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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
How do you assess expansion
Finger tips along mid axillary line, and thumbs as pointers
26
Causes of reduced chest wall movement
Any lung, pleural or chest wall disease Kyphoscoliosis AnkSpond Neuromuscular
27
What should you be aware of in patients who have severe kyphoscoliosis
Oxygen sensitive
28
Why can you get dilated superficial veins
Superior VC blockage (Lung cancer)
29
What do you palpate
Neck (lymph and trachea) Axillae Chest wall movement Apex beat
30
Which distance is measured in the neck
Notch-cricoid distance
31
How do you assess tactile vocal fremitus
Say 99 | Feel vibrations with side of hands
32
What are you listening for in percussion
Left v Right Resonance Horizontal sounding finger
33
What does resonance on percussion suggest
Aerated lung tissue below
34
If uncertain about the presence of dullness what should you do
Tactile vocal fremitus and vocal resonance
35
In emphysema what will be absent on percussion
Cardiac and hepatic dullness
36
How best to assess trachea centrality
Sneak a finger above the sternum
37
When is resonance lost
Pleural effusion Consolidation/collapse/ fibrosis Raised diaphragm Over liver and heart (not in emphysema)
38
What gives a stony dull, lost resonance
Pleural effusion
39
When is resonance increased
Emphysema | Pneumothorax
40
Where to percuss posteriorly
Hands on knees Over trapezius 4-5 times each side lateral chest walls (3-4 times each side)
41
Where to percuss anteriorly
Over clavicles | In mid clavicular line (4-5 times each side)
42
How to auscultate
- use diaphragm - patient breathes deep - compare sides
43
Where do you ausculatate
Patient bending forward Over trapezius Mid clavicular line Over lateral chest walls
44
How many times do you auscultate over the trapezium
4-5 times each side
45
How many times do you auscultate over the mid clavicular line
4-5 times each side
46
What do you say to the patient when using your stethoscope
Deep breathe every time I put my stethoscope on your back
47
how many times do you auscultate over the lateral chest wall
3-4 times each side
48
What are normal sounds called
Vesicular
49
What is bronchial breathing
A much coarser sound, harsh. Tracheal sound transmitted out to the edge of the lung
50
When do you hear bronchial breathing
Fibrotic lung and consolidated, pleural effusion
51
What is bronchial breathing associated with
Whispering pectoriloquy
52
What is a wheeze
Expiratory musical sound
53
What are crackles
Caused by small airway closure. More noticeable at the bases.
54
What can cause crackles
Secretions in airways Consolidation Fibrotic lung disease Heart failure
55
What is a false positive for crackles
When they first recruit alveoli after being sat.
56
Why should you ask the patient to cough before listening for crackles
It clears secretions and prevents false crackles.
57
How do you assess whispering pectoriloquy
Whisper 1,2,3 | Listen for dramatic increase in volume around consolidated lung
58
What can cause whispering pectoriloquy
Consolidation, causing enhanced conduction

2b (28 decks)

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