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Phase 2b Medicine > Respiratory examination signs > Flashcards

Respiratory examination signs Flashcards

1
Q

What are the clinical signs to look for at the end of the bed?

A
  • age
  • cyanosis
  • shortness of breath
  • cough
  • wheeze
  • stridor
  • pallor
  • oedema
  • cachexia (ongoing muscle loss that is not entirely reversed with nutritional supplementation)
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2
Q

What objects and equipment to look for at the end of the bed?

A
  • oxygen delivery services
  • sputum pot
  • other medical equipment
  • cigarettes or vaping equipment
  • mobility aids
  • vital signs
  • fluid balance
  • prescriptions
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3
Q

What should look for in the hands?

A
  • colour
  • tar staining
  • skin changes
  • joint swelling or deformity
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4
Q

What does a fine tremor show?

A

Typically associated with beta-2-agonist use (e.g. salbutamol)

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5
Q

What does asterixis (flapping tremor) show?

A

CO2 retention e.g. T2 rest failure such as COPD.

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6
Q

What could excessively warm and sweaty hands be associated with?

A

CO2 retention

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7
Q

What can a bounding pulse be associated with?

A

Underlying CO2 retention (e.g. T2 respiratory failure)

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8
Q

What is pulses paradoxus associated with?

A

Pulse wave volume decreases significantly during the inspiratory phase. This is a late sign of cardiac tamponade, severe acute asthma and severe exacerbations of COPD

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9
Q

When measuring respiratory rate, the expiratory phase is often prolonged in which conditions?

A

asthma exacerbations and in patients with COPD.

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10
Q

What does a raised JVP indicate the presence of?

A

Venous hypertension.

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11
Q

Give some respiratory causes of a raised JVP

A
  • Pulmonary HTN: causes right-sided heart failure, often occurring due to COPD or interstitial lung disease
  • There are several other causes of a raised JVP that relate to the cardiovascular system (e.g. CHF, tricuspid regurg and constrictive pericarditis)
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12
Q

What signs should you look out for in the face?

A

Plethoric complexion

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13
Q

What is a plethoric complexion and what is it associated with?

A

A congested red-faced appearance associated with polycythaemia (e.g. COPD) and CO2 retention (e.g. type 2 respiratory failure)

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14
Q

What signs should you look for in the eyes?

A
  • conjunctival pallor (suggest underlying anaemia)

- ptosis, mitosis and enophthalmos

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15
Q

What signs should you look for in the mouth?

A
  • central cyanosis (associated with hypoxaemia)

- oral candidiasis (fungal infection commonly associated with steroid inhaler use)

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16
Q

Inspection of chest: what should you look for?

A
  • scars

- chest wall deformities

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17
Q

What is cyanosis?

A

Bluish discolouration of the skin due to poor circulation

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18
Q

What could a shortness of breath signify?

A
  • asthma
  • pulmonary oedema
  • pulmonary fibrosis
  • lung cancer
  • COPD
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19
Q

What pathologies can a productive cough be associated with?

A
  • pneumonia
  • bronchiectasis
  • COPD
  • CF
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20
Q

What may a dry cough suggest?

A
  • asthma

- interstitial lung disease

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21
Q

What is a wheeze associated with?

A
  • asthma
  • COPD
  • bronchiectasis
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22
Q

What is stridor?

A

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

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23
Q

What causes stridor?

A
  • foreign body inhalation (acute)

- subglottic stenosis (chronic)

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24
Q

What can pallor suggest?

