Respiratory Notes Flashcards
Name 4 must ask questions for a respiratory examination
Occupation
Where you fit as a child?
Pets (pneumonitis, birds)
Hobbies (horses - hypersensitivity, pneumonitis to fungal)
If an old + smoker has haemoptysis what would you think may have caused it?
Lung cancer
If a young person has haemoptysis what would you think may have caused it?
PE
What may be a respiratory cause of collapse
PE? Sudden cardiac arrythmias
What features of past medical history in a respiratory examination may point you towards sarcoidosis
Breathlessness + tiredness, skin rashes, dryness
Past medical history in a respiratory examination of ‘cured cancer’ may suggest what
Pleural effusion
Why is Raynaud’s phenomenon relevant in a respiratory examination
Causes scarring of blood vessels - same can happen in the lungs
What may hypercalcaemia (polyuria) suggest in a respiratory examination
Lung cancer/sarcoidosis
How do you calculate pack years
No. of cigarettes smoked per day / 20 (number of cigarettes in a pack x number of years smoked
When in a respiratory examination does pack years cause a problem
At 20-30 pack years
Is marijuana or smoking worse for respiratory conditions
Marijuana (may be due to it being hotter)
What is a side effect of ACEi
Dry cough
What respiratory condition may aspirin/NSAIDs affect
Asthma
What respiratory condition is amiodarone associated with
Pulmonary toxicity
What is a side effect of clopidogrel/ticagrelor
Breathlessness
What is a side effect of BB
Wheeze
In a respiratory examination what over the counter medication do you want to know about
Vitamin D
What are the two potential causes of cyanosis in a respiratory examination
Due to poor circulation (e.g. peripheral vasoconstriction secondary to hypovolaemia)
Inadequate oxygenation of blood (e.g. right-to-left cardiac shunting)
Define tripod position
Sitting or standing, leaning forward and supporting the upper body with hands on knees or other surfaces
What respiratory conditions may cause a dry cough
Asthma or interstitial lung disease
What respiratory conditions may cause productive cough
Pneumonia, bronchiectasis, COPD, CF
Define a wheeze
Expiratory, whistling noise
Continuous, coarse, whistling sound produced in respiratory airways during breathing
Name 2 respiratory causes of a wheeze
COPD
Bronchiectasis
Define stridor
Inspiratory noises
High-pitched extra-thoracic breathing sounds + resulting from turbulent air flow through narrowed airways
Name 2 respiratory causes of stridor
Foreign body inhalation (acute)
Subglottic stenosis (chronic)
What respiratory condition may be seen with pursed lip breathing
COPD
Name 2 causes of pallor
Underlying condition - e.g. haemorrhage/chronic disease
Poor perfusion - e.g. congestive heart failure
What is the name for swelling of the limbs
Pedal oedema
What is oedema associated with
Right ventricular failure
What is pulmonary oedema associated to
Often secondary to left ventricular failure
Define cachexia
Ongoing muscle loss - not entirely reversed with nutritional supplements
What respiratory conditions is cachexia associated with
Malignancy (e.g. lung cancer)
Other end-stage respiratory disease (e.g. COPD)
How do you report a chest x-ray
ABCDE
Airways - trachea central
Breathing - lungs
Circulation - heart, aortic arch
Diaphragm - shape (dome), height
Everything else - soft tissue, pacemaker, breast shadow
Describe the normal shape of the diaphragm
Dome shape
Height - 70% of people r. diaphragm raised due to the liver - no more than 1.5cm
What is important to check of chest x-ray
Rib fractures
What would mitralisation on a chest x-ray
The heart would have a straight line coming down
If you see a ring the heart area on a chest x-ray what would this suggest
Valve replacement
What is empyema
Pus in any space
What is important to ask when someone says they have an allergy
What does it do to you
What can cause clubbing?
Bronchiectasis
Cancer
What is the landmark on a chest examination
Sternomastoid on both sides - check whether the trachea is centralised
How is best to feel the lymph nodes
Shrug the shoulders to feel better under the clavicles
What are normal breath sounds described as
Vesicular sounds
On a chest x-ray what two features need to be present to show a pneumothorax
Collapse lung
Absent lung tissue
What is the best way to locate the trachea
1st and 3rd finger on clavicle
2nd finger move around in between to locate the trachea
Pre warn the patient it may be uncomfortable
On a chest x-ray how can it be determined whether it is a tension or not pneumothorax
In a tension - trachea is pushed to the opposite side
Not tension - trachea is normal
How do we do chest expansion
Exhale all the way out and then inhale will move hands
Describe the order of a respiratory exam
- General inspection and observation, wash hands, introduction, identification, consent
- Hand
- Inspection
- Clubbing (Schamroth’s window)
- Fine tremor
- Asterixis
- Temperature (dorsal)
- Wasting of the intrinsic muscles - Radial pulse
- Rate and rhythm
- Assess resp rate at the same time - JVP, hepatojugular reflex
- Lymph nodes
- Look at face, in the eyes, in the mouth
- Inspect chest
- Palpitation of tracheal position, apex beat, chest expansion, tactile fremitus
- Percussion
- Auscultation and vocal resonance
- Repeat steps on the back + sacral oedema
- Inspect shins
- Pitting oedema
Why do you check wasting of intrinsic muscles on a respiratory exam
T1 nerve invasion by apical lung cancer
What is a normal resp rate
12-20 breaths per minute
What is a bounding pulse associated with
Underlying CO2 retention - typically type 2 respiratory failure
Describe pulsus paradox
Volume decreases significantly in inspiratory phase
Sign of late cardiac tamponade, severe acute asthma, severe exacerbations of COPD
What does the trachea deviate away from
Tension pneumothorax
Large pleural effusion
What does the trachea deviate towards
Lobar collapse
Pneumonectomy
What would signs of the shins and SOB be suggestive of
DVT secondary to PE
What extra tests would you request after a resp exam
BP
Inguinal lymph nodes
Assess peak flow
Check sputum pot
