Respiratory examination Flashcards
What are the possible causes of tracheal deviation?
Pushed away from pleural effusion or tension pneumothorax
Pulled towards fibrosis, a collapsed lung or a surgically removed lung
What are vesicular breathing sounds?
Normal breathing sounds of laminar airflow
What is the peak expiratory flow rate test?
Where the patient inhales to vital capacity, then exhales quickly and forcefully into peak flow meter to determine their FEV1. This can detect airway obstruction for assessment of asthma
In an absolute emergency, where’s the best place to make an incision if the patient cannot breath?
The cricothyroid membrane (an emergency tracheotomy)
Describe the process of a chest drain for pleural effusion
The patient should be sat at 45º and the drain is usually inserted in the 5th intercostal space in the mid-axillary line (in the safe triangle)
What clinical signs do you look for on inspection of the patient from the end of the bed?
Age Cyanosis SOB Cough Wheeze Stridor Pallor Oedema Cachexia
Why is age important to note on inspection?
Younger patients are more likely to have asthma or cystic fibrosis, while older patients are more likely to have COPD, interstitial lung disease or malignancy
What is the cause of cyanosis?
It’s due to either poor circulation or inadequate oxygenation of the blood
What could cause SOB?
Causes could be asthma, pulmonary oedema, pulmonary fibrosis, lung cancer and COPD
What causes coughs?
Productive coughs are associated with pneumonia, bronchiectasis, COPD and CF. A dry cough may suggest asthma, interstitial lung
disease or COVID19
What causes wheezing?
Wheezing’s often associated with asthma, COPD and bronchiectasis
What is stridor?
A high-pitched extra-thoracic breath sound due to turbulent airflow through narrowed airways
What causes stridor?
Stridor can be caused by foreign body inhalation or subglottic stenosis
What can pallor suggest?
Anaemia or poor perfusion from congestive cardiac failure
How does oedema typically present?
Swelling of the limbs- pedal oedema- or of the abdomen- ascites.
What’s oedema commonly associated with?
Right ventricular failure
What is cachexia?
Ongoing muscle loss that is not entirely reversed with nutritional supplementation
What is cachexia associated with?
Underlying malignancy e.g. lung cancer, and other end-stage respiratory diseases like COPD
What objects/equipment would you note on general inspection of the room?
Oxygen delivery devices (Venturi mask, non-rebreathing mask, nasal cannulae A sputum pot ECG leads, medications, catheters Cigarettes or vaping equipment Mobility aids like wheelchairs Vital signs
What 5 things do you look for on inspection of the patient’s hands in a respiratory examination?
Cyanosis Tar staining Skin changes like bruising and thinning of the skin Joint swelling or deformity Finger clubbing
What can bruising and thinning of the skin be associated with?
Long-term steroid use, e.g. for asthma, COPD or ILD
Why do you assess for a fine tremor in the patient’s hands?
A fine tremor is typically associated with beta-2 agonist use
What is asterixis?
A type of negative myoclonus characterised by irregular lapses of posture (CO2 retention flap) from conditions that result in type 2 respiratory failure (e.g. COPD)
What do you palpate the hands for initially?
Temperature
Cool hands may suggest poor peripheral perfusion
Excessively warm and sweaty hands can be associated with CO2 retention
