Vital Signs

Question 1

Ataxic breathing

Answer 1

• Biot’s breathing; can have unpredictable irregularity or regular irregular pattern; may be shallow, deep, or stop for a short period
• [Lesion in midbrain at medulla]

Question 2

Cheyne-Stokes

Answer 2

• Shallow or deep, Rapid shallow [tachypnea], Rapid deep [hyperpnea], Deep alternating with periods of apnea
• [Damage to both cerebral hemispheres (forebrain), Heart failure,
• Uremia, Drug induced respiratory depression, elderly

Question 3

Inspiratory cramps

Answer 3

lesions in the pons

Question 4

Caplan’s syndrome

Answer 4

Autoimm. condition in pt. with both rheumatoid arthritis and pneumoconiosis. Sx: cough, SOB, fibrosis, low grade fever, joint pain, morning stiffness, swollen MCP joints, rheumatoid nodules; Chest auscultation: diffuse râles that do not disappear on coughing or taking a deep breath

Question 5

General apperance (partial)

Answer 5

Eyes:

• Anemia – pallor of palpebral conjunctiva (have patient look up while Dr. pulls down eyelids); indicates arterial hypoxemia (ie. at high altitudes); due to incr. deoxygenated Hb >5 g
• Horner’s syndrome – partial ptosis, anhydrosis, & meiosis; seen in apical Pancoast lung tumors

Oral cavity:

• Cyanosis – bluish discoloration of oral cavity, skin (due to presence of >5g/dl deoxygenated Hb) o Halitosis – foul smell observed (ie. due to bronchiectasis, chronic septicemia)
• Hoarseness of voice
• Dry mucosa (due to heavy breathing)

Trachea:

• Should be midline
• Observe space between SCM and trachea (should be equal on both sides) Moves to same side of collapsed lung when breathe in
• Deviates to opposite side in tumor, pleural effusion, pneumothorax, goiter

Hands:

• Anemia – pallor of palpebral conjunctiva (have patient look up while Dr. pulls down eyelids); indicates arterial hypoxemia (ie. at high altitudes); due to incr deoxygenated Hb >5 g
• Clubbing – do Shamroth’s sign in a few fingers; see hypertrophy of angle btwn nail base & finger, beak shaped, drum stick appearance; indicates:
• chronic lung diseases (pyogenic, bronchogenic carcinoma, fibrosing alveolitis, bronchiectasis, empyema,) -heart diseases (cyanotic congential heart disease, subacute bacterial endocarditis, Tetralogy of Fallot) -GI disorders (inflamm. bowel disease