Respiratory exam Flashcards
CURB-65 for CAP?
- C - confusion (AMT <8/disoriented)
- U - urea >7
- R - RR >30**
- B - BP <90 or/60
- age >65
(RR>30 most prognostic***)
0-1 = mild 2 = admit >3 = ITU
define tachypnoea?
RR >15
ΔΔ ↓ RR?
ΔΔ • opioids • ↑ CO2 • ↓ thyroid • ↑ ICP • hypothalamic lesions
what is Cheyne-stokes respiration?
when does it happen?
cyclically increasing rate and depth of breathing
then diminishing resp effort and rate
then apnoea/hypopnoea
(b/c delay in circulation time b/n lungs and chemoreceptors)
ΔΔ
• brainstem stroke
• severe HF
• EOL
Hx: patient comes in with panic attack. An ABG is done. what expect to see?
respiratory alkalosis (increased RR)
Hx: patient has high RR, is making sighing noise, and has high blood sugar, ABG shows metabolic acidosis?
• Kussmaul (DKA) ΔΔ • acute renal failure • lactic acidosis • salicylate and methanol poisoning
Ex: patient has central cyanosis, a plethoric complexion, and tobacco staining of the nails. The chest is barrel-shaped and hyperinflated, they’re using accessory muscles to breathe, and have a raised JVP. On auscultation, there is a wheeze and reduced A/E. Swollen ankles.
Diagnosis?
COPD
(plethoric due to secondary polycythaemia)
(ankle swelling due to cor pulmonale)
Ex: respiratory patient presents with left eye dilated, and posteriorly displaced, with a droopy left lid?
HORNER’s syndrome; lung CA (Pancoast tumour)
unilateral • miosis • ptosis • anhidrosis • enophthalmos
ΔΔ if Horner’s syndrome but anhidrosis on chest as well as face?
ΔΔ if no anhidrosis at all?
ΔΔ
• CNS: stroke, SOL, MS
• if none: lesion after ciliary ganglion: carotid artery dissection/aneurysm/cluster headache
Ex: patient has:
- peripherally clubbing, tobacco staining
- fixed and raised JVP, +/- ptosis, cervical lymph enlarged
+/- collapse or effusion Ex
?
lung CA
Ex: reduced expansion, dull percussion, reduced breath sounds and vocal resonance localised to lower left lobe?
lobar collapse
Ex: reduced expansion, STONY dull percussion, reduced or absent breath sounds and vocal resonance?
pleural effusion
- Ex: patient has high HR, hyperinflated chest, and wheeze?
* if agitated + cyanosed + silent chest too?
- asthma
* severe asthma
Ex: low BP, confused, feverish, lymph nodes, with reduced expansion, dull percussion and bronchial breath sounds +/- pleural rub, increased vocal resonance?
pneumonia
Ex: clubbing, central cyanosis, reduced chest expansion and fine end inspiratory crackles?
(ankle swelling a late sign)
idiopathic pulmonary fibrosis (IPF)
also called “fibrosing alveolitis
Ex: pleural friction rub, pleuritic chest pain?
+/- reduced expansion with stony dull percussion
+/- unilateral oedematous warm tender calf
PE
Ex: asymmetrical expansion, resonant percussion, absent breath sounds?
if low BP?
pneumothorax
low BP indicates development of “tension” and reduced venous return to the heart, high risk arrest
Ex: red discolouration on skin?
erythema nodusum (sarcoidosis)
ΔΔ Ex: clubbing?
- lung CA
- ILD
- CF
- AV shunting
non-thoracic: • cirrhosis • coeliac • UC • Crohn's
ΔΔ shaky hands?
- fine tremor (salbutamol)
- flapping tremor/asterixis (CO2 retention/ventilatory failure, can also get in liver/renal failure, CNS lesion, drugs, or electrolyte imbalance)
Ex: ↑JVP?
- right sided HF
- tension pneumothorax
- severe acute asthma
- +/- massive PE
- SVC obstruction (if raised and non-pulsatile)
Ex: hyperinflated patient with ↑JVP, ECHO shows right heart dilatation, pulmonary HT, pulmonary arterial vasocontriction?
cor pulmonale
causing COPD
ΔΔ Ex: lymphadenopathy?
- rubbery - Hodgkins
- tender - dental sepsis, tonsillitis
- matted/stony hard/fixed to deep structures - mets
ΔΔ Ex: tracheal deviation?
- (AWAY) tension pneumothorax
- (TOWARDS) collapse, fibrosis, pneumonectomy
- upper mediastinal mass (retrosternal goitre, lymphoma, lung CA)
Ex: bilateral basal medium crackles?
pulmonary oedema
ΔΔ Ex: common causes of pleural effusion if:
1) protein < 30g (transudate)
2) protein > 30g (exudate)
transudates:
• LVF
• cirrhosis/ low albumin
• peritoneal dialysis
exudates:
• malignancy
• parapneumonic (pneumonia, lung/subphrenic abscess, or bronchiectasis)
Ex: stony dull percussion note, ascites + raised CA-125?
Meigs’ syndrome (ovarian tumour + pleural effusion)
