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Respiratory Block: Clinical Examination > The Respiratory Examination > Flashcards

The Respiratory Examination Flashcards

1
Q

The lungs are protected by a cylinder made up of:

A
  • Ribs
  • Vertebra
  • Diaphragm
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2
Q

What does pleural effusion mean?

A

Accumulation of fluid within the pleural cavity

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3
Q

What makes up the Mediastinum?

A

The heart, trachea, oesophagus and great blood vessels and nerves sit between the lungs and make up a structure called the mediastinum

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4
Q

Left lung structure

A

Apex of the heart points to the left, making the left lung smaller:

  • 2 lobes
  • separated by the oblique fissure
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5
Q

Right Lung Structure

A
  • Both horizontal (upper) and oblique (lower) fissures

- 3 lobes

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6
Q

Muscles of respiration are:

A
  1. Diaphragm

2. Intercostal muscles

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7
Q

Normal Respiratory Rate

A

16-25 breaths / minute

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8
Q

Tachypnoea is defined as:

A

Rapid respiratory rate: >25 breaths per minute

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9
Q

Bradypnoea is defined as:

A

Respiratory rate below 8

- a level associated with sedation and adverse prognosis

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10
Q

In normal relaxed breathing, what muscles are active?

A

The diaphragm is the only active muscle, and is active only in inspiration
- expiration is a passive process

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11
Q

What is a sign of an increase in the work of breathing?

A

The use of accessory muscles of inspiration

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12
Q

The use of accessory muscles in respiration are a characteristic sign of what condition?

A

COPD

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13
Q

What are the accessory muscles?

A
  • Sternocleidomastoids
  • Platysma
  • Strap muscles of the neck
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14
Q

What does use of the accessory muscles characteristically cause?

A

Elevation of the shoulders with inspiration - aid respiration by increasing chest expansion

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15
Q

Contraction of the abdominal muscles during expiration may occur in:

A

Patients with obstructed airways

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16
Q

What is often seen in patients with severe COPD on inspiration?

A

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

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17
Q

What is a characteristic breathing pattern seen in COPD?

A

Pursed-lips breathing

18
Q

Tracheal tug is seen in:

A
  1. COPD

2. Severe asthma - especially in kids

19
Q

What is a tracheal tug?

A

Increased diaphragmatic movements may cause downward displacement of the trachea during inspiration: tracheal tug

20
Q

What is the benefit of pursed-lips breathing in COPD?

A

This manoeuvre reduces the patient’s breathlessness possibly by providing continuous positive airway pressure and helping to prevent airway collapse during expiration

21
Q

What makes patients with severe COPD feel more comfortable?

A

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

22
Q

Central cyanosis becomes evident at what point?

A

When the absolute concentration of deoxygenated Hb is 50g/L of capillary blood

23
Q

Cyanosis is usually obvious when arterial oxygen saturation falls below what point?

A

Below 90% in a person with normal Hb

24
Q

What are examples of lung diseases serious enough to cause central cyanosis?

A
  • pneumonia
  • COPD
  • pulmonary embolism
25
Q

Cough character: lack of the usual explosive beginning may indicate what?

A

Vocal cord paralysis (the bovine cough)

26
Q

Cough character: A muffled, wheezy, ineffective cough suggests what?

A

Obstructive pulmonary disease

27
Q

Cough character: A very loose, productive cough suggests what?

A

Excessive bronchial secretions due to:

  • chronic bronchitis
  • pneumonia
  • bronchiectasis
28
Q

Cough character: A barking or croupy cough suggests what?

A

Suggests a problem with the upper airway:

- the pharynx / larynx or pertussis infection

29
Q

Cough character: What may cause a dry, irritating cough?

A

Occurs with:

  • chest infection
  • asthma
  • carcinoma of the bronchus
  • sometimes with LV failure or interstitial lung disease
30
Q

What causes stridor?

A

Obstruction of the larynx or trachea:

  • foreign body
  • tumor
  • infection
  • inflammation
31
Q

Causes of hoarseness (dysphonia):

A
  • 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
32
Q

What is Hypertrophic Pulmonary Osteoarthropathy?

A

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
33
Q

Causes of HPO

A
  • primary lung carcinoma

- pleural fibromas

34
Q

What can cause wasting of the small muscles of the hand and weakness of finger abduction?

A

Compression and infiltration by a peripheral lung tumor of a lower trunk of the T1 nerve

35
Q

What are important cardiac signs of severe asthma?

A

Tachycardia and pulsus paradoxus

36
Q

Why is tachycardia seen in asthma?

A
  • tachycardia is a common SE of the treatment of asthma with beta-blockers
  • and accompanies dyspnoea or hypoxia of any cause
37
Q

Clinical signs of severe CO2 retention

A
  • confusion
  • warm peripheries
  • bounding pulse
38
Q

A flapping tremor with a 2- to 3- second cycle may occur in what conditions?

A

In severe CO2 retention (usually due to COPD)

- also seen in liver and renal failure

39
Q

Clinical examination of the nose (nostrils) what could polyps indicate?

A

Asthma

40
Q

Clinical examination of the nose (nostrils) what could enlarged turbinates indicate?

A

Various allergic conditions

41
Q

Clinical examination of the nose (nostrils) what could a deviated septum indicate?

A

Nasal obstruction

Respiratory Block: Clinical Examination (2 decks)

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