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Phase 2b Medicine > Respiratory Examination > Flashcards

Respiratory Examination Flashcards

1
Q

What angle should the bed be at in a resp exam?

A

45 degrees

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2
Q

What should be exposed in a resp exam?

A

The chest and the lower legs

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3
Q

What is the importance of age in a resp exam?

A

May help indicate the pathology

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4
Q

What resp diagnoses are more likely in younger patients?

A

Asthma or CF

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5
Q

What resp diagnoses are more likely in older patients?

A

COPD, interstitial lung disease or malignancy

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6
Q

What is cyanosis?

A

Bluish discolouration of the skin due to poor circulation or inadequate oxygenation of blood

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7
Q

What are some causes of cyanosis?

A
  • Peripheral vasoconstriction secondary to hypovolaemia

- Right-to-left cardiac shunting

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8
Q

What are the signs of shortness of breath clinically?

A
  • Nasal flaring
  • Pursed lips
  • Use of accessory muscles
  • Intercostal muscle recession
  • Tripod position (sitting or standing leaning forward and supporting the upper body with hands on knees)
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9
Q

What is a significant indicator of shortness of breath?

A

Inability to speak in full sentences

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10
Q

What conditions may present with shortness of breath?

A
  • Asthma
  • Pulmonary oedema
  • Pulmonary fibrosis
  • Lung cancer
  • COPD
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11
Q

What pathologies may a productive cough be associated with?

A
  • Pneumonia
  • Bronchiectasis
  • COPD
  • CF
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12
Q

What pathologies may a dry cough be associated with?

A
  • Asthma

- Interstitial Lung Disease

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13
Q

What is a wheeze?

A

A continuous, coarse, whistling sound produce in the respiratory airways during breathing

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14
Q

What conditions is a wheeze associated with?

A

Asthma, COPD, bronchiectasis

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15
Q

What is stridor?

A

A high-pitched extra-thoracic breath sound resulting from turbulent airflow through narrowed upper airways

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16
Q

What are causes of stridor?

A

Foreign bodies or subglottic stenosis

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17
Q

What may cause pallor?

A

Underlying anaemia or poor perfusion

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18
Q

What conditions may cause pallor?

A

Haemorrhage, chronic disease, congestive cardiac failure

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19
Q

How does oedema present?

A
  • Swelling of the limbs (pedal oedema)

- Abdominally (ascites)

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20
Q

What is oedema associated with?

A

Right ventricular failure

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21
Q

What does pulmonary oedema occur secondary to?

A

Left ventricular failure

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22
Q

What objects and equipment should be noted on a resp exam?

A
  • Oxygen delivery devices
  • Sputum pot
  • Other medical equipment
  • Cigarettes or vaping equipment
  • Mobility aids
  • Vital signs
  • Fluid balance
  • Prescriptions
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23
Q

What should be noted on general inspection of the hands in a resp exam?

A
  • Colour
  • Tar staining
  • Skin changes
  • Joint swelling or deformity
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24
Q

What is the importance of the colour of the hands in a resp exam?

A

Cyanosis of the hands may suggest underlying hypoxaemia

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25
Q

What is the importance of the tar staining of the hands in a resp exam?

A
  • Caused by smoking

- Risk factor for respiratory disease (COPD, lung cancer)

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26
Q

What is the importance of the skin changes of the hands in a resp exam?

A
  • Bruising and thinning of the skin can be associated with long-term steroid use
  • Associated with asthma, COPD, ILD
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27
Q

What is the importance of joint swelling or deformity of the hands in a resp exam?

A
  • May be associated with rheumatoid arthritis

- Has extra-articular manifestations e.g. pleural effusions/pulmonary fibrosis

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28
Q

What is finger clubbing?

A

Uniform soft tissue swelling of the terminal phalanx of a digit

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29
Q

What is finger clubbing associated with?

A
  • Lung cancer
  • ILD
  • CF
  • Bronchiectasis
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30
Q

How do you assess for finger clubbing?

A
  • Place the nails of the index fingers back to back
  • Should be a diamond space window
  • This is lost in finger clubbing
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31
Q

Why is assessing for a fine tremor important in a resp exam?

A

Associated with beta-2-agonist use

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32
Q

How do you assess for a fine tremor?

A

Ask the patient to hold out their hands in an outstretched position and observe for a fine tremor

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33
Q

What may a aserixis indicate?

A

Carbon dioxide retention - type 2 resp failure

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34
Q

How do you investigate for asterixis?

A
  • Ask the patient to cock their hands backward at the wrist

- Observe

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35
Q

What are the important aspects of temperature in a resp exam?

