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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
Name 2 respiratory causes of stridor
Foreign body inhalation (acute) Subglottic stenosis (chronic)
26
What respiratory condition may be seen with pursed lip breathing
COPD
27
Name 2 causes of pallor
Underlying condition - e.g. haemorrhage/chronic disease Poor perfusion - e.g. congestive heart failure
28
What is the name for swelling of the limbs
Pedal oedema
29
What is oedema associated with
Right ventricular failure
30
What is pulmonary oedema associated to
Often secondary to left ventricular failure
31
Define cachexia
Ongoing muscle loss - not entirely reversed with nutritional supplements
32
What respiratory conditions is cachexia associated with
Malignancy (e.g. lung cancer) Other end-stage respiratory disease (e.g. COPD)
33
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
34
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
35
What is important to check of chest x-ray
Rib fractures
36
What would mitralisation on a chest x-ray
The heart would have a straight line coming down
37
If you see a ring the heart area on a chest x-ray what would this suggest
Valve replacement
38
What is empyema
Pus in any space
39
What is important to ask when someone says they have an allergy
What does it do to you
40
What can cause clubbing?
Bronchiectasis Cancer
41
What is the landmark on a chest examination
Sternomastoid on both sides - check whether the trachea is centralised
42
How is best to feel the lymph nodes
Shrug the shoulders to feel better under the clavicles
43
What are normal breath sounds described as
Vesicular sounds
44
On a chest x-ray what two features need to be present to show a pneumothorax
Collapse lung Absent lung tissue
45
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
46
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
47
How do we do chest expansion
Exhale all the way out and then inhale will move hands
48
Describe the order of a respiratory exam
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
Why do you check wasting of intrinsic muscles on a respiratory exam
T1 nerve invasion by apical lung cancer
50
What is a normal resp rate
12-20 breaths per minute
51
What is a bounding pulse associated with
Underlying CO2 retention - typically type 2 respiratory failure
52
Describe pulsus paradox
Volume decreases significantly in inspiratory phase Sign of late cardiac tamponade, severe acute asthma, severe exacerbations of COPD
53
What does the trachea deviate away from
Tension pneumothorax Large pleural effusion
54
What does the trachea deviate towards
Lobar collapse Pneumonectomy
55
What would signs of the shins and SOB be suggestive of
DVT secondary to PE
56
What extra tests would you request after a resp exam
BP Inguinal lymph nodes Assess peak flow Check sputum pot

Phase 2B (15 decks)

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