The Respiratory Examination Flashcards
The lungs are protected by a cylinder made up of:
- Ribs
- Vertebra
- Diaphragm
What does pleural effusion mean?
Accumulation of fluid within the pleural cavity
What makes up the Mediastinum?
The heart, trachea, oesophagus and great blood vessels and nerves sit between the lungs and make up a structure called the mediastinum
Left lung structure
Apex of the heart points to the left, making the left lung smaller:
- 2 lobes
- separated by the oblique fissure
Right Lung Structure
- Both horizontal (upper) and oblique (lower) fissures
- 3 lobes
Muscles of respiration are:
- Diaphragm
2. Intercostal muscles
Normal Respiratory Rate
16-25 breaths / minute
Tachypnoea is defined as:
Rapid respiratory rate: >25 breaths per minute
Bradypnoea is defined as:
Respiratory rate below 8
- a level associated with sedation and adverse prognosis
In normal relaxed breathing, what muscles are active?
The diaphragm is the only active muscle, and is active only in inspiration
- expiration is a passive process
What is a sign of an increase in the work of breathing?
The use of accessory muscles of inspiration
The use of accessory muscles in respiration are a characteristic sign of what condition?
COPD
What are the accessory muscles?
- Sternocleidomastoids
- Platysma
- Strap muscles of the neck
What does use of the accessory muscles characteristically cause?
Elevation of the shoulders with inspiration - aid respiration by increasing chest expansion
Contraction of the abdominal muscles during expiration may occur in:
Patients with obstructed airways
What is often seen in patients with severe COPD on inspiration?
In-drawing of the intercostal and supraclavicular spaces - this is due to a delayed increase in lung volume despite the generation of large negative pleural pressures
What is a characteristic breathing pattern seen in COPD?
Pursed-lips breathing
Tracheal tug is seen in:
- COPD
2. Severe asthma - especially in kids
What is a tracheal tug?
Increased diaphragmatic movements may cause downward displacement of the trachea during inspiration: tracheal tug
What is the benefit of pursed-lips breathing in COPD?
This manoeuvre reduces the patient’s breathlessness possibly by providing continuous positive airway pressure and helping to prevent airway collapse during expiration
What makes patients with severe COPD feel more comfortable?
Leaning forward with their arms on their knees
- this position compresses the abdomen and pushes the diaphragm upwards partly restoring its normal domed shape and improving effectiveness during inspiration
Central cyanosis becomes evident at what point?
When the absolute concentration of deoxygenated Hb is 50g/L of capillary blood
Cyanosis is usually obvious when arterial oxygen saturation falls below what point?
Below 90% in a person with normal Hb
What are examples of lung diseases serious enough to cause central cyanosis?
- pneumonia
- COPD
- pulmonary embolism
Cough character: lack of the usual explosive beginning may indicate what?
Vocal cord paralysis (the bovine cough)
Cough character: A muffled, wheezy, ineffective cough suggests what?
Obstructive pulmonary disease
Cough character: A very loose, productive cough suggests what?
Excessive bronchial secretions due to:
- chronic bronchitis
- pneumonia
- bronchiectasis
Cough character: A barking or croupy cough suggests what?
Suggests a problem with the upper airway:
- the pharynx / larynx or pertussis infection
Cough character: What may cause a dry, irritating cough?
Occurs with:
- chest infection
- asthma
- carcinoma of the bronchus
- sometimes with LV failure or interstitial lung disease
What causes stridor?
Obstruction of the larynx or trachea:
- foreign body
- tumor
- infection
- inflammation
Causes of hoarseness (dysphonia):
- may indicate recurrent laryngeal nerve palsy associated with carcinoma of the lung (usually left sided)
- most common cause = laryngitis or use of inhaled corticosteroids for asthma
- non respiratory: hypothyroidism
What is Hypertrophic Pulmonary Osteoarthropathy?
An uncommon but important association with clubbing:
- characterized by the presence of periosteal inflammation at the distal ends of long bones, the wrists, the ankles, the metacarpal and metatarsal bones.
- swelling and tenderness over the wrists and other involved areas
Causes of HPO
- primary lung carcinoma
- pleural fibromas
What can cause wasting of the small muscles of the hand and weakness of finger abduction?
Compression and infiltration by a peripheral lung tumor of a lower trunk of the T1 nerve
What are important cardiac signs of severe asthma?
Tachycardia and pulsus paradoxus
Why is tachycardia seen in asthma?
- tachycardia is a common SE of the treatment of asthma with beta-blockers
- and accompanies dyspnoea or hypoxia of any cause
Clinical signs of severe CO2 retention
- confusion
- warm peripheries
- bounding pulse
A flapping tremor with a 2- to 3- second cycle may occur in what conditions?
In severe CO2 retention (usually due to COPD)
- also seen in liver and renal failure
Clinical examination of the nose (nostrils) what could polyps indicate?
Asthma
Clinical examination of the nose (nostrils) what could enlarged turbinates indicate?
Various allergic conditions
Clinical examination of the nose (nostrils) what could a deviated septum indicate?
Nasal obstruction
