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Year 3 Examinations > Respiratory Examination > Flashcards

Respiratory Examination Flashcards

1
Q

What deformities should you visually inspect for at the start of a respiratory examination? (4)

A

Pectus excavatum, pectus carinatum (pigeon chest), scoliosis and kyphosis

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2
Q

What 2 conditions is barrel chest associated with?

A

Emphysema and arthritis

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3
Q

What should you inspect the environment for when conducting a respiratory examination? (4)

A

Peak flow meter, inhalers, nebuliser and sputum pot

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4
Q

What should you inspect the hands for when conducting a respiratory examination? (4)

A

Flapping tremor of CO2 retention for at least 30 seconds
Assess pulse and respiratory rate simultaneously
Cyanosis (temperature)
Clubbing

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5
Q

What common conditions can fingernail clubbing be indicative of? (4)

A 
Lung cancer
Congenital heart defects 
Infectious endocarditis
Interstitial lung disease
Chronic lung infections that occur in people with bronchiectasis, cystic fibrosis, or lung abscess
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6
Q

What is the normal crico-sternal distance?

A

2cm/2 finger breadths

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7
Q

What condition can affect the crico-sternal distance?

A

COPD due to the hyperexpanded (barrel) chest can reduce the distance

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8
Q

What is tracheal tug?

A

When the trachea appears to be tugged into the thorax due to the barrel chest

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9
Q

What can cause tracheal deviation? (2)

A

If something pushes the mediastinum (tension pneumothorax with air outside one lung) or their is something pulling the mediastinum (collapse and consolidation caused by endobronchial obstruction)

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10
Q

How do you assess chest expansion? (2)

A

Test upwards movement by placing hands on the anterior chest wall
Test lateral movement by putting hands on the lateral chest walls

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11
Q

How do you locate consolidation?

A

By finding where there is increased tactile vocal fremitus

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12
Q

What do you ask the patient to say and how do you assess tactile vocal fremitus?

A

“99”

Put your hand on its side on the chest wall in 6 different places

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13
Q

What is dullness in percussion of the chest wall caused by?

A

Fluid or consolidation

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14
Q

What is pulmonary consolidation?

A

When a region of normally compressible lung tissue has filled with liquid instead of air.

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15
Q

What type of sound resonates upon the percussion of the chest wall in consolidation?

A

Dull (stony dull)

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16
Q

How do you confirm consolidation?

A

Ask the patient to whisper 1-2-3 whilst you listen with your stethoscope over where you think there is consolidation, if the lung is normal you will not hear a thing.

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17
Q

What does wasting of the thenar and hypothenar eminences indicate?

A

Seen when apical lung tumours (Pancoast’s tumour) impinge on the C8/T1 nerve roots

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18
Q

What is seen when apical lung tumours (Pancoast’s tumour) impinge on the C8/T1 nerve roots?

A

Wasting of the thenar and hypothenar eminences

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19
Q

What is peripheral cyanosis in the absence of central cyanosis indicative of?

A

Is reflective of peripheral vasoconstriction and stasis of blood in the peripheries

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20
Q

How can you see central cyanosis?

A

Seen in the tongue and lips due to desaturation of central arterial blood

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21
Q

What is asterixis?

A

Asterixis is manifest by sudden loss of dorsiflexion causing flexion movements towards the neutral position at the wrist

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22
Q

What is asterixis a sign of?(2)

A

Sign of carbon dioxide retention (‘carbon dioxide flap’) or hepatic encephalopathy (‘liver flap’).

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23
Q

What gives rise to an irregularly irregular pulse?

A

Atrial fibrillation

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24
Q

What gives rise to a ‘slow-rising’ pulse?

A

Aortic stenosis

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25
Q

What gives rise to a ‘bounding’ pulse?

A

CO2 retention

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26
Q

What gives rise to a ‘jerky’ pulse?

A

Hypertrophic cardiomyopathy

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27
Q

Which pulse is unlikely to be detected peripherally: slow-rising/bounding/jerky?

A

Jerky

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28
Q

What type of pulse is indicative of aortic stenosis?

A

Slow-rising

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29
Q

What type of pulse is indicative of CO2 retention?

A

Bounding

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30
Q

What type of pulse is indicative of hypertrophic cardiomyopathy?

A

Jerky

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31
Q

What is radio-radial delay a sign of?

A

Aortic coarctation

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32
Q

What is strength inequality of arm pulses a sign of?

A

Aortic dissection

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33
Q

What is a collapsing pulse indicative of?

A

Aortic regurgitation

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34
Q

What is water-hammer pulse a sign of?

A

Aortic regurgitation

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35
Q

What is radio-femoral delay a sign of?

