Respiratory examination Flashcards
What should you look for during general inspection of the patient in a resp exam?
Colour change (cyanosis/pallor), shortness of breath, cachexia, resp rate, scars, added sounds
What should you look for during general inspection of the bedside in a resp exam?
Cigarettes, oxygen/ oxygen masks, nebulisers, inhalers, sputum pot, cigarettes, vape
What should you look for when inspecting the hands in a resp exam?
Tar staining Clubbing Peripheral cyanosis Flap/ tremor Temperature Small muscle wasting Dilated veins Cap refill
What are the respiratory causes of clubbing?
Low blood oxygen
Lung cancer
Pulmonary fibrosis
Bronchiectasis
Does COPD cause clubbing?
NO
What may cause a fine tremor of the hands in the context of a resp exam?
Drugs like salbutamol
What do dilated veins of the hand suggest in a resp exam?
Hypercapnia
How do you test for asterixis and what would a positive test mean?
Ask them to hold out their hands and cock them back, if they flap they may have co2 retention
How should you take the pulse and resp rate?
Take the radial pulse for 15 secs then the resp rate for 30 secs, don’t tell them you are taking the resp rate
If the pulse is irregular how long should you take it for?
30 seconds/ a minute (just longer than 15 seconds)
What are the main causes of tachycardia in a resp exam?
Infection
Pulmonary embolism
Asthma
Why may conjunctival pallor be relevant in a resp exam?
It is a sign of anaemia which occurs if there is significant shortness of breath
What is whiteness of the tongue called medically?
Oral candida
What common medication does not cause oral candida? (but people often think it does)
Inhaled salbutamol
What causes oral candida?
Inhaled steroids
Amoxicillin
What are the 3 notable features of Horner’s syndrome?
Ptosis
Anhydrosis
Decreased pupil size
What is the significance of Horner’s syndrome when identified in a resp exam?
It could be due to lung cancer, specifically a pancoast tumor which is an apical cancer
What will polycythemia do to someones complexion?
Cause it to be plethoric/ruddy due to widened blood vessels
What examinations are done on the neck in a resp exam?
Tracheal position
JVP
What causes the trachea to deviate away from the problematic side?
Tension pneumothorax
Pleural effusion
What causes the trachea to deviate towards the problematic side?
Lobar collapse
Pneumonectomy
On inspection what will a scar under the pecs near the midline of the axilla indicate?
Lateral thoracotomy
When inspecting the chest what should you always ask the patient to do?
Lift their arms to see any subtle or hidden scars
What is the medical name for a funnel shaped chest and what causes it?
Pectus excavatum
Congenital condition or from connective tissue disease
What is the medical name for pigeon shaped chest?
Pectus caranatum
When inspecting the chest what should you look for?
Respiratory distress (are they using their accessory muscles or anything)
Shape of chest (asymmetry, hyperexpansion, pectus excavasum or carinatum)
Scars (make sure to check axilla)
Chest drains
What do you palpate for in a resp exam?
Apex beat
Chest expansion
What causes a displaced apex beat?
Right ventricular hypertrophy
Large pleural effusion
Tension pneumothorax
What causes asymmetrical chest expansion?
Pneumothorax, pneumonia, pleural effusion
What causes reduced chest expansion?
Pulmonary fibrosis
What is hyperresonant to precussion?
Air
What is dull to percussion?
Consolidation
What are pleural effusions to percussion?
Stony dull
What does increased vibration over one area during tactile vocal fremitus indicate?
Increased tissue density eg tissue density, mass
Lobar collapse
What does decreased vibration over one area during tactile vocal fremitus indicate?
Pneumothorax
What are the 3 main types of breath sounds?
Bronchial
Vesicular
Reduced
What are added breath sounds?
Wheeze and crackles
What causes a wheeze?
Narrowing of airways eg due to narrowing or secretions
What causes an expiratory wheeze commonly? Which condition is this seen in?
Narrowing of smaller airways
Often seen in asthma
What is wheeze on inspiration referred to as?
Stridor
What causes an inspiratory wheeze?
A larger airway eg due to foreign body
What are the 2 types of crackles?
Coarse and fine
What causes coarse crackles?
Pneumonia (consolidation)
What causes fine crackles?
Pulmonary fibrosis
What causes increased volume when vocal resonance is tested?
Increased tissue density eg consolidation, tumor, lobar collapse
What causes decreased volume when vocal resonance is tested?
Fluid or air outside of lungs eg pleural effusion or pneumothorax
What should you look for when inspecting the back?
Kyphosis or scoliosis
What may kyphosis and scolios cause in relation to a resp exam?
Reduced lung capacity
Why may sacral oedema or peripheral oedema be relevant in a resp exam?
They are signs of cor pulmonale
What is cor pulmonale?
The right side of the heart fails
Why does cor pulmonale arise?
Blood vessels constrict where there is less oxygen and dilate where there is more oxygen so if someone has chronically low oxygen the blood vessels supplying the right side of the heart will constrict
What are the respiratory causes of lymphadenopathy in the neck?
Metastatic lung cancer
TB
Sarcoidosis
Viral upper resp tract infections
What investigations may one do after a resp exam?
X-ray
Sputum pot
Oxygen levels
