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Respiratory > Respiratory Examination > Flashcards

Respiratory Examination Flashcards

1
Q

What are the main respiratory system presenting symptoms?

A
  • Cough
  • Haemoptysis
  • Dyspnoea
  • Hoarseness
  • Wheeze
  • Fever/night sweats
  • Chest pain
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2
Q

What should you ask about in a resp system past medical history?

A
  • pneumonia/bronchitis
  • TB
  • Atopy - asthma, eczema, hay fever
  • previous CXR abnormalities
  • lung surgery
  • myopathy
  • neurological disorders
  • CT disorders - rheumatoid, SLE
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3
Q

What is a loud brassy cough characterisitic of?

A

pressure on the trachea (tumour)

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4
Q

What is a hollow, bovine cough characteristic of?

A

recurrent laryngeal nerve injury

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5
Q

What is a barking cough characteristic of?

A

occur in croup (infection of the upper airway)

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6
Q

What are the main causes of chronic cough?

A
  • pertussis
  • TB
  • asthma
  • foreign body
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7
Q

What are the main causes of a dry chronic cough

A
  • acid irritation (GORD)
  • ACEi
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8
Q

What is haemoptysis?

A

coughing up blood

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9
Q

What are the main infective causes of haemoptysis?

A
  • TB
  • bronchitis
  • pneumonia
  • abscess
  • COPD
  • Viruses
  • fungi
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10
Q

What are the main categories that cause haemoptysis?

A
  • Infective
  • Neoplastic
  • Vascular
  • Parenchymal
  • Pulmonary hypertension
  • Coagulopathies
  • Trauma/foreign body
  • Pseudo-haemoptysis
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11
Q

What are the vascular causes of haemoptysis?

A
  • PE
  • Vasculitis
  • AVM
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12
Q

What are the parenchymal causes of haemoptysis?

A
  • Fibrosis
  • Sarcoidosis
  • Goodpasture Syndrome
  • Cystic fibrosis
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13
Q

What are thr acute causes of SOB?

A
  • foreign body
  • pneumothorax
  • PE
  • Pulmonary oedema
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14
Q

What are the subacte causes of SOB?

A
  • anaemia
  • parenchymal
  • effusion
  • psychogenic
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15
Q

What are the chronic causes of SOB?

A
  • COPD
  • Non-resp causes
    • heart failure
    • anaemia
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16
Q

What are the 8 main steps of the resp. exam?

A
  1. General inspection
  2. Hands - inspection, asterixis
  3. Arms - pulse, RR, BP
  4. Neck - trachea deviation, JVP, lymphadenopathy
  5. Face
  6. Front of chest - aoex beat, expansion, vocal fremitus, percussion, auscultation, vocal resonance
  7. Back of chest (REPEAT)
  8. For completion - sacral and ankle oedema, peripheral pulses, temp, SpO2, sputum, PEFR
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17
Q

What should be observed from the end of the bed in a resp exam?

A
  • General appearance
  • accessory myscle use and pursed lip breathong
  • Nutritional status/cachexia
  • Oxygen
  • Look inside sputum pot
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18
Q

What does pursed lip breathing suggest?

A

lower airway obsteuction (COPD)

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19
Q

What does a decreased nutritional status/cachexia suggest?

A

COPD/malignancy

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20
Q

What are the main signd observed in the nails?

A
  • Finger clubbing
  • Koilonychia
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21
Q

What does koilonchyia suggest

A

Iron def anaemia

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22
Q

What can be observed in the face in a resp exam?

A

Cushingoid (moon face, plethora, acne, hirsute)

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23
Q

What does cushingoid suggest?

A

long term steroid use (COPD)

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24
Q

What are the main things that can be observed and examined in the hands?

A
  • peripheral cyanosis
  • feel temperature
  • dilated veins
  • tar-staining
  • 1st web-space wasting
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25
Q

What does peripheral cyanosis suggest?

A
  • PVD
  • Rayaund’s
  • CCF
  • with central cyanosis
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26
Q

What do dilated veins in the hands suggest?

A

hypercapnia - build up of CO2 in the blood stream

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27
Q

What are the two types of tremor looked for in the hands in a resp exam?

A
  • Asterixis - flapping tremor
  • Fine tremor
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28
Q

What does flapping tremor suggest?

A
  • CO2 retention
  • hepatic/renal failure
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29
Q

What does a fine tremor suggest?

A

B2 agonist overdose

salubutamol inhalers

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30
Q

What does a bounding pulse suggest?

A

hypercapnia

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31
Q

What is observed in the eyes during a resp exam?

A
  • Conjuntival pallor
  • Horner’s syndrome
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32
Q

What does conjuntival pallor suggest?

A

anaemia

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33
Q

What does Horner’s syndrome suggest

A

Pancoast’s tumour

tumour in the apex of the lung

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34
Q

What does 1st web space wasting in the hands suggest?

A

Pancoast tumour

35
Q

What can be observed in the mouth in a respo exam?

A
  • central cyanosis
  • candidia
36
Q

What does central cyanosis indicate?

A
  • hypoxic lung disease
  • cardiac shunt
  • abdnormal Hb
37
Q

What are the likely causes of oral thrush?

A
  • steroid inhalers
  • immunocompromised patient
38
Q

What should be observed and examined in the neck of a patient in a respo exam?

A
  • JVP
  • Position of the trachea
  • Lymph nodes
39
Q

What do tender lymph nodes suggest?

