Respiratory examination Flashcards
What ‘red flags’ should prompt a chest x-ray?
- haemoptysis
- breathlessness
- fever
- chest pain
- weight loss
What are the types of sputum?
- serous
- mucoid
- purulent
- rusty
Describe serous sputum
- clear, watery (acute pulmonary oedema)
- frothy, pink (alveolar cell cancer)
Describe mucoid sputum
- clear, grey (chronic bronchitis/COPD)
- white, viscid (asthma)
What are the possible causes of yellow purulent sputum
- acute bronchopulmonary infection
- asthma (eosinophils)
What are the possible causes of green sputum?
longer standing infection
- pneumonia
- bronchiectasis
- cystic fibrosis
- lung abcess
Describe rust sputum
rusty colour - pneumococcal pneumonia
What are the possible causes of haemoptysis?
- tumour
- infection
- vascular
- vasculitis
- trauma
- cardiac
- haematological
What are the causes of non-central chest pain
Pleural:
- infection
- malignancy
- pneumothorax
- pulmonary infarction
- connective tissue disease
Chest wall:
- malignancy
- cough/breathlessness
- muscle spasm
- Rib fracture
- intercostal nerve
- thoracic shingles
What are the causes of central chest pain?
- tracheal
- cardiac
- oesophageal
- great vessels
- mediastinal
What are the non-cardiorespiratory causes of breathlessness?
- anaemia
- metabolic acidosis
- obesity
- psychogenic
- neurogenic
What are the cardiac causes of breathlessness?
- LV failure
- mitral valve disease
- cardiomyopathy
- constrictive pericarditis
- pericardial effusion
What are the causes of respiratory breathlessness?
- airway
- parenchyma
- pulmonary circulation
- pleural
- chest wall
- neuromuscular
What factors may be important from the past history?
- atopy
- asthma
- past illnesses (whooping cough, measles, pneumonia, TB)
- connective tissue disorders
- malignancy
- recent travel
- recent surgery
- neuromuscular
What should be asked in the drug history?
- type, dose and frequency of inhaler
- effectiveness of previously prescribed medications
What important diseases should be asked about in family history?
- Cystic fibrosis
- atopy
- COPD
- TB
What should you ask the patient about their social history?
- smoking
- pets
- occupation
How should you start the respiratory examination?
- wash hands
- introduce self
- confirm name & DOB
- explain procedure
- gain consent
What should you look for in the general inspection?
- observe appearance
- look for sputum pots, oxygen, inhalers, intercostal drains
- count RR
- stridor
- hoarseness
What should you look for on the hands?
- temperature
- clubbing of nails
- palmar erythema
- pallor of palmar creases
- peripheral cyanosis
- tar staining
- fine tremor
- asterixis (flapping tremor of CO2 retention)
- pulse
What should you look for on the face?
- pale conjuctiva (anaemia)
- central and peripheral cyanosis
What should you look for on the chest?
- scars
- deformities
- assess chest movements
- use of accessory muscles
What should you palpate on the neck?
lymph nodes
- palpate one side at a time from behind the patient
tracheal deviation
- place fingers on either side (may be uncomfortable)
What should you palpate on the chest?
- chest expansion
- tactile fremitus (99)
