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MD2 Examinations > Respiratory Examination > Flashcards

Respiratory Examination Flashcards

1
Q

What are the basic steps of the respiratory examination?

A

General inspection

Hands

Head and neck

Chest (lungs)

Bedside tests of respiratory function

Heart

Abdomen and legs

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2
Q

What might be observed on general inspection in a respiratory exam?

A

“Sick or not sick”

Orientated or confused or drowsy

Respiratory distress (at rest or when moving/undressing): indicated by obvious respiratory effort, noisy breathing (e.g. stridor)

Other: febrile, sputum mug, equipment (IV treatment, supplemental O2, NIV)

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3
Q

What might be observed in the hands in the respiratory exam?

A

Clubbing

Pallor

Radial pulse

Peripheral cyanosis

C8-T1 lesion (wasting of intrinsic hand muscles, parastheisa over hypothenar eminence and medial forearm)

Tobacco staining

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4
Q

What are the signs of digital clubbing?

A

Increased nail-bed fluctuation

Loss of nail-fold angle (>150 degrees)

Increased curvature of long axis of nail

Soft tissue swelling (drum-sticking)

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5
Q

List 3 respiratory, 3 cardiac, and 3 oher causes of clubbing

A

Respiratory: suppurative lung disease (e.g. bronchiectasis, TB, lung abscess), lung cancer (NSCLC), pulmonary fibrosis

NOT chronic bronchitis/COPD

Cardiac: SBE, congenital cyanotic heart disease, left atrial myxoma

Others: IBD, PBC, idiopathic

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6
Q

What is the mechanism of cyanosis?

A

Bluish discolouration of skin +/- mucous membranes due to increased deoxy Hb (>4g/100mL)

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7
Q

Distinguish between peripheral and central cyanosis in terms of their mechanism

A

Peripheral: circulatory insufficiency (increased O2 extraction)

Central: respiratory insufficiency (decreased O2 saturation of Hb)

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8
Q

What should be looked for on examination of the neck in the respiratory exam?

A

JVP

Trachea

LNs (stand behind patient except when examining the supraclavicular LNs)

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9
Q

Describe the surface markings for the lungs (anterior and posterior)

A
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10
Q

What may be observed on inspection of the chest in the respiratory examination?

A

Not sensitive or specific BUT look for:

Chest movement (use of accessory muscles, symmetry, paradoxical movement of chest and abdomen)

Skin changes (scars, pigmentation)

Chest wall deformity (barrel, kyphoscoliosis, funnel, pigeon)

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11
Q

What should be palpated for in the respiratory examination?

A

Degree of chest movement: asymmetry, reduced expansion (can be seen in most lung pathologies and if evident, suggests significant abnormality)

Chest wall and thoracic spine tenderness

Palpable breath sounds

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12
Q

3 causes of increased percussion note

A

Pneumothorax

Hyperinflation

Lung cyst

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13
Q

6 causes of decreased percussion note

A

Consolidation

Collapse (atelectasis)

Dense fibrosis

Pleural fluid/thickening

Elevated hemidiaphragm

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14
Q

What are normal breath sounds called?

A

Vesicular

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15
Q

What are increased breath sounds called?

A

Bronchial breathing

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16
Q

What extra sounds may be heard on auscultation of the chest in a respiratory exam?

A

Crepitations (crackles)

Ronchi (wheezes)

Pleural rub

17
Q

Describe the 3 characteristics of bronchial breathing

A

“Blowing” sound in inspiration and expiration

Expiration as long as inspiration

Pause between inspiration and expiration

18
Q

Give 3 examples of conditions in which bronchial breathing may be observed

A

Consolidation (without proximal obstruction)

May be heard in collapse (atelectasis) or pleural effusion

19
Q

Give 6 examples of conditions in which reduced breath sounds may be heard

A

Airflow obstruction

Hyperinflation

Pleural effusion

Pneumothorax

Thick chest wall

Lung collapse

20
Q

Why might wheezes occur?

A

Partial bronchial obstruction

21
Q

How should wheeze be characterised?

A

High or low pitched

Inspiratory or expiratory

Focal or diffuse

22
Q

List 5 conditions in which wheeze might occur

A

Asthma

Chronic bronchitis

Pulmonary oedema

Foreign body

Lung tumour

23
Q

How should crepitations be characterised?

A

High or low pitched

Inspiratory or expiratory

24
Q

Why might crepitations occur?

A

Bubbling of air through secretions

Sudden opening of small airways and alveoli with rapid equalisation of pressures

25
Q

List 5 possible causes of crackles

A

Pulmonary oedema

Pulmonary fibrosis

Pneumonia

Bronchiectasis

Atelectasis

26
Q

What is pleural rub?

A

Non-musical sound, usually longer and lower pitch than crepitations

Inspiratory with mirror image in expiration

Not cleared with coughing

May be palpable

Often associated with pleuritic pain

27
Q

What is the mechanism of pleural rub?

A

Sliding of roughened pleural surfaces (without intervening pleural fluid)

28
Q

What are the broad causes of pleural rub?

A

Inflammation (infective, non-infective)

Tumour

29
Q

What else should be measured on auscultation?

A

Forced expiratory time: listen over the trachea, should be less than 3 seconds (>6 secs indicates significant airflow obstruction)

30
Q

What other regions should be examined during a respiratory examination and why?

A

Heart: features of pulmonary HTN, for other explanations of dyspnoea or haemoptysis

Abdomen: for features of RHF, liver metastases, etc

Legs: for features of RHF, venous thrombosis

31
Q

What findings are expected on respiratory examination in the setting of consolidation?

A

Usually no shift in trachea, small change in chest movement

Decreased percussion note

Increased breath sounds (bronchial, +/- crepitations)

Increased vocal resonance

32
Q

What findings are expected on respiratory examination in the setting of pleural effusion?

A

Mediastinal shift (to other side) and decreased movement only if very large

Decreased percussion note

Decreased breath sounds

Decreased vocal resonance

33
Q

What findings are expected on respiratory examination in the setting of pneumothorax?

A

Mediastinal shift (depending on size) and sometimes decreased chest movement

Increased percussion note

Decreased breath sounds

Decreased vocal resonance

NB Can’t detect clinically if small

34
Q

List 8 signs seen in COPD

A

Respiratory distress

Cachexia

Cyanosis

Plethoric facies

Signs of hyperinflation

Wheezes

Signs of pulmonary HTN +/- RHF

Prolonged forced expiratory time

35
Q

List 4 signs of pulmonary HTN

A

Palpable RV heave and 2nd HS

Loud S2

S4

Pulmonary flow murmur

36
Q

List 3 signs of RHF

A

Elevated JVP

S3

Peripheral oedema, ascites, pleural effusions

37
Q

List 3 causes of reduced percussion note at lung base

A

Consolidation/collapse or dense fibrosis of lung

Pleural effusion or thickening

Elevated hemidiaphragm (pulled up, pushed up or paralysed)

MD2 Examinations (6 decks)

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