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MD3001resp > Respiratory examination > Flashcards

Respiratory examination Flashcards

1
Q

structure of the respiratory exam?

A

1- introduction
2- explanation
3- palpation
4- percussion
5- auscultation

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2
Q

introduction?

A
  • ensure adequate hand hygiene
  • introduce self
  • confirm name and DOB
  • explain procedure
  • seek permission
  • position patin at 45 degrees
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3
Q

general inspection?

A
  • does the patient look well?
  • look around patient
  • look at patient
  • listen (audible stridor, hoarseness, pattern of speech)
  • any pathological signs?
  • do they have an inhaler, nebuliser?
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4
Q

stridor?

A

-loud harsh, high pitched respiratory sound.
- usually on respiration
- upper airway obstruction

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4
Q

what do you do on close inspection and palpitation?

A

examine hands = inspect, palpate warmth and ventilation, flapping terror and fine tremor
- palpate radial pulse
- count respiratory rate
- inspect eyes, face, mouth and pharynx

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5
Q

signs of central cyanosis?

A

blue tongue, lips, hands and feet and mucos membranes of the oral cavity.
palor

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6
Q

what are respiratory causes of clubbing?

A
  • bronchial carcinoma
  • mesothelioma
  • chronic supportive lung disease = (bronchiectasis, lung abscess, empyema)
  • pulmonary fibrosis
  • cystic fibrosis
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7
Q

cause of Horners syndrome?
clinical features?

A
  • damage to cervical sympathetic nerves

clinical features:
- unilateral mitosis
- partial ptosis
- loss of sweating (anhidrosis)

may indicate serious pathology

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8
Q

cause of a fine tremor

A

excessive use of B agonists

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9
Q

cause of flapping tremor?

what will it look like?

A
  • severe ventilatory failure with C02 retention
  • hold hands outstretched
  • wrists cocked back
  • look for a jerky, flapping tremor
  • associated confusion
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10
Q
A
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11
Q

what are you looking for on close inspection of the chest?

A
  • scars= cardiac surgery, tharoctomy, chest drains ect
  • pattern of breathing
  • shape of chest (symmetry, deformity, increase in AP diameter)
  • prominent veins on chest wall (SVC obstruction)
  • JVP?
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12
Q

what are you palpating on the neck and chest?

A
  • lymph nodes
  • subcutaneous emphysema
  • rib fractures
  • mediastinal position
  • chest expansion
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13
Q

how do palpate for chest expansion?

A
  • do it anterior and posterior
  • ask patient to breathe deeply
  • thumbs should move apart equally
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14
Q

palpation of the mediastinal position?

A
  • trachael position
  • look for the parasternal notch
  • right middle finger 2cm above the notch
  • gently press don and back
  • palpate space to either Side
  • should be central
  • look for cardiac apex and assess for right ventricular heave
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15
Q

when you are palpating for subcutaneous emphysema, what are you looking for?

A
  • crackling sensation
  • air in subcutaneous tissue
  • neck and face swelling?
  • consider trauma and underlying pneumothorax?
16
Q

what are the 3 types of displacement of the trachea towards the lesion?

A
  • lobar collapse
  • pneumonectomy
  • pulmonary fibrosis
17
Q

what are the 2 types of displacement of the trachea away from the lesion?

A
  • large pleural effusion
  • tension pneumothorax which is a medical emergency
17
Q

what is the other type of tracheal deviation?

A

mediastinal masses

18
Q

how do you do percussion?

A
  • percuss, anterior, posterior and lateral chest
  • use middle finger/left hand
  • apply firmly to patients chest
  • strike its middle phalanx with the middle finger or the right hand
  • percuss over intercostal space
  • however perks clavicles directly
  • compare the left and right
  • listen to the sound produced
19
Q

percussion node and cause?

resonant=
hyper resonant=
dull =
stony or very dull=

A

remnant = normal lung

hyper resonant = emphysema, large bullae or pneumothorax

dull = collapse, consolidation or fibrosis

stony or very dull = pleural effusion or haemothorax

20
Q

what are you doing in a tactile vocal fremitus?

