Respiratory Examination Flashcards
What are the 7 specific areas asked about in a respiratory PC?
- Chest pain
- Dyspnoea
- Cough
- Sputum
- Haemoptysis
- Wheeze
- Systemic upset
What does flapping tremour indicate?
CO2 retention
What does a fine tremor indicate?
overuse of salbutamol inhaler
What are the respiratory causes of clubbing?
- bronchial carcinoma
- Mesothelioma
- Chronic suppurative (pus-making) lung diease
- Bronchiectasis
- lung abscess
- emphysema
- Pulmonary fibrosis
- Cystic fibrosis
What is polycythaemia?
high concentration of RBC in blood making it thick and difficult to circulate through vessels and organs. Gives a ‘ruddy’ complexion
What is Horner’s Syndrome?
damage to cervical sympathetic nerves
What are the clinical features of Horner’s Syndrome?
- unilateral miosis
- partial ptosis
- loss of sweating on the same side
What are prominent veins on the chest wall and indication of?
SVC obstruction
What is surgical emphysema?
air in the subcutaneous tissue
What conditions are likely to cause tracheal deviation towards the leison?
- lobar collapse
- pneumonectomy
- pulmonary fibrosis
What conditions are likely to causes tracheal deviation away from the leison?
- Large pleural effusion
- tension pneumothorax
causes of a resonant percussion note?
normal lung
Causes of a hyperresonant percussion note?
**Too much air
- emphysema
- large bullae (air filled sac)
- pneumothorax
Causes of a dull percussion note
Fluid/Solid
- Collapse
- Consolidation
- Fibrosis
Causes of a “stony” or very dull percussion note
- pleural effusion
- haemothorax
What causes increased fremitus/vibration?
consolidation or fibrosis
What causes decreased fremitus/vibration?
pleural effusion, pneumonia or collapse
Describe vesicular breathing
- inspiratory sounds last longer than expiration
- soft intensity
- relatively low pitch
- located over most of both lungs
When are vesicular breath sounds diminished? and give examples
when normal lung is displaced by air
- obesity
- pleural effusion
- pneumothorax
- collapse
- hyperinflation - emphysema in COPD
Describe bronchial breathing
- expiratory sound lasts longer than inspiratory
- loud intensity of sound
- pitch is relatively high
- heard over the manubrium (larger proximal airways)
- harsh in nature
- gap between inspiration and expiration
Why does bronchial breathing occur?
damage to small airways/alveoli
What are crackles and what do they sound like?
high pitched, discontinuous sounds
similar to the sound produced by rubbing your hair between your fingers
Potential causes of crackles?
- pulmonary oedema
- pulmonary fibrosis
- bronchial secretions
- COPD
- pneumonia
- lung abscess
- TB
- Bronchiolitis
- bronchiectasis
What is pleural rub?
- associated with pleuritic pain
- like “creaking leather”
- low pitched
Causes of pleural rub?
- PE
- pneumonia
- vasculitis (irritation of the lining of the lung)
What is wheeze?
- continuous oscillation of opposing airways
- Muscial quality, high pitched
- louder in expiration
- implies airway narrowing
causes of wheeze
COPD/ASthma
Localised - lung tumour
Polycythaemia =
abnormally increase concentration of Hb in the blood (increased haemocrit). Either through reduction in plasma volume or increase in RBC numbers
Cyanosis =
a bluish discolouration of the skin due to poor circulation or inadequete oxygenation of the blood
Horner’s Syndrome
An interruption of nerve supply from the brian to the face and eye on one side of the body (sympathetic nerve supply)
- unequal size of pupil (miosis)
- Dropping of the eyelid (psosis)
- Anhydrosis (lack of sweating)
What can cause horner’s syndrome?
A tumour at the apex of the lung
What is pancoast’s tumour?
tumour of the pulmonary apex. Defined by location and usually spreads to nearby tissues.
Most are non-small cell cancers
Cor pulmonale =
abnormal enlargement of the RHS of the heart as a result of lung disease (pulmonary vessels)
Surgical emphysema =
when air/gas is located in the subcutaneous tissues (between skin and pleura)
Vesicular breath sounds =
heard across the lung surface. Lower-pitched, resultiing sounds with higher intensity during inspiration
- during expiration sounds intensity can fade
- inspiratation = 2-3x the length of expiration
Bronchial breath sounds =
tubular hollow sounds which are heard over large airways (2nd and 3rd intercostal spaces)
Louder and higher pitched than vesicular breath sounds
