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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
Q

What is oedema typically associated with?

A

Right ventricular failure.

26
Q

When does pulmonary oedema often occur?

A

Secondary to left ventricular failure

27
Q

What is cachexia commonly associated with?

A

Underlying malignancy (e.g. lung cancer) and other end-stage respiratory diseases (e.g. COPD)

28
Q

What conditions is a sputum pot relevant to?

A
  • COPD

- bronchiectasis

29
Q

What can cyanosis of the hands suggest?

A

Underlying hypoxaemia

30
Q

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

A

Long-term steroid use (e.g. asthma, COPD, interstitial. lung disease)

31
Q

What may joint swelling deformity may associated with?

A

rheumatoid arthritis which has several extra-articular manifestations that affect the respiratory system (e.g. pleural effusions/pulmonary fibrosis)

32
Q

What could finger clubbing suggest?

A
  • lung cancer
  • interstitial lung disease
  • cystic fibrosis
  • bronchiectasis
33
Q

In healthy adults, the respiratory rate should be between?

A

12-20 breaths per minute

34
Q

A respiratory rate of fewer than 12 breaths per minute is referred to as?

A

Bradypnoea (e.g. opiate overdose)

35
Q

A respiratory rate of more than 20 breaths per minute is referred to as?

A

Tachypnoea (e.g. acute asthma)

36
Q

What is ptosis, mitosis and enophthalmos features of?

A

Horner’s syndrome (? caused by a pancoast tumour)

37
Q

Scars of the chest

A
  • median sternotomy scar
  • axillary thoracotomy scar
  • posterolateral thoracotomy scar
  • infraclavicular scar
  • radiotherapy-associated skin changes
38
Q

Chest wall deformities

A
  • 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
Q

What are causes of tracheal deviation?

A

Trachea deviates away: tension pneumothorax and large pleural effusions

Trachea deviates towards: lobar collapse and pneumonectomy

40
Q

What are causes of abnormal cricosternal distance?

A

A distance of fewer than 3 fingers suggests underlying lung hyperinflation (e.g. asthma, COPD)

41
Q

What are some causes of displaced apex beat?

A
  • right ventricular hypertrophy (e.g. pulmonary HTN, COPD, interstitial lung disease)
  • large pleural effusion
  • tension pneumothorax
42
Q

What are symmetrical causes of reduced chest expansion?

A
  • pulmonary fibrosis reduces lung elasticity restricting overall chest expansion
43
Q

What are asymmetrical causes of reduced chest expansion?

A
  • pneumothorax
  • pneumonia
  • pleural effusion
    would all cause ipsilateral reduced chest expansion
44
Q

What are the 4 types of percussion note?

A
  • resonant
  • dullness
  • stony dullness
  • hyper-resonance
45
Q

What do resonant sounds suggest?

A

Normal finding

46
Q

What do dullness sounds suggest?

A

Increased tissue density e.g. cardiac dullness, consolidation, tumour, lobar collapse)

47
Q

What do stony dullness sounds suggest?

A

Typically caused by an underlying pleural effusion

48
Q

What do hyper-resonance sounds suggest?

A

The opposite of dullness, suggestive of decreased tissue density (e.g. pneumothorax)

49
Q

Abnormal tactile vocal fremitus: what does increased vibration suggest?

A

Increased tissue density e.g. consolidation, tumour and lobar collapse

50
Q

Abnormal tactile vocal fremitus: what does decreased vibration suggest?

A

Presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax)

51
Q

What is bronchial (harsh-sounding) breath sounds associated with?

A

consolidation

52
Q

What do quiet breath sounds suggest?

A

reduced air entry into that region of the lung (e.g. pleural effusion, pneumothorax)

53
Q

What are coarse crackles associated with?

A

pneumonia, bronchiectasis and pulmonary oedema

54
Q

What do fine end-inspiratory crackles suggest? (sounds like velcro)

A

pulmonary fibrosis

55
Q

Abnormal vocal resonance: increased volume

A

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

56
Q

Abnormal vocal resonance: decreased volume

A

presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax)

57
Q

Respiratory causes of lymphadenopathy

A
  • lung cancer with metastases
  • tuberculosis
  • sarcoidosis
58
Q

What can evidence of erythema nodosum be associated with?

A

sarcoidosis

59
Q

What further assessments and investigations would you want to carry out?

A

?

  • O2 sats
  • temp and BP
  • sputum sample
  • peak flow
  • CXR
  • ABG

Phase 2b Medicine (7 decks)

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