Respiratory history examination Flashcards
What is important in examination?
Don’t unduly put them in pain or discomfort
What do overal in examination?
Study hand and inspect whole patient, examine extremites oedema esp, expose chest wiht privicy in mind, expose the chest, inspect front and back of chest, examin the back of chest percussion palpation auscultation
What to look for wiht initial impression?
Cough, Wheeze stridor, laboured breathing pursed lipped breathing COPD, nutritional state obestiy, paraphernala inhalers nebulisers sputum pots
How to expose paitnet?
Dont need to take bras off
What is clubbing?
loss of nail bed angle, spongines of nailbed, increased curvature in 2 planesCommonest cause is lung cancer, PF chronic suppurative lung disease bronchiectasis empyema,
What tremors are there for respiratory causes?
Flapping asterixis in resp failure. Fine tremor from beta2-agonists
What can you see on hands?
Warmth oedema tobacco stains coal dust tatoos
What is bounding pulse?
High volume pulse with warm peripheries CO2
What to think about when taking breathing?
need to see natural breathing so don’t make it obviously
What to inspect in chest?
Rate rhythm pattern prolonged expiration symmetry chest vs abdominal use of accessory muscles assess expansion with your chest wall
What to palpate?
Neck lymph nodes trachea, apex beat axillae and expansion
What is tactile vocal fremitus?
Say 99 feel vibrations with the side of my hands
What should you here with percussion?
Compare left vs right and one space to the next heard should be dull should be resonant everywhere else. resonance implies aerated lung do axillae as well put finger horizontally
How to use the stethoscope?
direct auscultation can put ear on chest but not acceptable.
How to auscultate?
Traezius 2-5 times each side posteriorly
What are bronchial breathing?
higher pitched distinct inspiratory and expiratory phases heard over fibrotic or consolidated lung and above pleural effusion associated with whispering pectoriloquy when whispering
What are the crackles?
crackles crepitation crackles are more noticable at the bases can be caused by seretions in airways coughing consolitation fibrotic lung disease and heard faulure
What are wheezes?
Rhonchi sugest airflow obstruction
What are cautions for spirometry?
Haemoptysis unknown cause, pneumothorax, recent surgery, thoracic abdominal cerebral aneurism, unstable cardiovascular incident, recent acute exacerbation of infection, six weeks usually adequate to carry out test
What are main issues with spirometry?
Effort dependant. need to get reproducible results. needs to have age sex height and ethnic origin
How is spirometry used?
Diagnostice and monitoring of COPD astratifying severeity, also help with asthma evidence and can see fibrosis if there is restriction
What are normal FVC values/
Vital Capacity total volume should be 80% of predicted
FVC same
FEV1 forces expiratory volume should get 80% of predicted and FEV1/FVC ration is ration should be more than 70% less shows obstruction
What can cause obstruction how ot identify?
Asthma reversible COPD not reversible Bronchiectasis foreing body tumour mucous plugging
What is mild COPD?
FVC is normal but with obstruction
What can cause restriction?
Fibrosis, obesity, hyphosis/scoliosis neromscluar disorders need specialist follow up
What does KCO?
Gas transfer per unit of lung surface
What is FENO test?
Airways inflammation can be affecte by diet and allergies
What is aim of oxygen?
aim to restore oxygen in hypoxia, not used for breathlessness alone
What to consider with oxygen therapy?
safeguarding airway, enhancing circulating volume correcting severe anaemia enahacning cardiac output increase FIO2
What is important to consider with type 2 respiratory failure?
they are at risk of CO2 retention like COPD and kyphosis
What to look at in patient’s neck and face?
Complexion cyanosis eyes neck Jugular venous pressure elevated with peripheral oedema vena cava obstruction when fixed, trachea deviation/
What are signs of respiratory failure?
Central cyanosis tongue lips bottom of tongue, peripheral cyanosis much less reliable, reaction ot cold poor perfusion anxiety
What to look for in chest wall?
deformity under and over inflation, yphosis barrel chest COPD,AP diameter lateral diameter flattening, Scars radiotherapy chances aspiration wounds dilated veins
What is importance of resonance?
lost in pleural effusion, consolidation, collapse fibrosis raised diaphragm, over the iver hear except in emphysema
increases in pneummothorax and emhyseme
