Respiratory examination theory (geeky medics) Flashcards
What treatments or adjuncts found in the patient’s vicinity would be considered remarkable?
- O2
- Inhalers
- Nebulisers
- Sputum pots
When examining from the end of the bed what patient signs could indicate SOB?
- Nasal flaring
- Pursed lips (maintains lung pressure preventing large airways from collapsing)
- Use of accessory muscles
If the paitent is unable to speak in full sentences what could this indicate?
…
If the patient has bluish/purple discolouration what does this indicate?
Cynaosis (oxygen saturation <85%)
What other symptoms can be seen from a general inspection that could suggest respiratory patholgy?
- Chest wall abnormalities or asymmetries. e.g. barrel chest = COPD
- Cachexia = malignancy
- Cough. Productive or dry?
- Wheezing? Asthma / COPD / allergy related
What does a low hand temperatur indicate?
- peripheral vasoconstriction / poor perfusion
What sign on the hand could indicate the patient is a smoker?
Tar staining (increased risk of COPD / lung cancer)
What does a bluish discolouration in the finger nails indicate?
Peripheral cynosis (O2 saturation <85%)
What could clubbing of the fingernails indicate?
- lung cancer
- interstital lung disease (umbrella term for diseases effecting the interstitium. Idiopathic pulmonary fibrosis is the most common cause)
- bronchiectasis (abnormal widening of the bronchioles -> + mucus -> + infection)
What is the normal adult ranges for breathing and pulse rate?
- 12-20 breaths/minute
- 60-100 beats/min
What are you looking for when feeling for the pulse? What abnormal pulse can be found?
- rate and rhythm
- Pulsus paradoxus - pulse wave volume decreases with inspiration - COPD / Asthma
What does a fine tremour in the hands indicate?
Can be a side effect of beta 2 agonist (e.g. salbutamol - causes smooth muscle relaxation)
What does a flapping tremour indicate?
- CO2 retention - type 2 respiratory failure - COPD
What is the difference between type I and type II respiratory failure?
- Type I involves low oxygen saturation and normal or low levels of CO2 saturation.
- Type II involves low oxygen saturation AND high levels of CO2 saturation
What disease is implicated when inspecting the lower eyelid for conjucatival pallor? How is anaemia related to respiratory diseases?
- Anaemia
- …
What is Horner’s syndrome and what are its signs?
- Horner’s syndrome may reflect serious disease to the chest or neck. Unilateral symptoms arise when the ipsilateral sympathetic trunk is damaged.
- ptosis (drooping of eyelid) / constricted pupil (miosis) / anhidrosis (inability to sweat properly) on affected side / enopthalmos (posterior displacement of the eyeball in the orbit)
Why would you inspect the mouth and bottom of the tongue of the patient?
- blueish discolouration of the lips / inferior aspect of the tongue indicagtes central cynosis.
What is cyanosis and what can cause it?
- Cyanosis is defined as a bluish discoloration, especially of the skin and mucous membranes, due to excessive concentration of deoxyhemoglobin in the blood caused by deoxygenation. Cyanosis is divided into two main types: Central (around the core, lips, and tongue) and Peripheral (only the extremities or fingers)
- Central cynosis is often due to a circulatory or ventilatory problem that leads to poor blood oxygenation in the lungs - present when arterial oxygen saturation <85%.
- Acute - asphyxiation
- Chronic - pnuemonia / COPD / hypoventilation
How do you measure the JVP and what may a raised JVP indicate?
- number of cm from sternal angle to the upper border of the pulsation
- Internal jugular vein is located inbetween the two heads of the SCM
- pulmonary hypertension / hypervolemia (fluid overload)
When inspecting the chest what scars could be present and what do they represent?
- mid-axillary = chest drains
- posterior chest = lobectomy
When inspecting the chest what skin changes may be found?
- erythema (superficial redding of the skin due to dilation of blood cappilaries) / thickened skin - indication of recent of previous radiotherapy
What could asymmetry of the chest indicate?
- major surgery:
- pneumonectomy (removal of a lung or part of the lung)
- thoracoplasty (removal of ribs from chest wall to permanently collapse the cavities can be done for patients with tuberculosis in the hope of putting the lung at rest and therefor inactivating the disease)
What deformities of the chest can be found and what do they implicate?
- Barrel chest - COPD (occurs because the lungs are chronically overinflated with air, so the rib cage stays partially expanded all the time)
- Pectus excavatum (a congenital deformity of the anterior thoracic wall)
- Pectus carinatum (aka. pigeon chest, is a deformity of the chest characterized by a protrusion of the sternum and ribs)
What does tracheal examination show?
- A difference in the amount of space suggests deviation
- Tracheal deviation results from unequal intrathoracic pressure within the chest cavity - most commonly associated with traumatic pneumothorax
