphysema
  • dextrocardia
  • obesity
  • large pleural effusion
20
Q

What are the causes of unilateral reduced expansion?

A
  • pneumothorax
  • pleural effusion
  • pneumonia
  • collapse
21
Q

What conditions would you find tracheal deviation towards the pathology?

A

lobar collapse

pneumonectomy

22
Q

What conditions would you find tracheal deviation away from pathology?

A

large pleural effusion

tension pneumothorax

23
Q

what could be the cause of a hyper resonant percussion note (resp exam)?

A

Large air filled spaces e.g.

  • markedly emphysemous lung
  • pneumothorax
24
Q

What could be the cause of a dull percussion note (resp exam)?

A

Lung separated from the chest wall

e. g. pleural fluid
- consolidation
- collapse

25
Q

what could be the cause of a stony dull percussion note (resp exam)?

A

stony dull percussion is characteristic of a large pleural effusion

26
Q

What does normal vesicular breathing sound like?

A
  • rustling quality

- sound should increase steadily during inspiration then fade quickly during expiration

27
Q

What could be the cause of diminished vesicular breathing sounds?

A

Thick chest wall:
- pleural thickening

Or if sound conduction is reduced:
- emphysema or shallow breathing

28
Q

What does diminished vesicular breathing sound like?

A
  • similar in character to normal vesicular breathing but quieter.
29
Q

What does bronchial breathing sound like?

A
  • breath sounds are loud and billowing.
  • similar pitch and length of inspiration and expiration.
  • audible gap between inspiration and expiration.
30
Q

what could be the cause of bronchial breathing?

A
  • pneumonic consolidation
31
Q

what are the causes of early inspiratory crackles?

A

small airway disease such as bronchiolitis

32
Q

what are the causes of mid inspiration crackles?

A

pulmonary oedema

33
Q

what are the causes of late inspiration crackles

A
  • interstitial lung disease
  • COPD
  • pneumonia
34
Q

what causes crackles throughout inspiration and expiration?

A

bronchiectasis

35
Q

what is the creaking sound that sounds like crunching snow or creaking of leather -heard on auscultation?

A

Pleural rub

36
Q

what are the causes of pleural rub heard on auscultation whilst deep breathing?

A

pneumonia

pulmonary embolism

37
Q

on tactile vocal resonance what could be a cause of increased sound transmission ?

A

consolidation

38
Q

how do you differentiate between consolidation and pleural effusion with tactile vocal resonance?

A

consolidation - sound will be louder

pleural effusion - sound will be quieter.

39
Q

what are the causes of interstitial lung disease?

A

1) idiopathic

2) Extrinsic allergic alveolitis:
- pigeon fancier’s lung
- farmer’s lung

3) Sarcoidosis

4) Autoimmune
- RA,
- systemic sclerosis
- ankylosing spondylitis

5) Occupational
- asbestos
- pneumoconiosis
- silicosis

6) drugs
- methotrexate
- amiodarone
- nitrofurantoin

7) familial

Year 3 - History and Examination (22 decks)

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