A
  • Cool hands = poor peripheral perfusion

- Excessively warm = CO2 retention

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36
Q

What pulse should be took in a resp exam?

A
  • Radial pulse

- Should be used to calculate heart rate - count for 60s if irregular

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37
Q

When may a bounding pulse be found in a resp exam?

A

Associated with underlying CO2 retention e.g. type 2 resp failure

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38
Q

When may a pulsus paradoxus be found in a resp exam?

A
  • Late sign of cardiac tamponade
  • Severe acute asthma
  • Severe COPD exacerbations
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39
Q

What is pulsus paradoxus?

A

When the pulse wave volume decreases significantly during inspiration

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40
Q

When should you observe a patients resp rate?

A

While pretending to do the pulse

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41
Q

What asymmetries may there be in the resp rate in a resp exam?

A

The expiratory phase may be longer in asthma exacerbations/COPD

42
Q

Name a cause of bradypnoea

A

Opiate overdose

43
Q

Name a cause of tachypnoea

A

Acute asthma

44
Q

What may the JVP indicate?

A

An indirect measure of the central venous pressure

45
Q

How do you measure the JVP?

A
  • Ask the patient to turn their head to the left
  • Inspect for the IJV, between the medial end of the clavicle and the ear lobe
  • Measure the JVP by assessing the vertical distance between the sternal edge and the top of the pulsation point of the IJV
46
Q

What is a healthy length for the JVP?

A

No greater than 3cm

47
Q

What does a raised JVP indicate?

A

Venous hypertension

48
Q

What is a resp cause of raised JVP?

A

Pulmonary hypertension:

- Causes R HF, due to COPD/ILD

49
Q

What are 3 cardio causes of raised JVP?

A
  • Congestive heart failure
  • Tricuspid regurgitation
  • Constrictive pericarditis
50
Q

What is the purpose of the hepatojugular reflux test?

A

It involves application of pressure to the liver whilst observing for a sustained raise in JVP

51
Q

What does a plethoric complexion indicate in a resp exam?

A
  • Polycythaemia (COPD)

- CO2 retention (type 2 resp failure)

52
Q

What is a plethoric complexion?

A

A congested red face

53
Q

What may conjunctival pallor indicate?

A

Underlying anaemia

54
Q

What is the importance of looking for Horner’s syndrome in a resp exam?

A

It occurs when the sympathetic trunk is damaged by a pathology e.g. lung cancer affecting the apex of the lung (Pancoast tumour)

55
Q

What are the features of Horner’s syndrome?

A
  • Ptosis
  • Miosis
  • Enophthalmos
  • May also be anhydrosis
56
Q

What are two important mouth signs to look for in a resp exam?

A
  • Central cyanosis (hypoxaemia)

- Oral candidiasis (fungal infection associated with steroid inhaler use)

57
Q

What are the importance off inspecting scars in a resp exam?

A

See if there has been any cardio/resp procedures or radiotherapy-associated skin changes

58
Q

What is the importance of noting asymmetry in chest wall deformities?

A

Typically associated with pneumonectomy or thoracoplasty

59
Q

What is pectus excavatum?

A

A caved-in or sunken appearance of the chest

60
Q

What is pectus carinatum?

A

Protrusion of the sternum and ribs

61
Q

What is barrel chest?

A
  • Chest wall appears wider and taller than normal

- Associated with chronic lung diseases such as asthma and COPD

62
Q

How do you assess tracheal position?

A
  • Dip your index finger into the thorax beside the trachea
  • Gently apply side pressure to locate the border of the trachea
  • Compare this space to the other side of the trachea using the same process
  • Difference in space = deviation
63
Q

In what conditions does the trachea deviate away from the affected side?

A
  • Tension pneumothorax

- Large pleural effusions

64
Q

In what conditions does the trachea deviate towards the affected side?

A
  • Lobar collapse

- Pneumonectomy

65
Q

What is the cricosternal distance?

A

The distance between the inferior border of the cricoid cartilage and the suprasternal notch

66
Q

How do you assess the cricosternal distance?

A
  • Measure the distance between the suprasternal notch and cricoid cartilage using fingers (BASED ON PATIENT FINGERS)
67
Q

What does an abnormal cricosternal distance indicate?

A

Lung hyperinflation e.g. asthma, COPD

68
Q

Why is it important to palpate the apex beat in a resp exam?

A

Due to there being resp causes

69
Q

How do you palpate the apex beat?

A
  • Place fingers horizontally across the chest

- Usually in the 5th intercostal space in the midclavicular line

70
Q

What are respiratory causes of a displaced apex beat?

