Brainscape's Knowledge GenomeTM

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


See full index

Clinical skills > Respiratory examination > Flashcards

Respiratory examination Flashcards

1
Q

What are the possible causes of tracheal deviation?

A

Pushed away from pleural effusion or tension pneumothorax

Pulled towards fibrosis, a collapsed lung or a surgically removed lung

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

What are vesicular breathing sounds?

A

Normal breathing sounds of laminar airflow

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

What is the peak expiratory flow rate test?

A

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

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

In an absolute emergency, where’s the best place to make an incision if the patient cannot breath?

A

The cricothyroid membrane (an emergency tracheotomy)

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

Describe the process of a chest drain for pleural effusion

A

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)

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

What clinical signs do you look for on inspection of the patient from the end of the bed?

A 
Age
Cyanosis
SOB
Cough
Wheeze
Stridor
Pallor
Oedema
Cachexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is age important to note on inspection?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the cause of cyanosis?

A

It’s due to either poor circulation or inadequate oxygenation of the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What could cause SOB?

A

Causes could be asthma, pulmonary oedema, pulmonary fibrosis, lung cancer and COPD

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

What causes coughs?

A

Productive coughs are associated with pneumonia, bronchiectasis, COPD and CF. A dry cough may suggest asthma, interstitial lung
disease or COVID19

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

What causes wheezing?

A

Wheezing’s often associated with asthma, COPD and bronchiectasis

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

What is stridor?

A

A high-pitched extra-thoracic breath sound due to turbulent airflow through narrowed airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What causes stridor?

A

Stridor can be caused by foreign body inhalation or subglottic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can pallor suggest?

A

Anaemia or poor perfusion from congestive cardiac failure

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

How does oedema typically present?

A

Swelling of the limbs- pedal oedema- or of the abdomen- ascites.

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

What’s oedema commonly associated with?

A

Right ventricular failure

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

What is cachexia?

A

Ongoing muscle loss that is not entirely reversed with nutritional supplementation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is cachexia associated with?

A

Underlying malignancy e.g. lung cancer, and other end-stage respiratory diseases like COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What objects/equipment would you note on general inspection of the room?

A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What 5 things do you look for on inspection of the patient’s hands in a respiratory examination?

A 
Cyanosis
Tar staining
Skin changes like bruising and thinning of the skin
Joint swelling or deformity 
Finger clubbing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What can bruising and thinning of the skin be associated with?

A

Long-term steroid use, e.g. for asthma, COPD or ILD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why do you assess for a fine tremor in the patient’s hands?

A

A fine tremor is typically associated with beta-2 agonist use

23
Q

What is asterixis?

A

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)

24
Q

What do you palpate the hands for initially?

A

Temperature
Cool hands may suggest poor peripheral perfusion
Excessively warm and sweaty hands can be associated with CO2 retention

25
Q

What is pulsus paradoxus?

A

When pulse wave volume decreases significantly during inspiration. This is a late sign of cardiac tamponade, severe acute asthma and severe exacerbations of COPD

26
Q

How do you assess breathing rate of the patient?

A

Continue palpating their radial pulse but bring their hand across their chest so as to feel the expansions of the chest without making it obvious that you are assessing their breathing rate

27
Q

What is normal respiratory rate?

A

12-20 breaths per minute

28
Q

What do you do after assessing pulse rate and respiratory rate?

A

Assess JVP and the hepatojugular reflux test

29
Q

What is a plethoric complexion of the face?

A

A congested red-faced appearance associated with polycythaemia (e.g. COPD) and CO2 retention

30
Q

What relevant signs do you look for in the patient’s eyes?

A

Conjunctival pallor for anaemia

Ptosis, miosis and enophthalmos for Horner’s syndrome

31
Q

What is Horner’s syndrome?

A

Horner’s syndrome occurs when the sympathetic trunk is damaged by pathology such as lung cancer affecting the apex of the lung (e.g. Pancoast tumour)

32
Q

What signs do you look for in a patient’s mouth for a respiratory examination?

A

Central cyanosis- hypoxaemia
Oral candidiasis- a fungal infection commonly associated with steroid inhaler use. Characterised by pseudomembranous white slough which can be wiped away to reveal underlying erythematous mucosa

33
Q

What do you look for on inspection of the chest?

A

Scars and chest wall deformities

34
Q

What is an axillary thoracotomy scar likely to be from?

A

Insertion of chest drains

35
Q

What causes tracheal deviation?

A

The trachea deviates away from pneumothorax and large pleural effusions, but towards lobar collapse and pneumonectomy

36
Q

What are the 3 respiratory causes of a displaced apex beat?

A

Right ventricular hypertrophy e.g. in pulmonary hypertension, COPD or ILD)
Large pleural effusion
Tension pneumothorax

37
Q

What do you do after palpating the apex beat?

A

Assess chest expansion with the thumb technique

38
Q

What is the respiratory cause of symmetrical reduced chest expansion?

A

Pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion

39
Q

What are the 3 respiratory causes of asymmetrical reduced chest expansion?

A

Pneumothorax, pneumonia and pleural effusion

40
Q

After assessing chest expansion, you percuss the chest. What are the 4 areas to percuss on each side?

A

Supraclavicular region (for lung apices
Infraclavicular region
Chest wall- 3-4 locations bilaterally
Axilla

41
Q

What causes dullness on percussion?

A

Increased tissue density, possibly due to cardiac dullness, consolidation, a tumour or lobar collapse

42
Q

What causes stony dullness on percussion?

A

An underlying pleural effusion

43
Q

What causes hyper resonance?

A

Decreased tissue density, e.g. pneumothorax

44
Q

What do you do after percussion of the chest?

A

Auscultate for breathing sounds

45
Q

What are bronchial breath sounds?

A

Harsh-sounding breathing on inspiration and expiration, which are equal. This is associated with consolidation

46
Q

After auscultation of breathing sounds, what do you do in the respiratory examination?

A

Vocal resonance- patient says 99 when you place your stethoscope on the same areas you percussed

47
Q

What does decreased volume over an area suggest?

A

The presence of fluid or air outside the lung (pleural effusion, pneumothorax)

48
Q

What does increased volume over an area suggest?

A

Increased tissue density (e.g. consolidation, tumour or lobar collapse)

49
Q

What do you do having assessed vocal resonance?

A

Palpate the patient’s lymph nodes

50
Q

What are 3 respiratory causes of lymphadenopathy?

A

Lung cancer with metastases
Tuberculosis
Sarcoidosis

51
Q

After assessing the patient’s lymph nodes, what do you do?

A

Assess the posterior chest- inspection, chest expansion, percussion, auscultation and vocal resonance

52
Q

Having assessed the patient’s posterior chest, what do you do to finish the examination?

A

Check for pitting sacral and pedal oedema. Assess the calves for signs of DVT

53
Q

What are 6 possible further investigations?

A 
Check oxygen saturation
Take a sputum sample
Perform a peak flow assessment
Request a chest x-ray
Take an ABG
Perform a full cardiovascular examination

Clinical skills (10 decks)

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