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Phase 1b - Clinical Practical Assessment (CPA) > Respiratory Examination > Flashcards

Respiratory Examination Flashcards

1
Q

What exposure is required for a respiratory examination?

A

From the pubic symphisis upwards

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2
Q

What position is required for a respiratory examination?

A

Supine position with the upper body elevated 45 degrees + Sitting position

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3
Q

What are the potential signs of respiratory distress on general inspection from the end of the bed (8)?

A
  • Tachypnoea
  • Cough
  • Cyanosis
  • Use of accessory muscles
  • Audible wheeze
  • Nasal flaring
  • Sweating
  • Tripod
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4
Q

How is the trachea assessed?

A
  • The trachea should be located equidistant between the clavicular heads as it is a midline structure
  • Tracheal deviation arises due to unequal intrathoracic pressure
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5
Q

What is the clinical significance tracheal deviation away from the side of a lesion (3)?

A
  • Extensive pleural effusion
  • Tension pneumothorax
  • Chest expansion
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6
Q

What is the clinical significance tracheal deviation towards the side of a lesion (3)?

A
  • Upper lobe collapse
  • Upper lobe fibrosis
  • Pneumonectomy
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7
Q

How is chest expansion assessed?

A
  • Normal chest expansion should be 4-5 cm and symmetrical
  • Expansion should take off at the same time bilaterally
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8
Q

What is the clinical significance of unilateral decrease in chest expansion (4)?

A
  • Pneumothorax
  • Pleural effusion
  • Collapsed lung
  • Consolidation
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9
Q

What is the clinical significance of symmetrical decrease in chest expansion (4)?

A
  • Asthma
  • COPD
  • Fibrosis
  • Rib Fracture
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10
Q

How are the lungs percussed?

A
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11
Q

What is the clinical significance of hyper-resonant percussion (4)?

A
  • Pneumothorax
  • Hollow bowels
  • COPD
  • Acute Asthma
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12
Q

What is the clinical significance of hypo-resonant percussion (5)?

A
  • Bone
  • Tumour
  • Consolidation
  • Collapse
  • Normal liver
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13
Q

What is the clinical significance of stoney dull percussion (2)?

A
  • Pleural effusion
  • Haemothorax
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14
Q

How are the lungs auscultated?

A
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15
Q

What is the clinical significance of bronchial breath sounds (4)?

A
  • Consolidation
  • Pleural effusion
  • Pulmonary fibrosis
  • Collapsed lung
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16
Q

What is the clinical significance of polyphonic sounds (4)?

A
  • Asthma
  • COPD
  • Heart failure
  • Bronchiectasis
17
Q

What is the clinical significance of monophonic sounds (2)?

A
  • Carcinoma
  • Foreign body
18
Q

What is the clinical significance of wheeze sounds (1)?

A
  • High pitched sound due to airway narrowing, loudest on expiration
19
Q

What is the clinical significance of stridor sounds (1)?

A
  • High pitched sound due to upper airway obstruction
20
Q

What is the clinical significance of crackles sounds (1)?

A
  • High pitched, discontinuous popping sounds from air being forced through a collapsed or fluid, pus or mucus filled airway
21
Q

What is the clinical significance of fine crackles sounds (1)?

A
  • Velcro like sound during late inspiration originating from small airways. Caused by fluid or fibrosis.
22
Q

What is the clinical significance of coarse crackles sounds (1)?

A
  • Heard in early inspiration originating from large airways
23
Q

How is tactile vocal fremitus performed?

A
  • Palpable vibrations as a result of sound transmitting through lung tissue
24
Q

What is the clinical significance of increased tactile vocal fremitus (3)?

A
  • Consolidation pneumonia
  • Tumour
  • Lobe collapse
25
Q

What is the clinical significance of decreased tactile vocal fremitus (3)?

A
  • COPD
  • Pleural effusion
  • Pneumothorax
26
Q

Which lymph nodes are assessed in a respiratory examination (11)?

A
27
Q

How are lymph nodes assessed?

A
  • Using the pads of the fingers in a circular motion palpate across all the cervical lymph node groups. Note:
    • Size
    • Mobility
    • Tenderness
    • Consistency
28
Q

What is the clinical significance of lymphadenopathy?

A
  • Infection
  • Inflammation
  • Malignancy
  • Medication
  • Benign idiopathic
29
Q

How does COPD present (6)?

A
  • Bilaterally decreased chest expansion
  • Hyper-resonant percussion
  • Polyphonic wheeze
  • Prolonged expiratory phase
  • Decreased tactile vocal fremitus
  • Hyperinflated chest
30
Q

How does pneumothorax present (5)?

A
  • Decreased chest expansion ipsilaterally
  • Tracheal deviation away from lesion if tension pneumothorax
  • Hyper-resonant percussion over pneumothorax
  • Decreased intensity of breath sounds on affected side
  • Decreased tactile vocal fremitus on affected side
31
Q

How does lobar collapse present (5)?

A
  • Tracheal deviation towards lesion
  • Decreased chest expansion ipsilaterally
  • Dullness percussion
  • Reduced breath sounds over affected area
  • Increased tactile vocal fremitus
32
Q

How does consolidation present (4)?

A
  • Decreased chest expansion ipsilaterally
  • Dullness to percussion
  • Bronchial breath sounds over consolidation
  • Increased tactile vocal fremitus
33
Q

How does pleural effusion present (6)?

A
  • Decreased chest expansion ipsilaterally
  • Tracheal deviation away from lesion if extensive effusion
  • Stoney dull percussion
  • Reduced intensity breath sounds
  • Bronchial breath sounds
  • Reduced tactile vocal fremitus
34
Q

How does fibrosis present (2)?

A
  • Bilateral decrease in chest expansion
  • Fine end inspiratory crackles
35
Q

How does acute asthma present (4)?

A
  • Bilateral decrease in chest expansion
  • Hyper-resonant percussion
  • Expiratory wheeze
  • Prolonged expiratory phase
36
Q

How are X-Rays in a Systematic Approach (ABCDE)?

A
  • Airway:
    • Is the trachea central?
    • Carina
    • Trace the bronchi and hilar structures
  • Breathing:
    • Lung borders
    • Pleural borders - vasculature is not seen peripheral to this
  • Cardiac:
    • ​The heart should be no more than half the width of chest cavity
    • Right border: right atrium
    • Left border: left Atrium and left ventricle
  • Diaphragm:
    • Shape
    • Assess costophrenic and cardiophrenic angles, note any blunting
  • Everything else:
    • Mediastinal contours, bones, soft tissues and devices

Phase 1b - Clinical Practical Assessment (CPA) (5 decks)

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