Respiratory examination Flashcards
What does a bounding pulse on the internal jugular vein signify?
hypercapnia
What are some respiratory causes of raised JVP? (4)
Right ventricular failure
Tension pneumothorax
Severe acute asthma
Pulmonary embolism
On percussion, what does a stony dull sound mean?
pleural effusion
What is the definition of a raised JVP?
> 3cm in vertical height above the sternal angle
What can cause a deviated trachea?
tension pneumothorax
large pleural effusion
collapsed lung
pneumonectomy
If percusion note is dull with both consolidation and effusion, how can you tell the difference with auscultation?
Consolidation gives increased breathing sounds,
effusion there are no breathing sounds.
What can cause finger clubbing? (6)
Interstitial lung disease
Emphysema
TB
Bronchiectasis
Cystic fibrosis
Lung malignancy
Where is the apex heart beat?
5th intercostal space, mid-clavicular line
On percussion, what does hyper-resonance signify?
pneumothorax
What is a sign of Pancoast’s tumour in the apex of the lung
muscle wasting of dorsal interossi and thenar eminance
When checking lung expansion, how much should the extension be?
>5cm
If the cricosternal distance is less than three fingers, what can this indicate?
hyperinflated lungs
On percussion, what does a dull sound signify? (4)
consolidation
lung collapse
pneumonectomy
cryptogenic fibrosing alveolitis
What’s the golden rule with fever, cough and pleuritic chest pain?
It’s pneumonia until proven otherwise.
what may cause a deviation of the apex heart beat?
a deviation of the mediastinum following a pneumothorax
What’s the difference between fine and course crackles?
Course: fluid (oedema) or infection in small airways
fine: heard in chronic lung diseases
Name five signs of respiratory distress
Tachypnoea
Tripod position
Use of accessary muscles
Pursed lips
Flared nostrils
what is a normal respiratory rate?
12-16 breaths per minute
What’s the sputum like with pulmonary oedema?
Pink, frothy.
What things to look for at initial general inspection of patient?
Alertness
Wellness
Body habitus
Signs of resp distress
Breathing pattern
Breath sounds
Cough
What can cause a wheeze?
bronchospasm (asthma)
collapse due to loss of lung elasticity (COPD)
mucus obstruction
fluid in terminal bronchiole (oedema)
if just one side; malignancy, foreign body
What are coarse crackles associated with?
- consolidation
- COPD
What is the pleural rub associated with?
Usually associated with pleuritic pain (inflammed pleura)
- pneumonia
- pulmonary embolism
- pleurisy
What is a monophonic wheeze associated with?
Large-airway obstruction
What is a polyphonic wheeze associated with?
small-airway obstruction
- asthma
What are fine crackles associated with?
Early inspiration
- pulmonary oedema
Late inspiration
- Fibrosis
What could increase vocal resonance (99) ?
consolidation
Vesicular breathing
Vesicular breath sounds can be heard over most areas of lungs.
Sound intensity can be higher when the stethoscope is positioned nearer to the bases and the periphery of the lung.
Rhonchi Definition
Continuous low pitched, rattling lung sounds that often resemble snoring.
Obstruction or secretions in larger airways are frequent causes of rhonchi.
They can be heard in patients with chronic obstructive pulmonary disease (COPD), bronchiectasis, pneumonia, chronic bronchitis, or cystic fibrosis. Rhonchi usually clear after coughing.
What can be detected in left lateral decubitus position?
Mitral stenosis
- use bell, lightly on apical impulse.
What is bronchial breathing?
Bronchial breath sounds are tubular, hollow sounds which are heard when auscultating over the large airways (e.g. second and third intercostal spaces). They will be louder and higher-pitched than vesicular breath sounds.
What does a pleural friction rub sound like?
creaking sound similar to treading in fresh snow.
Which part of breathing to you hear a pleural rub?
deep breathing at the end of inspiration and beginning of expiration.
