Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Respiratory Examination > Flashcards

Respiratory Examination Flashcards

1
Q

4 steps to the introduction of the examination

A
  1. Introduce yourself & confirm patient identity
  2. Explain procedure, gain consent, and ensure chaperone if needed
  3. Wash hands
  4. Position patient at 45º
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Signs of respiratory disease on general inspection around bedside

A
  • Inhalers/medications
  • Nebuliser
  • Sputum pot
  • Oxygen
  • Drips
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Signs of respiratory disease on general inspection of patient

A
  • Breathlessness
  • Pain/discomfort
  • Position
  • Use of accessory muscles
  • Audible inspiratory strider
  • Expiratory wheeze
  • pattern of speech (I.e. interrupts speech flow to take breath)
  • Sound of cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does an audible inspiratory stridor indicate?

A

Upper airway obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does an expiratory wheeze indicate?

A

Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hoarseness of the voice can indicate…

A
  • Laryngitis

- Lung cancer -> laryngeal nerve palsy or laryngeal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Assessment of the hands includes the following 9 things:

A
  1. Assess circulation, warmth, filling of veins (capillary refill time)
  2. Finger clubbing
  3. Tar-staining (long-term smoking)
  4. Koilonychia (Iron deficiency anemia -> SOB)
  5. Flapping tremor
  6. Fine tremor
  7. Radial pulse
  8. Respiratory rate
  9. Peripheral cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name 6 respiratory causes of finger clubbing:

A
  1. Lung cancer
  2. Mesothelioma
  3. Pulmonary fibrosis
  4. Bronchiectasis (late stages)
  5. Empyema
  6. Cystic fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What would a flapping tremor indicate?

A

CO2 retention

Can cause warm hands, bounding pulse, coarse irregular flapping tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What would a fine tremor indicate?

A

Use of b-agonist inhalers/nebulisers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tachycardia of > X indicates a severe asthma attack

A

> 110bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What 6 things are you observing in the face?

A
  1. Colour -> polycythemia 2º to chronic lung disease or smoking
  2. Pursed lip breathing on expiration (pts with emphysema)
  3. Central cyanosis
  4. Horner’s Syndrome
  5. Anemia in eyes
  6. Iritis, conjunctivitis -> TB, sarcoidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What 4 things are you inspecting on the chest?

A
  1. Scars (thoracotomy scar, chest drain)
  2. Chest shape (asymmetry, deformity, AP diameter)
  3. Prominent chest wall veins
  4. Pattern of breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where would one find a thoracotomy scar/chest drain?

A

2nd intercostal space mid-clavicle are line

OR

In axilla (4th-6th intercostal spaces)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In what condition will the patient have a large AP diameter with little lateral expansion?

A

COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What would prominent chest wall veins suggest?

A

SVC obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What 5 things are you looking for when palpating the neck and chest?

A
  1. JVP
  2. Position of trachea
  3. Tracheal tug (cricosternal distance)
  4. Position of apex beat
  5. Expansion of chest anteriorly & posteriorly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is the JVP elevated? (6)

A
  1. R heart failure (2º to chronic lung disease or PE)
  2. Fluid overload
  3. Massive PE
  4. Tension pneumothorax
  5. Cardiac tamponade
  6. SVC obstruction
19
Q

What is tracheal tug?

A

The trachea will be pulled down on inspiration due to hyperinflation

Seen in COPD

20
Q

What is the normal cricosternal distance?

A

2-3 finger breadths, reduced with hyperinflation

21
Q

Explain the causes of tracheal deviation towards/away from the pathology:

A

Towards pathology: Collapse, pneumonectomy, fibrosis

Away from pathology: Tension pneumothorax, very big pleural effusion

22
Q

What heave are you feeling for L of the sternum?

A

R ventricular heave

23
Q

When percussing the chest what are the possible percussion notes?

A
  1. Resonant
  2. Hyper resonant
  3. Dull
  4. Stony dull
24
Q

What are the possible causes of each percussion note?

A

Resonant -> Normal lung
Hyper resonant -> Emphysema, large bullae, pneumothorax
Dull -> Consolidation, collapse, fibrosis, alveolar fluid, pleural thickening, neoplasm
Stony dull -> Pleural effusion, hemathorax

25
Q

Name 4 deformities of the chest on inspection and possible causes:

A

Barrel chest -> hyperinflation (COPD)

Pectus excavatum (funnel chest) -> developmental defect

Pectus carinatum (pigeon chest) -> increased respiratory effort during development

Paradoxical movement chest/abdo -> COPD or obstruction

26
Q

What is a medical cause of a parasternal heave?

