Respiratory examination Flashcards
6 common symptoms of respiratory disease
Cough
Sputum production
Coughing up blood (haemoptysis)
Shortness of breath/difficulty breathing (dyspnoea)
Chest pain
Wheeze
Bronchial sounds
Harsh breath sounds conducting the turbulence from the trachea. Abnormal in the periphery. Audible if lung has become solidified due to tumour, fluid
Crackles
‘Wet sounds’ from fluid in the lung
Wheezes
‘Dry sound’ causes by restrictions in the airway
Creaky shoe noise
Causes by rubbing of the pleura
How do you describe breath sounds?
When (phase of breathing) what (type of sound) where (anatomy)
Give 7 differential diagnoses for the cause of haemoptysis
Respiratory:
Bronchial carcinoma
TB
Bronchiectasis
Pulmonary infarction
Lung abscess
Cardiovascular:
Left ventricular failure
Mitral stenosis
Other:
Bleeding from larynx, nasal cavity, autoimmune disease
Cause of chest pain in respiratory disease
Lungs have no sensory innervation. Pain felt in respiratory disease usually due to irritation of the pleural membranes which have sensory innervation.
Sharp pain, worse when coughing and on deep inspiration
Associated symptoms of respiratory disease
Fever/chills (pneumonia, acute bronchitis)
Night sweats (TB)
Loss of appetite
Unintentional drastic weight loss
Lumps
Decrease exercise tolerance
Hoarseness (cancer)
What do you look for when inspecting the hands in a respiratory examination?
Temperature and feel
Clubbing
Tar staining
Peripheral cyanosis
Coarse tremor and flap
Also take radial pulse
3 abnormalities of thorax shape
Pectus excavatum: sternum is sunken
Pectus carinatum; sternum protrudes outward
Barrel-shaped chest: anterior-posterior angle increased
Tactile vocal fremitus
Palpable vibration of the chest wall when the patient speaks
Increased over areas of consolidation
Decreased over areas of effusion
Absent in pneumothorax
Vocal resonance
Ask the patient to speak in a normal voice and auscultate the region of the chest where pathology is suspected – ‘ninety-nine’ will sound fuzzy over normal lung.
Whispering will sound loud in the presence of consolidation (Whispering Pectoriloquy)
Aegophony
ask the patient to say ‘ee’ sound and auscultate (increased resonance of voice sounds heard in lung consolidation and pulmonary fibrosis
Tracheal displacement
Trachea may be displaced towards the side of a pneumothorax, collapsed lung or away from a large pleural effusion.
Assess by placing finger in suprasternal notch
