Respiratory - Respiratory Exam Flashcards
What angle should the bed be at?
45 degrees
What clinical signs should you be looking for when inspecting the patient?
Age
Cyanosis
Shortness of breath
Cough
Wheeze
Stridor
Pallor
Oedema
Cachexia
What does cyanosis suggest?
Poor circulation (peripheral vasoconstriction secondary to hypovolaemia)
Inadequate oxygenation of blood
What signs can indicate shortness of breath?
Nasal flaring
Pursed lips
Accessory muscle use
Tripod position
Inability to speak in full sentences
What pathologies can a cough suggest?
Pneumonia
Bronchiectasis
COPD
CF
Dry cough- asthma or interstitial lung disease
What is a wheeze associated with?
Asthma
COPD
Bronchiectasis
What causes stridor?
High pitched sound from turbulent flow through narrowed upper airways
Foreign body inhalation
Subglottic stenosis
What is cachexia?
Ongoing muscle loss not entirely reversed with nutritional supplementation
Associated with lung cancer and COPD
What objects may be around the bed?
Oxygen delivery devices
Sputum pot
Medical equipment
Cigarettes or vape
Mobility aids
Vital signs
Fluid balance
Prescriptions
What should you be looking for when examining the hands?
Colour
Tar staining
Skin changes- bruising and thinning of the skin, associated with long-term steroid use (asthma, COPD, interstitial lung disease)
Joint swelling or deformity (RA- can affect respiratory system, pleural effusions, pulmonary fibrosis)
What causes finger clubbing?
Lung cancer
Interstitial lung disease
Cystic fibrosis
Bronchiectasis
What does a fine tremor suggest?
Associated with beta-2-agonist e.g. salbutamol
What is asterixis?
Flapping tremor
Due to CO2 retention in conditions that cause type 2 respiratory failure e.g. COPD
Can be caused by uraemia and hepatic encephalopathy
Liver stuff L-shape with hands
What can excessively warm and sweaty hands be associated with?
CO2 retention
When measuring the pulse what should you do if it’s irregular?
Measure for the full 60 seconds
What is a bounding pulse associated with?
Underlying CO2 retention (type 2 respiratory failure)
How should you assess the respiratory rate?
While palpating the radial pulse (no longer counting it) assess patient’s respiratory rate to avoid making patient aware you are observing their breathing
Full 60 seconds
What respiratory causes are there for a raised JVP?
Pulmonary hypertension- right-sided heart failure after COPD
What does a plethoric complexion mean?
Red-faced appearance
Polycythaemia
CO2 retention
COPD
What are the signs of Horner’s syndrome and why is it relevant?
Ptosis
Miosis
Enophthalmos
Pancoast tumour
What does central cyanosis and oral candidiasis suggest?
Central cyanosis
Hypoxaemia
Oral candidiasis
Fungal infection due to steroid inhaler (local immunosuppression)
What chest scars might you see and what do they mean?
Median sternotomy scar
CABG
Axillary thoracotomy scar
Chest drain insertion
Posterolateral thoracotomy scar
Lobectomy
Pneumonectomy
Oesophageal surgery
Infraclavicular scar
Pacemaker
Radiotherapy-associated skin changes- dry skin, thickened skin, depigmentation, telangiectasia
What chest wall deformities may you see and what do they mean?
Asymmetry
Associated with pneumonectomy and thoracoplasty
Pectus excavatum
Sunken appearance
Pectus carinatum
Protrusion of sternum and ribs
Barrel chest
COPD
What causes tracheal deviation?
Away
Tension PTX
Large pleural effusions
Towards
Lobal collapse
Pneumonectomy
What can cause a displaced apex beat?
RV hypertrophy (secondary to pulmonary hypertension, COPD, interstitial lung disease)
Large pleural effusion
Tension pneumothorax
What does reduced chest expansion mean?
Symmetrical
Pulmonary fibrosis
Asymmetrical
Pneumothorax
Pneumonia
Pleural effusion
What are the different types of percussion note and what they indicate?
Resonant
Normal
Dullness
Increased tissue density
(Consolidation, tumour, lobar collapse)
Stony dullness
Pleural effusion
Hyper-resonance
Pneumothorax
How is tactile vocal fremitus assessed?
Palpating over different areas while patient repeats 99
Increased vibration
Increased tissue density
(consolidation, tumour, lobar collapse)
Decreased vibration
Fluid or air outside of lung (pleural effusion or PTX)
What are the different quality of breath sounds?
Vesicular
Normal
Bronchial
Harsh-sounding
Pause between inspiration and expiration
Consolidation
What do different volumes of breath sounds suggest?
Quiet
- Reduced air entry
- Due to pleural effusion or PTX
Reduced breath sounds^
What added sounds when auscultating may you hear?
Wheeze
Asthma
COPD
Bronchiectasis
Stridor
High-pitched
Foreign body inhalation
Subglottic stenosis
Coarse-crackles
Pneumonia
Bronchiectasis
Pulmonary oedema
Fine end-inspiratory crackles
Pulmonary fibrosis
