Respiratory Examination Flashcards
What is the following sign and what may it indicate?
Cyanosis: bluish discolouration of the skin due to poor circulation (e.g. peripheral vasoconstriction secondary to hypovolaemia) or inadequate oxygenation of the blood (e.g. right-to-left cardiac shunting).
What signs may suggest shortness of breath?
signs may include nasal flaring, pursed lips, use of accessory muscles, intercostal muscle recession and the tripod position (sitting or standing leaning forward and supporting the upper body with hands on knees or other surfaces).
What is the difference between wheeze and stridor?
Wheeze: a continuous, coarse, whistling sound produced in the respiratory airways during breathing. Wheeze is often associated with asthma, COPD and bronchiectasis.
Stridor: a high-pitched extra-thoracic breath sound resulting from turbulent airflow through narrowed upper airways. Stridor has a wide range of causes, including foreign body inhalation (acute) and subglottic stenosis (chronic).
What is the following sign and what may it suggest?
a pale colour of the skin that can suggest underlying anaemia (e.g. haemorrhage/chronic disease) or poor perfusion (e.g. congestive cardiac failure). It should be noted that healthy individuals may have a pale complexion that mimics pallor.
What is the following sign and what may it suggest?
typically presents with swelling of the limbs (e.g. pedal oedema) or abdomen (i.e. ascites) and is often associated with right ventricular failure. Pulmonary oedema often occurs secondary to left ventricular failure.
What is the following sign and what may it suggest?
Cachexia: ongoing muscle loss that is not entirely reversed with nutritional supplementation. Cachexia is commonly associated with underlying malignancy (e.g. lung cancer) and other end-stage respiratory diseases (e.g. COPD).
What is the following sign and what may it suggest?
Tar staining: caused by smoking, a significant risk factor for respiratory disease (e.g. COPD, lung cancer).
What is the following sign and what may it suggest?
Skin changes: bruising and thinning of the skin can be associated with long-term steroid use (e.g. asthma, COPD, interstitial lung disease).
What may join deformities suggest?
Joint swelling or deformity: may be associated with rheumatoid arthritis which has several extra-articular manifestations that affect the respiratory system (e.g. pleural effusions/pulmonary fibrosis)
What is the following sign and what may it suggest?
Finger clubbing is associated with several underlying disease processes, but those most likely to appear in a respiratory OSCE station include lung cancer, interstitial lung disease, cystic fibrosis and bronchiectasis
What is being assessed in the image?
Assess for the presence of a fine tremor:
Ask the patient to hold out their hands in an outstretched position and observe for a fine tremor which is typically associated with beta-2-agonist use (e.g. salbutamol).
What is being assessed in the image?
Asterixis (also known as ‘flapping tremor’) is a type of negative myoclonus characterised by irregular lapses of posture causing a flapping motion of the hands. In the context of a respiratory examination, the most likely underlying cause is CO2 retention in conditions that result in type 2 respiratory failure (e.g. COPD). Other causes of asterixis include uraemia and hepatic encephalopathy.
What warm hands suggest?
In healthy individuals, the hands should be symmetrically warm, suggesting adequate perfusion.
Cool hands may suggest poor peripheral perfusion.
Excessively warm and sweaty hands can be associated with CO2 retention.
What may a bounding pulse suggest?
Bounding pulse: can be associated with underlying CO2 retention (e.g. type 2 respiratory failure).
What may pulsus paradoxus suggest?
Pulsus paradoxus: pulse wave volume decreases significantly during the inspiratory phase. This is a late sign of cardiac tamponade, severe acute asthma and severe exacerbations of COPD (therefore it is unlikely to be relevant to most OSCE scenarios)
Define Tachypnoea and Bradypnoea
In healthy adults, the respiratory rate should be between 12-20 breaths per minute.
A respiratory rate of fewer than 12 breaths per minute is referred to as bradypnoea (e.g. opiate overdose).
A respiratory rate of more than 20 breaths per minute is referred to as tachypnoea (e.g. acute asthma).
What may a raised JVP suggest?
A raised JVP indicates the presence of venous hypertension. Respiratory causes of a raised JVP include:
Pulmonary hypertension: causes right-sided heart failure, often occurring due to COPD or interstitial lung disease.
There are several other causes of a raised JVP that relate to the cardiovascular system (e.g. congestive heart failure, tricuspid regurgitation and constrictive pericarditis).
What is the following sign and what may it indicate?
Conjunctival pallor: suggestive of underlying anaemia. Ask the patient to gently pull down their lower eyelid to allow you to inspect the conjunctiva.
Explain what lung pathology the following symptoms as well as enopthalmos may indicate?
Ptosis, miosis and enophthalmos: all features of Horner’s syndrome (anhydrosis is another important sign associated with the syndrome). Horner’s syndrome occurs when the sympathetic trunk is damaged by pathology such as lung cancer affecting the apex of the lung (e.g. Pancoast tumour).
What is the following sign and what may it indicate?
Central cyanosis: bluish discolouration of the lips and/or the tongue associated with hypoxaemia.
What is the following sign and what may it indicate?
Oral candidiasis: a fungal infection commonly associated with steroid inhaler use (due to local immunosuppression). It is characterised by pseudomembranous white slough which can be easily wiped away to reveal underlying erythematous mucosa.
What is the following sign and what may it indicate?
Median sternotomy scar: located in the midline of the thorax. This surgical approach is used for cardiac valve replacement and coronary artery bypass grafts (CABG).
What is the following sign and what may it indicate?
Axillary thoracotomy scar: located between the posterior border of the pectoralis major and anterior border of latissimus dorsi muscles, through the 4th or 5th intercostal space. This surgical approach is used for the insertion of chest drains.
What is the following sign and what may it indicate?
Posterolateral thoracotomy scar: located between the scapula and mid-spinal line, extending laterally to the anterior axillary line. This surgical approach is used for lobectomy, pneumonectomy and oesophageal surgery.