A

infection

40
Q

What do non-tender enlarged lymph nodes suggest?

A

malignancy

41
Q

When is the cricosternal angle decreased?

A

in hyperinflation (COPD)

42
Q

When is the JVP elevated?

A
  • RHF
  • PE
  • SVC obstruction
43
Q

What does the trachea deviate towards?

A

collapse

44
Q

What does the trachea deviate away from?

A

tension/big effusion

45
Q

What should be inspected on the chest in a resp exam?

A
  • AP-diameter
  • scars
  • deformity of the spine/chest
  • intercostal indrawing
46
Q

What does an increased A-P diameter suggest?

A

hyperinflation (COPD)

47
Q

What is Hoover’s sign and what does it suggest?

A
  • hyperinflation (COPD)
48
Q

What should be palpated on the chest in a resp exam?

A
  • chest expansion - is there symmetry?
  • apex beat
  • RV heave
49
Q

Why do you palpate the apex beat?

A

check for mediastinal shift

50
Q

What does mediastinal shift suggest?

A

collapse, tension or effusion

51
Q

What does a RV heave suggest?

A

RVH (cor pulomale)

52
Q

What is the likely pathology if the chest is hyperresonant to percussion

A

pneumothorax

53
Q

What is the likely pathology if the chest is dull to percussion?

A
  • consolidation
  • collapse
  • pneumonectomy
54
Q

What is the likely pathology if the chest is stony dull to percussion?

A

effusion

55
Q

What are the two main types of breathing?

A

vesicular and bronchial

56
Q

What does wheexze suggest?

A

small airway obstruction (asthma, COPD)

57
Q

What do crepitations suggest?

A

fluid in airspaces

secretions, pus and oedema

58
Q

Describe the mediastinal shift, percussion note, breath sounds and vocal resonance in consolidation

A
  • no mediastinal shift
  • dull percussion note
  • bronchial or decreased breath sounds
  • increased vocal resonance
59
Q

Describe the mediastinal shift, percussion note, breath sounds and vocal resonance in collapse

A
  • mediastinal shift towards the affected side
  • Dull percussion note
  • decreased or absent breath sounds
  • decreased/absent vocal resonance
60
Q

Describe the mediastinal shift, percussion note, breath sounds and vocal resonance in effusion

A
  • Mediastinal shift away from the affected side
  • stony dull percussion note
  • decreased or absent breath sounds
  • decreased/absent vocal resonance
61
Q

Describe the mediastinal shift, percussion note, breath sounds and vocal resonance in pneumothorax

A
  • mediastinal shift Away from the affected side
  • (hyper) resonant percussion note
  • decreased/absent breath sounds
  • decreased/absent vocal resonance
62
Q

Describe the mediastinal shift, percussion note, breath sounds and vocal resonance in pneumoectomy

A
  • Mediastinal shift towards the affected side
  • dull percusssion note
  • absent breath sounds
  • absent vocal resonance
63
Q

What sign is looked for in the back?

A

sacral oedema

64
Q

What sign is looked for in the ankles?

A

peripheral oedema

65
Q

What does peripheral and/or sacral oedema suggest?

A

Right sided heart failure

66
Q

What investigations should be offered after the respiratory exam?

A
  • Peak flow
  • PFTs
  • Spirometry
  • CXR
  • ABGs
67
Q

What are the main signs of bronchial breathing?

A
  • loud and blowing
  • inspiration = expiration
  • audible gap between inspiration and expiration
68
Q

What is the difference between transudate and exudate?

A
  • Transudate = protein <30g/L
  • Exudate = protein >30g/L
69
Q

Causes of a transudate pleural effusion

A
  • LVF
  • volume overload
  • hypoalbuminaemia
  • Meig’s syndrome
70
Q

What is meig’s syndrome?

A

triad of benign ovarian tumor with ascites and pleural effusion

71
Q

What are the main causes of an exudate pleural effusion?

A
  • Infection - pneumonia, TB
  • Infarction - PE
  • Inflammation - RA, SLE
  • Malignancy
72
Q

What are the main signs of respiratory distress?

A
  • Tachypnoea
  • Nasal flaring
  • trachael tug
  • use of accessory muscles
  • intercosral, subcostal and sternal recession
  • Pulsus paradoxus
73
Q

What is tracheal tug?

A

pulling of the thyroid cartilage towards the sternal notch in inspiration

74
Q

What are the causes of bronchial breathing?

A
  • consolidation
  • localised fibrosis
  • present above pericardial/pleural effusion
75
Q

What are the main causes of diminished breath sounds?

A
  • pleural effusion
  • pleural thickening
  • pneumothorax
  • bronchial obstruction
  • asthma
  • COPD
76
Q

What is the main cause of a silent chest

A

life threatneing asthma

77
Q

What are the main causes of crepitiations and describe the type of crepitiation

A
  • pulmonary oedema - fine and late in inspiration
  • brochestasis - coarse and mid inspiration
  • small airway disease - early inspiratory
  • alevolar disease - late/pan inspiratory
78
Q

When can a pleural rub be heard?

A
  • pneumonia
  • pulmonary infarction
79
Q

What is kussmaul respiration?

A

deep, signing breaths in metabolic acidosis (DKA, renal impairment)

80
Q

What causes neurogenic hyperventilation?

A

pontine lesions

81
Q
A
82
Q
A
83
Q
A

Respiratory (10 decks)

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