Respiratory Examination Flashcards
To remember the stages of a respiratory examination and learn the underlying pathology
What are you looking out for when ‘inspecting from the end of the bed’?
- oxygen
- nebulisers
- asthma inhalers
- peak flow
- intubation
- Cigarettes
What signs on the patient should be observed from general inspections
- Pain
- SOB
- Cyanosis
- Coughing
- Wheezing
- Nutritional state- cachexia/obesity
- Pink puffer- emphysema
- Blue bloater- bronchitis
- Chest deformities
- Scars on the chest wall or lower limbs (vein harvesting)
Anaemia Visible pulsations SOB Pallor Oedema Cyanosis Malar rash Oedema Nutritional state Syndromic features (Down’s, Marfan’s) Scars- Mitral valvotomy, Thoracotomy
What should be looked for when assessing the patients SOB during the general patient inspection?
- assess respiratory rate
- kussmaul breathing- deep and laboured breathing in acidotic
- pursed lips- COPD to increase intrathoracic pressure allowing for full exhalation
- Splinting diaphragm/use of accessory muscles
What are you looking for when inspecting the dorsum of the hands and what are these signs indicative of?
- Tar staining
- Capillary refill
- Peripheral cyanosis
- Tremor
- Coarse – CO2 retention
- Fine – Salbutamol effect
What respiratory conditions can clubbing be a sign of?
- Bronchial carcinoma
- Bronchiectasis
- Empyema
- Fibrosing alveolitis
What are you looking for when inspecting the palmar side of the hands?
- Tar staining
- Palmar erythema/warm – CO2 retention
- Peripheral cyanosis
- Tremor
- Coarse – CO2 retention
- Fine – Salbutamol effect
How long should capillary refill time be?
<3 seconds
What respiratory conditions could cause a fast and slow heart rate respectively?
Fast- B2 agonist effect
Slow- CO2 retention
What is pulsus paradoxus?
An abnormally large decrease in pulse volume during inspiration
What is Horners syndrome and what are the three main signs of it?
Interruption of sympathetic supply to the orbit results in:
- Ptosis- drooping or falling of the upper eyelid
- Miosis- excessive pupil constriction (specifically in one eye)
- Anhydrosis- inability to sweat normally
- red-eye
- enopthalmos
What are some common causes of Horner’s syndrome?
- Apical pulmonary disease – Pancoast’s syndrome (malignant neoplasm of the superior sulcus of the lung)
- Cervical lymphadenopathy
- Thyroid enlargement
- Central lesions – tumours/ demyelinating disease
What else should be observed on the face?
- Central cyanosis
- Oral thrush- side effect of steroid use
What is the order for palpating the cervical lymph nodes?
Anterior Cervical (both superficial and deep)- from the angle of the jaw to the top of the clavicle.
Posterior Cervical: Extend in a line posterior to the SCMs but in front of the trapezius, from the level of the mastoid bone to the clavicle.
Tonsillar: Located just below the angle of the mandible.
Sub-Mandibular: Along the underside of the jaw on either side.
Sub-Mental: Just below the chin.
Supra-clavicular: In the hollow above the clavicle, just lateral to where it joins the sternum.
What respiratory conditions will cause a raised JVP and why?
- Pulmonary hypertension and consequent Cor pulmonare (pulmonary heart disease)
The increased pressure and resistance in the pulmonary arteries (pulmonary hypertension) results in the right ventricle being unable to effectively pump blood out of the ventricle and into the pulmonary arteries. This leads to back pressure of blood in the right atrium, the vena cava and the systemic venous system.
- COPD
- Lung fibrosis
What would cause a deviation of the trachea towards the site of the lesion?
Collapse and consolidation of the lung caused by endobronchial obstruction (compensatory hyperinflation of other lung)
What would cause a deviation of the trachea away from the site of the lesion?
- Tension pneumothorax
- Pleural effusion
- Mass e.g. tumour