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2b > Respiratory Examination > Flashcards

Respiratory Examination Flashcards

1
Q

Overall scheme

A

Introduce and handshake
Extremities
Inspect chest (front&back)
Palpate, percuss and auscultate the front and back of chest

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2
Q

Four steps to respiratory examination

A

Inspection
Palpation
Percussion
Auscultation

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3
Q

Things to note in the initial inspection

A 
Cough
Wheeze
Stridor
Laboured breathing
Purse lipped breathing
Nutritional state
Paraphernalia
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4
Q

What do you look at on inspection

A 
Face and skin
Hands and feet
Neck
Expose chest fully
-chest wall
-breathing movements
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5
Q

Things to look for on the hands

A 
Digital clubbing
Tremor
Warmth
Oedema
Tobacco stains
Coal dust tattoos
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6
Q

What is the most common cause of clubbing

A

Lung cancer

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7
Q

What are respiratory causes of clubbing

A

Cancer
Fibrosing alveolitis
Bronchiectasis
Empyema

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8
Q

What is a flapping tremor associated with

A

Respiratory failure

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9
Q

What is a fine tremor associated with

A

Beta 2 agonists

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10
Q

What is a bounding pulse with warm peripheries a sign of

A

CO2 retention

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11
Q

What are you inspecting the face and neck for

A 
Complexion, cyanosis
Eyes
Neck
-JVP
-Trachea (deviation? tug?)
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12
Q

When is JVP elevated

A

Peripheral oedema and raised JVP in cor pulmonale.

Fixed SVC obstruction

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13
Q

Is breathlessness a symptom or sign

A

Symptom

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14
Q

Is tachypnoea a symptom or sign

A

Sign

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15
Q

What causes central cyanosis

A

Arterial desaturation (low PaO2)

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16
Q

What causes peripheral cyanosis

A

Reaction to cold, poor perfusion, anxiety

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17
Q

What are signs of respiratory failure

A

Central and peripheral failure

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18
Q

Lung cancer and clubbing

A

Lung cancer until proven otherwise

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19
Q

What are you inspecting the chest wall for

A

Deformity, under and over inflation

Scars, radiotherapy changes, dilated veins, aspiration wounds.

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20
Q

What doesnt ever cause clubbing

A

COPD

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21
Q

What is flapping tremor a sign of

A

Liver failure

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22
Q

Things to look for in chest wall movement

A

Rate, rhymthm, prolonged expiration, movement patterns

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23
Q

Where is a sensitive place for central cyanosis

A

Bottom of the tongue

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24
Q

Chest wall movement patterns

A

Symmetry
Chest vs abdo
Accessory muscle use
Assess expainsion

25
Q

How do you assess expansion

A

Finger tips along mid axillary line, and thumbs as pointers

26
Q

Causes of reduced chest wall movement

A

Any lung, pleural or chest wall disease
Kyphoscoliosis
AnkSpond
Neuromuscular

27
Q

What should you be aware of in patients who have severe kyphoscoliosis

A

Oxygen sensitive

28
Q

Why can you get dilated superficial veins

A

Superior VC blockage (Lung cancer)

29
Q

What do you palpate

A

Neck (lymph and trachea)
Axillae
Chest wall movement
Apex beat

30
Q

Which distance is measured in the neck

A

Notch-cricoid distance

31
Q

How do you assess tactile vocal fremitus

A

Say 99

Feel vibrations with side of hands

32
Q

What are you listening for in percussion

A

Left v Right
Resonance
Horizontal sounding finger

33
Q

What does resonance on percussion suggest

A

Aerated lung tissue below

34
Q

If uncertain about the presence of dullness what should you do

A

Tactile vocal fremitus and vocal resonance

35
Q

In emphysema what will be absent on percussion

A

Cardiac and hepatic dullness

36
Q

How best to assess trachea centrality

A

Sneak a finger above the sternum

37
Q

When is resonance lost

A

Pleural effusion
Consolidation/collapse/ fibrosis
Raised diaphragm
Over liver and heart (not in emphysema)

38
Q

What gives a stony dull, lost resonance

A

Pleural effusion

39
Q

When is resonance increased

A

Emphysema

Pneumothorax

40
Q

Where to percuss posteriorly

A

Hands on knees
Over trapezius
4-5 times each side
lateral chest walls (3-4 times each side)

41
Q

Where to percuss anteriorly

A

Over clavicles

In mid clavicular line (4-5 times each side)

42
Q

How to auscultate

A
  • use diaphragm
  • patient breathes deep
  • compare sides
43
Q

Where do you ausculatate

A

Patient bending forward
Over trapezius
Mid clavicular line
Over lateral chest walls

44
Q

How many times do you auscultate over the trapezium

A

4-5 times each side

45
Q

How many times do you auscultate over the mid clavicular line

A

4-5 times each side

46
Q

What do you say to the patient when using your stethoscope

A

Deep breathe every time I put my stethoscope on your back

47
Q

how many times do you auscultate over the lateral chest wall

A

3-4 times each side

48
Q

What are normal sounds called

A

Vesicular

49
Q

What is bronchial breathing

A

A much coarser sound, harsh. Tracheal sound transmitted out to the edge of the lung

50
Q

When do you hear bronchial breathing

A

Fibrotic lung and consolidated, pleural effusion

51
Q

What is bronchial breathing associated with

A

Whispering pectoriloquy

52
Q

What is a wheeze

A

Expiratory musical sound

53
Q

What are crackles

A

Caused by small airway closure. More noticeable at the bases.

54
Q

What can cause crackles

A

Secretions in airways
Consolidation
Fibrotic lung disease
Heart failure

55
Q

What is a false positive for crackles

A

When they first recruit alveoli after being sat.

56
Q

Why should you ask the patient to cough before listening for crackles

A

It clears secretions and prevents false crackles.

57
Q

How do you assess whispering pectoriloquy

A

Whisper 1,2,3

Listen for dramatic increase in volume around consolidated lung

58
Q

What can cause whispering pectoriloquy

A

Consolidation, causing enhanced conduction

2b (28 decks)

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