A

Aortic coarctation

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36
Q

What is a sign of aortic coarctation?

A

Radio-femoral delay

Radio-radial delay

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37
Q

What is a sign of aortic regurgitation?

A

Water-hammer/collapsing pulse

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38
Q

How do you test for a collapsing pulse?

A

Examine for a collapsing pulse by placing your fingers across the anterior aspect of patient’s forearm and applying just enough pressure to occlude the radial pulse.
Confirm that the patient has no pain in their shoulder, and then elevate their arm above their head whilst maintaining the position of your hand.
You are feeling for a forceful knocking sensation that is typical of aortic regurgitation, commonly known as the ‘collapsing’ or ‘water-hammer’ pulse.

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39
Q

How do you test for a water-hammer pulse?

A

Examine for a collapsing pulse by placing your fingers across the anterior aspect of patient’s forearm and applying just enough pressure to occlude the radial pulse.
Confirm that the patient has no pain in their shoulder, and then elevate their arm above their head whilst maintaining the position of your hand.
You are feeling for a forceful knocking sensation that is typical of aortic regurgitation, commonly known as the ‘collapsing’ or ‘water-hammer’ pulse.

40
Q

What is pulsus paradoxus usually defined as?

A

An inspiratory decline in systolic BP that exceeds 10mmHg, but a more appropriate threshold may be 12mmHg which has been shown to be the upper 95% confidence interval for an inspiratory drop in normal individuals.

41
Q

Which patients does pulses paradoxus occur in?

A

Patients with cardiac tamponade and is a highly sensitive and specific sign in identifying the condition in those with known pericardial effusions.

42
Q

What is cardiac temponade?

A

Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space

43
Q

What is an aortic dissection?

A

An aortic dissection is a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect).

44
Q

What is aortic coarctation?

A

A congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts

45
Q

What should you always check for in patients with suspected pericardial disease?

A

Pulsus paradoxis

46
Q

How to measure pulsus paradoxis?

A

Begin by measuring the BP as described but on hearing the first Korotkoff sound, prevent further deflation of the cuff. In patients with paradox, the sounds are intermittent with respiration. Note this pressure then continue to deflate the cuff until sounds are heard throughout the respiratory cycle. The amount of paradox in mmHg is the difference between the pressure at this point and the initial measurement.

47
Q

When looking at the eyes in a respiratory examination what are you looking for?(4)

A

Assess pupil size and symmetry.
Look at the eyelids, the normal upper lid lies 1.5mm below the superior corneal limbus.
Ptosis refers to drooping of the upper eyelid, this can be partial or complete.
Enophthalmos is a sign which refers to posterior displacement of the eye, a difference of 2mm between the eyes is usually evident on examination.

48
Q

What is enophthalmos?

A

A sign which refers to posterior displacement of the eye, a difference of 2mm between the eyes is usually evident on examination.

49
Q

When looking at the face and mouth in a respiratory examination what are you looking for?(2 and 1)

A

Rashes and anhydrosis (loss of sweating)

Elevate their tongue to inspect the underside for marked blue discolouration

50
Q

How can you look for central cyanosis and what does it reflect?

A

Elevate their tongue to inspect the underside for marked blue discolouration indicating central cyanosis, reflecting inadequate blood oxygenation in the lungs or increased oxygen extraction in the tissues.

51
Q

What is a malar rash?

A

A characteristic macular, non itchy rash in the shape of a butterfly over the bridge of the nose and across the cheeks

52
Q

What causes malar rash?

A

Systemic lupus erythematosus

53
Q

What respiratory conditions is systemic lupus erythematosus associated with? (3)

A

Pulmonary fibrosis, pleural effusion and pulmonary emboli.

54
Q

What is lupus pernio?

A

A rash characterised by violaceous smooth shiny plaques on the face which is a sign of sarcoidosis which is associated with pulmonary fibrosis and bronchiectasis.

55
Q

What is lupus permit a sign of?

A

a rash characterised by violaceous smooth shiny plaques on the face which is a sign of sarcoidosis which is associated with pulmonary fibrosis and bronchiectasis.

56
Q

What is sarcoidosis associated with?

A

Pulmonary fibrosis and bronchiectasis.

57
Q

Ptosis, miosis (small pupil), anhydrosis and apparent endophthalmos are seen in what condition?

A

Horner’s syndrome

58
Q

What signs are seen in Horner’s sydrome? (4)

A

Ptosis, miosis (small pupil), anhydrosis and apparent endophthalmos

59
Q

What is wrong in Horner’s syndrome? Give a cause of Horner’s syndrome?

