respiratory exam glossary

Question 1

Pulsus paradoxes

Answer 1

This is an exaggeration of the normal pattern whereby the systolic pressure and the pulse pressure fall during inspiration. Normally the decrease in systolic pressure as measured by a sphygnomanometer is less than 10 mmHg.
Pulsus paradoxus is occasionally observed in patients with obstructive airways disease (asthma) and pericardial tamponade.

Question 2

Stridor

Answer 2

Incomplete obstruction to airflow within the upper respiratory tract leads to turbulence and the intense musical sound of stridor.

Question 3

Hoarse

Answer 3

(of a person’s voice) sounding rough and harsh, typically as the result of a sore throat or of shouting: a hoarse whisper.

Question 4

Cachexia

Answer 4

a condition caused by chronic disease characterized by wasting, emaciation (abnormally thin), feebleness (weak), and inanition (exhaustion caused by lack of nurishment).

Question 5

purulent

Answer 5

consisting of or containing pus.

Question 6

mucoid

Answer 6

involving, resembling, or of the nature of mucus.

Question 7

Cyanosis

Answer 7

This is a blue discoloration of the skin caused by 5 g or more of reduced haemoglobin per 100 ml of blood in the capillaries.

Question 8

Central cyanosis

Answer 8

Central cyanosis only occurs when the oxygen saturation of arterial blood is less than 85%. Causes include:

-decreased PO2 of inspired air - high altitude
hypoventilation
-parenchymal lung disease - massive pulmonary embolism, chronic airflow limitation with cor pulmonale
-right to left cardiac shunt - congenital cyanotic heart disease

Central cyanosis may be simulated by methaemoglobulinaemia and sulphaemoglobulinaemia. Also, a patient with polycythaemia may present with central cyanosis.

Question 9

Peripheral cyanosis

Answer 9

This is due to poor peripheral circulation.

Possible causes:

• all causes of central cyanosis cause peripheral cyanosis
• low cardiac output e.g. heart failure
• vasoconstriction e.g. due to low ambient temperature, Raynaud’s phenomenon
• arterial obstruction e.g. atheroma
• venous obstruction

Question 10

Tension pneumothorax

Answer 10

A tension pneumothorax develops when there is an oblique opening into the pleura which acts as a flap valve. Air enters into the pleural cavity during inspiration but cannot escape during expiration. Pressure within the pleural cavity increases progressively, collapsing the lung and shifting the mediastinum to the opposite side. This is an emergency requiring urgent decompression. Untreated, the patient may die within minutes.

Question 11

Pleural effusion

Answer 11

The pleural cavity is a potential space which normally contains little fluid.

A pleural effusion is an accumulation of fluid within the pleural space.

The fluid may be either transudative or exudative:

• a transudate results from an alteration in the hydrostatic forces operating across the pleural membrane
• an exudate results from a change in the permeability of the membrane due to inflammation

A pleural effusion will only be detected:

• on a chest radiograph when the volume of the effusion exceeds 300 ml
• clinically when the volume exceeds 500 ml

Question 12

Lymphadenopathy

Answer 12

Lymphadenopathy is disease of the lymph nodes. Often the term is used to refer to palpable lymph nodes - i.e. nodes which are swollen, and thus by implication are diseased.

Question 13

Pectus excavatum

Answer 13

Pectus excavatum is the most common congenital deformity of the chest wall. The primary problem is a deformity of the costal cartilages which develop in a concave position and depress the sternum towards the vertebral column. The condition is usually apparent at birth and worsens with time. It may be familial.

Question 14

Pectus carinatum

Answer 14

Pectus carinatum describes a deformity of the chest wall in which there is an outward bowing of the sternum. It is often considered a congenital condition though it is probably acquired as a result of childhood respiratory illness or rickets.

Pectus carinatum is caused by an upward curving of the lower costal cartilages, usually the fourth to eighth, which push the sternum forward. It is less common than pectus excavatum.

The condition is benign and usually asymptomatic.

Surgical correction is possible

Question 15

Barrel chest

Answer 15

In a hyperinflated chest radiograph, more than six ribs can be seen above the diaphragm in the mid-clavicular line. There are also flat hemidiaphragms

Causes of hyperinflation include:

• asthma
• chronic obstructive airways disease

Question 16

Kyphosis

Answer 16

Kyphosis is a flexed curvature of the spine in a sagittal plane, as is present normally in the thoracic and sacral regions. However, the term has come to mean a pathological excessive curvature in this direction.

A postural kyphosis is common. This condition is known as a ‘round back’ or ‘drooping shoulders’. A postural kyphosis may be associated with other postural defects such as flat feet. This condition is voluntarily correctable.

A kyphosis is described as structural if it is fixed and is associated with changes in the shape of vertebrae. This condition may occur in osteoporosis of the spine, Paget’s disease, adolescent kyphosis - Scheuermann’s disease - and ankylosing spondylitis.

Kyphosis most commonly affects the thoracic spine. An abrupt alteration in the normally smooth thoracic curvature is called angular kyphosis

Question 17

Scoliosis (2 types)

Answer 17

This is a curve of the spine in the coronal plane.

1- Non-structural or mobile scoliosis has no rotational element - the curvature is secondary or compensatory to some condition outside the spine and disappears when that is corrected - for example, leg inequality produces a scoliosis which is corrected by sitting.

2- In structural or true scoliosis, the deformity is non-correctible - the curve is associated with rotation and sometimes, wedging of the vertebrae.

When scoliosis gives pain in a child or adolescent, especially when this occurs at night consider causes such as an osteoid osteoma, osteoblastoma or spinal tumour.

Question 18

Tachypnoea

Answer 18

A raised respiratory rate