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1 Medicine > Respiratory Examination > Flashcards

Respiratory Examination Flashcards

1
Q

What should be looked for at end of the bed?

A 
General appearance
Accessory muscle use, pursed lip breathing
Cachexia/nutritional status 
Oxygen, fluids, meds
Sputum pot (look inside)
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2
Q

what is pursed lip breathing a sign of?

A

lower airway obstruction (usually COPD)

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3
Q

what does cachexia suggest?

A

copd, malignancy

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4
Q

what should be checked on the hands?

A 
Peripheral cyanosis
Temperature
Dilated veins
Tar staining/ coal dust tattoos
1st wed space wasting
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5
Q

what is the temperature of the hands in central cyanosis?

A

warm

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6
Q

what is the temperature of the hands in peripheral cyanosis?

A

Cold

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7
Q

What is Raynaud’s?

A

Change in peripheries colour to white

Caused by spasm of small arteries restricting blood flow

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8
Q

What does dilation of the blood vessels in the skin suggest?

A

Hypercapnia

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9
Q

what does tar staining/ coal dust tattoos show?

A

Smoker
Mining
Risk for coal-workers pneumoconiosis

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10
Q

What does 1st web space wasting on hands suggest?

A

T1 lesion (e.g. pancoast tumour)

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11
Q

what needs to be looked at on the nails?

A

Finger clubbing

Koilonychia

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12
Q

what are the respiratory causes of clubbing

A

Interstitial lung disease
Malignancy (bronchogenic carcinoma, mesothelioma)
Suppurative lung disease

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13
Q

what are the types of suppurative lung disease?

A

Bronchiectasis (pus in the tubes)
Abscess (pus in a collection)
Empyema (pus outside lung)
Cystic fibrosis (pus everywhere)

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14
Q

what are the cardiovascular causes of clubbing?

A

Infective endocarditis
Cyanotic congenital heart disease
Atrial myxoma

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15
Q

what are the gastro causes of clubbing?

A

IBD
Hepatic cirrhosis
GI lymphoma
Coeliac disease

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16
Q

what is koilonychia a sign of?

A

Iron deficiency anaemia (cause of SOB)

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17
Q

what should be looked for in the wrist?

A

Flapping tremor (asterixis)
Fine physiological tremor
Respiratory rate
Radial pulse (rate and volume)

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18
Q

what is asterixis a sign of?

A 
Respiratory failure (CO2 retention)
Hepatic/renal failure
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19
Q

what drug can cause a fine physiological tremor?

A

Beta agonist (salbutamol)

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20
Q

how do you take respiratory rate?

A

Count over 15sec while pretending to take pulse

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21
Q

what may cause a bounding pulse?

A

Hypercapnia

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22
Q

what do you check for on the face?

A

cushingoid (moon face, plethora, acne, hirsute)

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23
Q

what may cause cushingoid face?

A

long term steroid treatment (e.g for cryptogenic fibrosing alveolitis, asthma, COPD, pulmonary fibrosis)

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24
Q

what should be checked for in the eyes?

A

conjunctival pallor

horner’s

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25
Q

what are some signs of horner’s in the eyes?

A

ptosis

miosis

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26
Q

what is a cause of conjunctival pallor?

A

anaemia

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27
Q

what are the causes of horner’s syndrome?

A 
central lesion
T1 root lesion
brachial plexus lesion
neck lesion 
with cluster headaches
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28
Q

what may be the cause of central lesion in horner’s syndrome?

A

stroke/tumour/MS

syringobulbia

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29
Q

what are the causes of T1 root lesion causing horner’s syndrome?

A

spondylosis

neurofibroma

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30
Q

what are the causes of brachial plexus lesion causing horner’s syndrome?

A

pancoast tumour
cervical rib
trauma/birth injury

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31
Q

what are the causes of neck lesion causing horner’s syndrome?

A

tumour
carotid artery aneurysm
sympathectomy

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32
Q

what should be checked for in the mouth?

A

central cyanosis

candida

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33
Q

what are the causes of central cyanosis?

A

hypoxic lung disease
cardiac shunt
abdormal Hb- methaemoglobinaemia (drugs, toxins)

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34
Q

what are the causes of peripheral cyanosis?

A

peripheral vascular disease
raynaud’s syndrome
heart failure
shock

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35
Q

what may cause candida in the mouth?

A

steroid inhalers

immunocompromised patient

36
Q

what should be checked in the neck?

A

JVP
trachea
lymph nodes

37
Q

how should the trachea be palpated?

A

“im going to feel for your windpipe”- always warn patient
position
cricosternal distance
“take a deep breath in”- any tug on inspiration

38
Q

what may cause trachea deviation?

A

towards collapse

away from tension/big effusion

39
Q

what is the normal cricosternal distance?

A

2-3 fingers

40
Q

what may change cricosternal distance?

A

reduced in hyperinflation –> COPD

41
Q

what should be checked before palpating lymph nodes?

A

any pain in neck

42
Q

what does tender lymph nodes suggest?

A

infection

43
Q

what do non-tender raised lymph nodes suggest?

A

suspicious of malignancy

44
Q

what should be checked on inspection?