A
  • use palm/ulnar border of hand
  • get them to say 99 and feel for vibration

increased fremitus = consolation or fibrosis
decreased fremitus= pleural effusion, pneumothorax or collapse

21
Q

how do you do auscultation?

A

1- use bell or diaphragm of stethoscope (bell for apices and diaphragm for chest)

2- ask patient to breathe deeply in and out through mouth

3- listen through full inspiration and full expiration

4- compare ides

5- listen for breathe sounds and added sounds

22
Q

what would a normal (vesicular) breathe sound, sound like?

A
  • intensity of sounds relates to airflow
  • inspiration longer than expiration
  • low pitched, quiet, heard over most of lung fields
  • no gap between inspiration and expiration
23
Q

when would you hear diminished vesicular breathe sounds?

A

when the normal lug is displaced by air
- in obesity
- pleural effusion
- pneumothorax
- collapse
- hyperinflation

24
Q

what are abnormal bronchial breathe sounds?

A
  • when the noise originates from larger airways
  • when damage to the small airways/ alveoli
  • harsh in nature
  • gap between inspiration and expiration
  • expiratory component dominates
25
Q

what are added sounds in ausciltation?

causes?

what is a fine late crackle a sign of?

A
  • crackles
    = high pitched discontinuous sounds
    (similar to the sound produced by rubbing your hair between your fingers

causes = pulmonary oedema, pulmonary fibrosis, bronchial secretions.

a fine late crackle is a feature of cryptogenic fibrosing alveolitis.

Pleural rub
= may be associated with pleuritic pain (sharp on inspiration/ coughing)
- low pitched

causes = PE, pneumonia, vasculitis.

wheeze
- continuous oscillation os opposing airway walls
- high pitched
- implies airway narrowing
- louder in expiration

causes = generalised = asthma/ COPD
localised = lung tumour

26
Q

what are other areas you should look at?

A

ankle oedema
sputum spots (green = infection)
obs chart
peak slow
spirometry

27
Q

When is vocal resonance used?

What are the 3 steps of vocal resonance?

What 2 things can increased vocal resonance indicate?

What 3 things can decreased vocal resonance indicate?

A
  • If there is a dull percussive note when there shouldn’t be, we need to check tactile vocal fremitus now or vocal resonance after auscultation – no need to do both
  • 3 steps of vocal resonance:
    1) Use stethoscope, ask patient to say “one, one, one”
    2) Compare with the other side.
  • Assess quality and amplitude
    3) Ask patient to whisper “one, one, one”.
  • Whispering is not heard over a normal lung but in consolidation the sound is transmitted
  • 2 things increased vocal resonance can indicate:
    1) Consolidation
    2) Fibrosis
  • 3 things decreased vocal resonance can indicate:
    1) Pleural effusion
    2) Pneumothorax
    3) Collapse
28
Q

what are 3 added sounds we may hear during auscultation?

A

1) Crackles
2) Pleural rub
3) Wheeze

29
Q

What 3 different types of breath sounds might we hear?

A

1) Vesicular (normal) breath sounds
2) Diminished vesicular breath sounds
3) Bronchial breath sounds (abnormal)

30
Q

what order should lymph nodes be palpated in the face/neck?

A

1) Pre-auricular
2) Posterior auricular
3) Submandibular
4) Submental
5) Cervical chain
6) Occipital

31
Q

what is ruddy complexion?

A

‘Ruddy’ complexion polycythaemia – elevated haemoglobin that causes red skin, especially in the face, hands, and feet

32
Q

What is erythema nodosum?

What is it caused by?

What is stridor? When can it be heard?

What does it indicate?

A
  • Erythema nodosum is inflammation of fat under skin causing raised red tender lumps that are painful with pressure
  • Caused by streptococcal infections
  • Stridor is a loud, harsh, high pitched respiratory sound
  • It can usually be heard on inspiration
    Stridor is indicative of an upper airway obstruction

MD3001resp (41 decks)

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