A
  • underlying anaemia (e.g. haemorrhage/ chronic disease)

- poor perfusion )e.g. CHF)

25
What is oedema typically associated with?
Right ventricular failure.
26
When does pulmonary oedema often occur?
Secondary to left ventricular failure
27
What is cachexia commonly associated with?
Underlying malignancy (e.g. lung cancer) and other end-stage respiratory diseases (e.g. COPD)
28
What conditions is a sputum pot relevant to?
- COPD | - bronchiectasis
29
What can cyanosis of the hands suggest?
Underlying hypoxaemia
30
What can bruising and thinning of the skin by associated with?
Long-term steroid use (e.g. asthma, COPD, interstitial. lung disease)
31
What may joint swelling deformity may associated with?
rheumatoid arthritis which has several extra-articular manifestations that affect the respiratory system (e.g. pleural effusions/pulmonary fibrosis)
32
What could finger clubbing suggest?
- lung cancer - interstitial lung disease - cystic fibrosis - bronchiectasis
33
In healthy adults, the respiratory rate should be between?
12-20 breaths per minute
34
A respiratory rate of fewer than 12 breaths per minute is referred to as?
Bradypnoea (e.g. opiate overdose)
35
A respiratory rate of more than 20 breaths per minute is referred to as?
Tachypnoea (e.g. acute asthma)
36
What is ptosis, mitosis and enophthalmos features of?
Horner's syndrome (? caused by a pancoast tumour)
37
Scars of the chest
- median sternotomy scar - axillary thoracotomy scar - posterolateral thoracotomy scar - infraclavicular scar - radiotherapy-associated skin changes
38
Chest wall deformities
- asymmetry: associated with pneumonectomy (e.g. lung cancer) and thoracoplasty (e.g. tuberculosis) - Pectus excavatum (a caved-in or sunken appearance of the chest - Pectus carinatum: protrusion of the sternum and ribs - Hyperexpansion (aka barrel chest): chest wall appears wider and taller than normal. Associated with chronic lung diseases such as asthma and COPD.
39
What are causes of tracheal deviation?
Trachea deviates away: tension pneumothorax and large pleural effusions Trachea deviates towards: lobar collapse and pneumonectomy
40
What are causes of abnormal cricosternal distance?
A distance of fewer than 3 fingers suggests underlying lung hyperinflation (e.g. asthma, COPD)
41
What are some causes of displaced apex beat?
- right ventricular hypertrophy (e.g. pulmonary HTN, COPD, interstitial lung disease) - large pleural effusion - tension pneumothorax
42
What are symmetrical causes of reduced chest expansion?
- pulmonary fibrosis reduces lung elasticity restricting overall chest expansion
43
What are asymmetrical causes of reduced chest expansion?
- pneumothorax - pneumonia - pleural effusion would all cause ipsilateral reduced chest expansion
44
What are the 4 types of percussion note?
- resonant - dullness - stony dullness - hyper-resonance
45
What do resonant sounds suggest?
Normal finding
46
What do dullness sounds suggest?
Increased tissue density e.g. cardiac dullness, consolidation, tumour, lobar collapse)
47
What do stony dullness sounds suggest?
Typically caused by an underlying pleural effusion
48
What do hyper-resonance sounds suggest?
The opposite of dullness, suggestive of decreased tissue density (e.g. pneumothorax)
49
Abnormal tactile vocal fremitus: what does increased vibration suggest?
Increased tissue density e.g. consolidation, tumour and lobar collapse
50
Abnormal tactile vocal fremitus: what does decreased vibration suggest?
Presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax)
51
What is bronchial (harsh-sounding) breath sounds associated with?
consolidation
52
What do quiet breath sounds suggest?
reduced air entry into that region of the lung (e.g. pleural effusion, pneumothorax)
53
What are coarse crackles associated with?
pneumonia, bronchiectasis and pulmonary oedema
54
What do fine end-inspiratory crackles suggest? (sounds like velcro)
pulmonary fibrosis
55
Abnormal vocal resonance: increased volume
increased tissue density (e.g. consolidation, tumour, lobar collapse)
56
Abnormal vocal resonance: decreased volume
presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax)
57
Respiratory causes of lymphadenopathy
- lung cancer with metastases - tuberculosis - sarcoidosis
58
What can evidence of erythema nodosum be associated with?
sarcoidosis
59
What further assessments and investigations would you want to carry out?
? - O2 sats - temp and BP - sputum sample - peak flow - CXR - ABG

Phase 2b Medicine (7 decks)

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