A

anterior-posterior diameter (A-P diameter)
scars (check back and sides)
deformity of chest/spine
intercostal indrawing (Hoover’s sign)

45
Q

what can A-P diameter increase be a sign of

A

hyperinflation (COPD)

46
Q

what scars may be seen on the chest?

A

thoracotomy (lobectomy/ pneumonectomy)

old chest drain sites

47
Q

what deformities of the chest may be seen?

A

pectus excavatum
pectus carinatum
scoliosis

48
Q

what disease may cause pectus carinatum?

A

asthma

49
Q

what disease may cause hoover’s sign?

A

hyperinflation (COPD)

50
Q

what should be done on palpation of respiratory system?

A

chest expansion
apex beat
RV heave

51
Q

what should be assessed in chest expansion?

A

palpate chest wall in 2 separate places

asymmetry

52
Q

what may cause displacement of apex beat?

A

mediastinal shift (collapse, tension, big effusion)

53
Q

what may cause RV heave

A

right ventricular hypertrophy (possible cor pulmonale)

54
Q

how many places should be checked on percussion?

A

8-10 places

55
Q

where should you start in percussion?

A

supraclavicular fossae and work down chest

56
Q

how should auscultation be carried out?

A
  1. take deep breath in and out through mouth”
    any wheeze or crepitations
    if crepitations heard, ask patient to cough and lsiten again
  2. vocal resonance- 99
57
Q

what does increased vocal resonance suggest?

A

consolidation

58
Q

what does decreased vocal resonance suggest?

A

collapse
effusion
pneumothorax

59
Q

what should be done in areas of increased vocal resonance?

A

whispering pectoriloquy

60
Q

what is whispering pectoriloquy?

A

whisper 99 every time i touch your chest with stethoscope

whispering would usually not be heard

61
Q

what causes whispering pectoriloquy?

A

loud conduction of whispered voice due to consolidation

62
Q

what causes wheeze?

A

small airway obstruction (COPD)

63
Q

what causes crepitations?

A

fluid in airspaces: secretions, pus, oedema

64
Q

what should be checked on back?

A

sacral oedema

65
Q

what should be checked on legs?

A

peripheral oedema

66
Q

what causes sacral and peripheral oedema?

A

right heart failure (e.g cor pulmonale)

67
Q

what should be done in conclusion?

A

review observation chart (HR, BP, RR, SpO2, temp)

investigation:
- peak flow
- PFTs
- CXR
- ABGs to check perfusion

68
Q

what should be done after all anterior tests?

A

repeat same process posteriorly

69
Q 
what findings would be found on consolidation?
mediastinal shift
percussion note
breath sounds
vocal resonance
A

no change in mediastinal shift
percussion dull
breath sounds bronchial or low
vocal resonance increased

70
Q 
what findings would be found on collapse/lobectomy/pneumonectomy?
mediastinal shift
percussion note
breath sounds
vocal resonance
A

mediastinal shift towards collapse
percussion note dull
breath sounds decreased on absent
vocal resonance decreased or absent

71
Q

what findings would be found on effusion/ raised hemidiaphragm

A

mediastinal shift away if big
percussion node stony dull
breath sounds low or absent
vocal resonance low or absent

72
Q

what findings would be found on pneumothorax?

A

mediastinal shift away if tension
percussion hyper-resonant
breath sounds low or absent
vocal resonance low or absent

73
Q

what findings would be found on pneumonectomy?

A

mediastinal shift towards
percussion note dull
breath sounds absent
vocal resonance absent

74
Q

how do you distinguish between collapse and lobectomy/pneumonectomy?

A

thoracotomy scar on chest

75
Q

indications for lobectomy/pneumonectomy?

A

bronchogenic cancer (25% non-small cell lung cancer are resectable)
bronchiectasis
trauma
TB

76
Q

how do you distinguish betwen effusion and raised hemidiaphragm?

A

examination findings identical

CXR to differentiate

77
Q

what are the cause of raised hemidiaphragm?

A

phrenic nerve palsy

caused by thoracic surgery, trauma, malignancy

78
Q

what are the signs of hyperinflation?

A 
reduced cricosternal distance +/- tracheal tug
increased A-P diameter
intercostal indrawing (Hoover's sign)
apex beat not palpable
hyper-resonant percussion note
79
Q

what are the features of bronchial breathing?

A

loud and blowing
inspiration length= expiration
audible gap between inspiration and expiration
reproducible by placing stethoscope over trachea

80
Q

what are the types of pleural effusion?

A

transudate and exudate

81
Q

what are the differences between transudate and exudate pleural effusion

A

transudate protein <30g/l

exudate protein >30 g/l

82
Q

what are the causes of transudate pleural effusion?

A

LVF
volume overload
hypoalbuminemia
meig’s syndrome

83
Q

what are the causes of exudate pleural effusion?

A

infection- pneumonia, TB
infarction- PE
inflammation- rheumatoid arthritis, SLE
malignancy- bronchogenic, mesothelioma

84
Q

what are the types of breathing

A

bronchial and vesicular

85
Q

where are vesicular breath sounds heard?

A

normally over most of lung

1 Medicine (10 decks)

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