A
  • R ventricular hypertrophy (pulm HTN, COPD, ILD)
  • Large pleural effusion
  • Tension pneumothorax
71
Q

How do you assess chest expansion?

A
  • Place the hands on the patient’s chest, inferior to the nipples
  • Wrap your fingers around either side of the chest
  • Bring your thumbs together in the midline, so that they touch
  • Ask the patient to take a deep breath in
  • Observe the movement of your thumbs
  • Reduced movement of one of your thumbs indicates reduced expansion on that side
72
Q

What are symmetrical causes of reduced chest expansion?

A
  • Pulmonary fibrosis

- Reduces lung elasticity, restricting overall chest expansion

73
Q

What are asymmetrical causes of reduced chest expansion?

A
  • Pneumothorax
  • Pneumonia
  • Pleural effusion
74
Q

What areas should be percussed on a resp exam?

A
  • Supraclavicular region (lung apices)
  • Infraclavicular region
  • Chest wall (3-4 locations bilaterally)
  • Axilla
75
Q

What may a resonant percussion mean in a resp exam?

A

Normal finding

76
Q

What may a dull percussion mean in a resp exam?

A
  • Increased tissue density

- Causes - cardiac dullness, consolidation, tumour, lobar collapse

77
Q

What may a stony dullness percussion mean in a resp exam?

A

Underlying pleural effusion

78
Q

What may a hyper-resonant percussion mean in a resp exam?

A
  • Decreased tissue density

- Cause - pneumothorax

79
Q

How do you assess tactile vocal fremitus?

A

Palpate over different areas of the chest while an number (e.g. 99) is constantly repeated using the ulnar border of your hand

80
Q

What does increased vibration in tactile vocal fremitus mean?

A
  • Increased tissue density

- Consolidation, tumour, lobar collapse

81
Q

What does decreased vibration in tactile vocal fremitus mean?

A
  • Presence of fluid or air outside the lung

- Pleural effusion, pneumothorax

82
Q

What is the technique to auscultate the chest?

A
  • Place the stethoscope over the relevant locations of the chest
  • Listen on expiration and inspiration
  • Assess the quality and volume of breath sounds, and added sounds
83
Q

What is the relevance of a vesicular breath sounds on a resp exam?

A

Normal in healthy people

84
Q

What is the relevance of a bronchial breath sounds on a resp exam?

A
  • Harsh sounding
  • Inspiration & expiration are equal and there is a pause between
  • Associated with consolidation
85
Q

What does a quiet breath sound on auscultation indicate?

A

Reduced air entry into that region of the lung e.g. pleural effusion, pneumothorax

86
Q

What does a wheeze sound like on auscultation?

A

A continuous, coarse, whistling sound produced in the respiratory airways during breathing

87
Q

In which conditions may there be a wheeze?

A

Asthma, COPD and bronchiectasis

88
Q

What does a stridor sound like on auscultation?

A

A high-pitched extra-thoracic breath sound resulting from turbulent airflow through narrowed upper airways

89
Q

In which conditions may there be a stridor?

A

Foreign body inhalation & subglottic stenosis

90
Q

What do coarse crackles sound like on auscultation?

A

Discontinuous, brief, popping lung sounds

91
Q

In which conditions may there be coarse crackles?

A

Pneumonia, bronchiectasis and pulmonary oedema

92
Q

What do fine end-inspiratory crackles sound like on auscultation?

A

Separating velcro

93
Q

In which conditions may there be fine end-inspiratory crackles?

A

Pulmonary fibrosis

94
Q

How do you assess vocal resonance?

A

Auscultating over different areas of the chest while a patient repeats a number

95
Q

What does an increased volume of vocal resonance indicate?

A
  • Increased tissue density

- Consolidation, tumour, lobar collapse

96
Q

What does a decreased volume of vocal resonance indicate?

A
  • Presence of fluid or air outside the lung

- Pleural effusion, pneumothorax

97
Q

What are respiratory causes of lymphadenopathy?

A
  • Lung cancer with metastases
  • Tuberculosis
  • Sarcoidosis
98
Q

Which lymph nodes should be felt in a respiratory exam?

A
  • Under chin
  • Behind ears
  • Along length of clavicle
99
Q

Which types of oedema should be noted in a resp exam and what may it indicate?

A
  • Sacral
  • Pedal
  • Congestive heart failure
100
Q

Why should the calves be assessed in a resp exam?

A
  • To look for signs of a DVT

- May have SOB secondary to a PE

101
Q

What further assessments and investigations should be carried out after a resp exam?

A
  • Vital signs
  • Sputum sample
  • Peak flow
  • Chest X-ray
  • ABG
  • Cardio exam if indicated

Phase 2b Medicine (17 decks)

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