A

Disruption of the sympathetic input to the face and can be caused by Pancoast’s tumour

60
Q

What is Pancoast’s tumour?

A

Pancoast tumor is a tumor of the pulmonary apex

61
Q

What can raise JVP/central venous pressure?

A

Right heart failure/SVC obstruction

62
Q

What can cause right heart failure?(5)

A

COPD, fluid overload, increased intrathoracic pressure, cardiac tamponade or constrictive pericarditis

63
Q

What can cause SVC obstruction?

A

Bronchial carcinoma, especially of the right upper lobe.

64
Q

What does a bronchial carcinoma causing SVC obstruction lead to?

A

Venous distension and oedema in the neck, face, upper chest and arms.

65
Q

What is venous distension and oedema in the neck, face, upper chest and arm indicative of?

A

Bronchial carcinoma causing SVC obstruction

66
Q

What can a crackling sensation under your fingers whilst palpating the chest be caused by?

A

Subcutaneous emphysema

67
Q

What can reduced expansion of the chest be caused by?(5)

A

Fibrosis, consolidation, effusion, collapse or pneumothorax

68
Q

What can displace the cardiac apex beat?(4)

A

Pleural effusion, lobar collapse, pneumothorax or pneumonectomy

69
Q

What is a parasternal heave suggestive of?

A

Right ventricular hypertrophy

70
Q

What can cause right ventricular hypertrophy?(3)

A

Pulmonary hypertension in chronic obstructive pulmonary disease, interstitial lung disease or multiple pulmonary emboli.

71
Q

What can cause a barrel shaped chest? (2)

A

COPD or severe asthma or any obstructive airway disease

72
Q

What is a barrel chest often coupled with?

A

Dorsal kyphosis and prominence of the sternum.

73
Q

What can cause pectus carinatum?

A

Chronic respiratory disease in childhood

74
Q

What can cause pectus excavatum?

A

Can arise due to connective tissue disease.

75
Q

What is peripheral oedema indicative of?(3)

A

Congestive cardiac failure or cor pulmonale secondary to pulmonary disease.

76
Q

What can a DVT present with?

A

Lower limb swelling or erythema

77
Q

What causes erythema nodosum?(3)

A

Streptococcal infection, tuberculosis and sarcoidosis

78
Q

Where and what is erythema nodosum?

A

A panniculitis (inflammation of subcutaneous adipose tissue) which causes tender nodules; often on the shins may be observed.

79
Q

What is inflammation of subcutaneous adipose tissue known as?

A

Panniculitis

80
Q

What is: panniculitis (inflammation of subcutaneous adipose tissue) which causes tender nodules; often on the shins may be observed.

A

Erythema nodosum

81
Q

Where do you auscultate for a pan systolic murmur?

A

Left lower sternal edge

82
Q

What is a pan systolic murmur indicative of?

A

Tricuspid regurgitation

83
Q

How do you detect a tricuspid regurgitation?

A

Auscultate the left lower sternal edge for a pan systolic murmur loudest during inspiration

84
Q

What is tricuspid regurgitation indicative of?

A

Right ventricle dilatation seen with pulmonary hypertension

85
Q

What is Graham Steel murmur caused by?

A

Caused by high velocity regurgitant flow across the pulmonary valve typical of pulmonary hypertension

86
Q

What does a Graham Steel murmur indicate?

A

Pulmonary hypertension

87
Q

Where do you auscultate for a Graham Steel murmur?

A

The left upper sternal edge for a high pitched early diastolic murmur loudest during inspiration

88
Q

What relevance is Tennessee in heart sounds? What is it indicative of?

A

The cadence of the 3 heart sounds – S1, S2 and S4 which are said to resemble that of the word ‘Tennessee’ which are seen in pulmonary stenosis or pulmonary hypertension

89
Q

What is a loud P2 heart sound indicative of?

A

Pulmonary hypertension

90
Q

What is a hyperresonant lung sound indicative of?

A

Pneumothorax, COPD

Hyperinflated lung tissue or air in the pleural space

91
Q

What is a dull/stony-dull lung sound indicative of?

A

Pleural effusion, presence of hepatic tissue, consolidation, pleural thickening
Solid organ or fluid

92
Q

What percussion note does pneumothorax cause?

A

Hyperresonant

93
Q

What percussion note does COPD cause?

A

Hyperresonant

94
Q

What percussion note does a pleural effusion cause?

A

Dull/stony-dull

95
Q

What percussion note does consolidation cause?

A

Dull/stony-dull

96
Q

What percussion note does presence of hepatic tissue cause?

A

Dull/stony-dull

97
Q

What percussion note does pleural thickening cause?

A

Dull/stony-dull

Year 3 Examinations (5 decks)

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