A

Cor pulmonale

27
Q

When would the apex beat be deviated?

A

Collapse

Tension pneumothorax

28
Q

What is involved in the vocal resonance test?

A

If an area of dullness is found on percussion, as you auscultate over the area ask the patient to say “one, one, one” and then whisper the same. Assess the quality and amplitude.

Whispering is not heard over a normal lung but in consolidation the sound is transmitted.

29
Q

How do you distinguish dull and stony dull percussion?

A

Using vocal resonance

Consolidation/collapse = increased vocal resonance
Pleural effusion = decreased vocal resonance

30
Q

Which is longer, inspiration or expiration?

A

Inspiration

31
Q

How are breath sounds produced?

A

By turbulent airflow in the large and small airways

32
Q

The larger the airway, what happens to the sound?

A

The larger the sound

33
Q

What are normal breath sounds?

A
  • Vesicular
  • Produced by small airways/alveoli
  • Low-pitched (heard best with the bell)
  • No gap between inspiration and expiration, but a gap between expiration and inspiration
34
Q

What happens to breath sounds when normal lung is displaced by air or fluid?

A

Breath sounds are decreased (I.e. pleural effusion, emphysema/pneumothorax)

35
Q

What are bronchial sounds?

A

Heard in pathologies when small airways/alveoli have been damaged (I.e. consolidation)

  • Noises from the large airways
  • Harsher sounding than vesicular breathing (i.e. Darth Vader breathing)
  • Gradually increase thru inspiration but stop near the end of inspiration (there IS a gap between inspiration and expiration)
36
Q

Name 3 abnormal added breath sounds

A
  1. Crackles -> high-pitched, discontinuous -> oedema/fibrosis/infection/fluid
  2. Wheeze -> high-pitched, musical -> asthma (small airway narrowing)
  3. Pleural rub -> low-pitched, creaking leather -> Pleurisy (pleural inflammation), pneumonia, PE with infarction
37
Q

Name causes for diminished breath sounds

A 
Local = pleural effusion, tumour, pneumothorax, pneumonia, collapse
Global = COPD
38
Q

Name causes of a wheeze

A 
Polyphonic = asthma, COPD
Monophonic = foreign body, carcinoma
39
Q

Which lymph nodes do you assess in this exam?

A
  • Anterior and posterior triangles
  • Supraclavicular
  • Submental
  • Submandibular
  • Tonsillar glands
  • Deep cervical chain in anterior triangle
  • Scalene nodes
40
Q

What can lymphadenopathy indicate in the context of this exam?

A

Pancoast tumour at the apex of the lung

41
Q

Why do you check for sacral and ankle oedema?

A

To assess for R heart failure

42
Q

Name the potential findings on examination of each of the following conditions in terms of palpating, percussion, and auscultation:

  1. Pneumonia/Consolidation
  2. Pleural effusion
  3. Pneumothorax
  4. Collapse
  5. COPD
A
  1. Palpation = decreased expansion unilaterally
    Percussion = Dull locally
    Auscultation = Crackles, bronchial, increased vocal resonance
  2. Palpation = decreased expansion unilaterally
    Percussion = Dull locally (stony dull)
    Auscultation = decreased breath sounds locally, decreased vocal resonance
  3. Palpation = trachea deviated away (if tension pneumothorax), decreased expansion unilaterally
    Percussion = Hyper resonant locally
    Auscultation = decreased/absent breath sounds locally
  4. Palpation = tracheal deviation towards, decreased expansion unilaterally
    Percussion = dull locally
    Auscultation = decreased breath sounds locally, decreased vocal resonance
  5. Palpation = increased cricosternal distance, increased expansion
    Percussion = decreased globally
    Auscultation = decreased breath sounds globally
43
Q

What other areas should you assess/mention to the examiner at the end of the respiratory examination?

A
  1. Look in sputum pot if available
  2. Look at observation chart (pulse, BP, temperature)
  3. Perform peak flow (+ refer for spirometry as appropriate)

Year 3 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions