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Phase 2B > Respiratory Notes > Flashcards

Respiratory Notes Flashcards

1
Q

Name 4 must ask questions for a respiratory examination

A

Occupation

Where you fit as a child?

Pets (pneumonitis, birds)

Hobbies (horses - hypersensitivity, pneumonitis to fungal)

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2
Q

If an old + smoker has haemoptysis what would you think may have caused it?

A

Lung cancer

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3
Q

If a young person has haemoptysis what would you think may have caused it?

A

PE

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4
Q

What may be a respiratory cause of collapse

A

PE? Sudden cardiac arrythmias

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5
Q

What features of past medical history in a respiratory examination may point you towards sarcoidosis

A

Breathlessness + tiredness, skin rashes, dryness

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6
Q

Past medical history in a respiratory examination of ‘cured cancer’ may suggest what

A

Pleural effusion

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7
Q

Why is Raynaud’s phenomenon relevant in a respiratory examination

A

Causes scarring of blood vessels - same can happen in the lungs

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8
Q

What may hypercalcaemia (polyuria) suggest in a respiratory examination

A

Lung cancer/sarcoidosis

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9
Q

How do you calculate pack years

A

No. of cigarettes smoked per day / 20 (number of cigarettes in a pack x number of years smoked

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10
Q

When in a respiratory examination does pack years cause a problem

A

At 20-30 pack years

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11
Q

Is marijuana or smoking worse for respiratory conditions

A

Marijuana (may be due to it being hotter)

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12
Q

What is a side effect of ACEi

A

Dry cough

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13
Q

What respiratory condition may aspirin/NSAIDs affect

A

Asthma

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14
Q

What respiratory condition is amiodarone associated with

A

Pulmonary toxicity

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15
Q

What is a side effect of clopidogrel/ticagrelor

A

Breathlessness

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16
Q

What is a side effect of BB

A

Wheeze

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17
Q

In a respiratory examination what over the counter medication do you want to know about

A

Vitamin D

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18
Q

What are the two potential causes of cyanosis in a respiratory examination

A

Due to poor circulation (e.g. peripheral vasoconstriction secondary to hypovolaemia)

Inadequate oxygenation of blood (e.g. right-to-left cardiac shunting)

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19
Q

Define tripod position

A

Sitting or standing, leaning forward and supporting the upper body with hands on knees or other surfaces

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20
Q

What respiratory conditions may cause a dry cough

A

Asthma or interstitial lung disease

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21
Q

What respiratory conditions may cause productive cough

A

Pneumonia, bronchiectasis, COPD, CF

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22
Q

Define a wheeze

A

Expiratory, whistling noise

Continuous, coarse, whistling sound produced in respiratory airways during breathing

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23
Q

Name 2 respiratory causes of a wheeze

A

COPD
Bronchiectasis

24
Q

Define stridor

A

Inspiratory noises

High-pitched extra-thoracic breathing sounds + resulting from turbulent air flow through narrowed airways

25
Q

Name 2 respiratory causes of stridor

A

Foreign body inhalation (acute)

Subglottic stenosis (chronic)

26
Q

What respiratory condition may be seen with pursed lip breathing

A

COPD

27
Q

Name 2 causes of pallor

A

Underlying condition - e.g. haemorrhage/chronic disease

Poor perfusion - e.g. congestive heart failure

28
Q

What is the name for swelling of the limbs

A

Pedal oedema

29
Q

What is oedema associated with

A

Right ventricular failure

30
Q

What is pulmonary oedema associated to

A

Often secondary to left ventricular failure

31
Q

Define cachexia

A

Ongoing muscle loss - not entirely reversed with nutritional supplements

32
Q

What respiratory conditions is cachexia associated with

A

Malignancy (e.g. lung cancer)

Other end-stage respiratory disease (e.g. COPD)

33
Q

How do you report a chest x-ray

A

ABCDE

Airways - trachea central
Breathing - lungs
Circulation - heart, aortic arch
Diaphragm - shape (dome), height
Everything else - soft tissue, pacemaker, breast shadow

34
Q

Describe the normal shape of the diaphragm

A

Dome shape
Height - 70% of people r. diaphragm raised due to the liver - no more than 1.5cm

35
Q

What is important to check of chest x-ray

A

Rib fractures

36
Q

What would mitralisation on a chest x-ray

A

The heart would have a straight line coming down

37
Q

If you see a ring the heart area on a chest x-ray what would this suggest

A

Valve replacement

38
Q

What is empyema

A

Pus in any space

39
Q

What is important to ask when someone says they have an allergy

A

What does it do to you

40
Q

What can cause clubbing?

A

Bronchiectasis
Cancer

41
Q

What is the landmark on a chest examination

A

Sternomastoid on both sides - check whether the trachea is centralised

42
Q

How is best to feel the lymph nodes

A

Shrug the shoulders to feel better under the clavicles

43
Q

What are normal breath sounds described as

A

Vesicular sounds

44
Q

On a chest x-ray what two features need to be present to show a pneumothorax

A

Collapse lung
Absent lung tissue

45
Q

What is the best way to locate the trachea

A

1st and 3rd finger on clavicle

2nd finger move around in between to locate the trachea

Pre warn the patient it may be uncomfortable

46
Q

On a chest x-ray how can it be determined whether it is a tension or not pneumothorax

A

In a tension - trachea is pushed to the opposite side

Not tension - trachea is normal

47
Q

How do we do chest expansion

A

Exhale all the way out and then inhale will move hands

48
Q

Describe the order of a respiratory exam

A
  1. General inspection and observation, wash hands, introduction, identification, consent
  2. Hand
    - Inspection
    - Clubbing (Schamroth’s window)
    - Fine tremor
    - Asterixis
    - Temperature (dorsal)
    - Wasting of the intrinsic muscles
  3. Radial pulse
    - Rate and rhythm
    - Assess resp rate at the same time
  4. JVP, hepatojugular reflex
  5. Lymph nodes
  6. Look at face, in the eyes, in the mouth
  7. Inspect chest
  8. Palpitation of tracheal position, apex beat, chest expansion, tactile fremitus
  9. Percussion
  10. Auscultation and vocal resonance
  11. Repeat steps on the back + sacral oedema
  12. Inspect shins
  13. Pitting oedema
49
Q

Why do you check wasting of intrinsic muscles on a respiratory exam

A

T1 nerve invasion by apical lung cancer

50
Q

What is a normal resp rate

A

12-20 breaths per minute

51
Q

What is a bounding pulse associated with

A

Underlying CO2 retention - typically type 2 respiratory failure

52
Q

Describe pulsus paradox

A

Volume decreases significantly in inspiratory phase

Sign of late cardiac tamponade, severe acute asthma, severe exacerbations of COPD

53
Q

What does the trachea deviate away from

A

Tension pneumothorax
Large pleural effusion

54
Q

What does the trachea deviate towards

A

Lobar collapse
Pneumonectomy

55
Q

What would signs of the shins and SOB be suggestive of

A

DVT secondary to PE

56
Q

What extra tests would you request after a resp exam

A

BP
Inguinal lymph nodes
Assess peak flow
Check sputum pot

Phase 2B (15 decks)

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