Week 1 Cardiorespiratory

Question 1

What’s signs could indicate a cardio respiratory problem

Answer 1

Shortness of breath 
Sputum 
Cough 
Wheeze 
Pain 
Changes in exercise tolerance 
Functional ability 
Psychosocial changes

Question 2

What’s involved in a objective assessment/examination

Answer 2

Observation 
Palpation 
Auscultation 
Chest X rays (CXR’s) & imaging 
Pulmonary function tests (PFT’s)
Pulse oximetry 
Arterial blood gases (ABG’s)
Functional ability/quality of life
Exercise tolerance tests 
Charts (+/- critical care)

Question 3

What to observe

Answer 3

General appearance - eyes, hands, mouth and oedema
Position
Chest
Shape, work of breathing, chest wall movement, breathing pattern
Skin colour - pale, ruddy and cyanosed
Abdomen, use of accessory muscles, nasal flaring, lines, drains, oxygen therapy, quality of voice (ability to talk in full sentences)

Question 4

General appearance - eyes and hands

Answer 4

Eyes 
- pallor - anaemia 
- plethora - high Hb
- jaundice - liver/blood disorders 
- drooping 
- odema - fluid retention 
Hands 
- flapping tremor, fine tremor, wastage, clubbing, nicotine stains, cyanosis and temperature - hot and cold.

Question 5

What’s causes of clubbing

Answer 5

Cardiac - congenital heart diseases and bacterial endocarditis
Lung disease - infective (bronchiectasis, lung abscess, empyema), fibrotic and malignant

Question 6

General appearance - mouth and oedema

Answer 6

Mouth 
- dry/dehydrated
- hydrated 
- cyanosis 
- purse lip breathing 
Oedema 
- peripheral 
- pitting

Question 7

What different chest shapes can they be

Answer 7

Scoliosis
Kyphosis
Kyphscoliosis
Pectus excavatum (funnel chest)
Pectus carinatum (pigeon test)
Hyper inflated/barrel

Question 8

What movements can occur in the chest wall

Answer 8

Symmetrical increase in antero-posterior, transverse and vertical dismaters of the chest
2 components:
- antero-posterior angle/pump handle
- transverse angle/bucket handle

Question 9

What breathing patterns occur in chest

Answer 9

Depth 
Chest movement all elements together 
In drawing/recession of intercostal space 
Paradoxical/hoovers sign/flail rib
Tracheal tug 
ASymmetry

Question 10

What can different skin colours indicate

Answer 10

Pale 
- anaemic
- low BP
Ruddy 
- retaining CO2
- Increased RBC 
Cyanosed 
- lack of O2
- central 
- peripheral

Question 11

What to know about abdomen

Answer 11

In a reclined but not slumped position.
Applying a flat hand and palpate gently the abdomen just below the rib cage.
Does the abdomen feel soft and mobile? Would the diaphragm be able to descend fully?

Question 12

What are the accessory muscles for inspiration

Answer 12

Diaphragm
External intercostals
Accessory muscles - scalenes, sternocleidomastoid, pectoralis major and minor, serratus anterior and latissimus dorsi.

Question 13

What are the accessory muscles for expiration

Answer 13

Passive elastic recoil of lungs
Accessory muscles - Rectus, abdominis, external and internal oblique, transversus abdominis, lowest fibres of iliocostalis, longissimus, serratus posterior inferior and quadratus lumborum.

Question 14

What’s nasal flaring

Answer 14

Dilation of nostrils
Mainly seen in children
Attempt to decrease airway resistance

Question 15

What to look for in quality of voice

Answer 15

Loudness
Wet sounding
Talking In full sentences
Audible sounds

Question 16

What’s tactile Fremitus and vocal fremitus

Answer 16

Tactile fremitus is the transmission of crackles felt on the outside of chest wall

Vocal fremitus measures speech vibrations transmitted through the chest wall. It increases when the underlying lung tissue is solid (consolidation) in some way and decrease in paitients with pneumothorax or effusions

Question 17

Whats surgical emphysema

Answer 17

Air in the subcutaneous tissue of chest, neck or face
Characteristic cracking on touch
Sign of pneumothorax

Question 18

What different exercise tolerance test are they

Answer 18

6 min walk test 
Incremental shuttle walk test 
3 min SWT 
Endurance shuttle test 
Chair-stand test 
Stair climbing test

Question 19

What’s order of ventilation

Answer 19

Respiratory centre of brain sends message to breathe 
Muscles of inspiration contract 
Diaphragm contracts and flattens 
Ribs swing up and out 
Causes changes in pressure and air is sucked in 
Equilibrium is reached and air stops 
Brain stops sending message 
Diaphragm relaxes and moves upwards 
Ribs move in and Down
Lungs deflate via elastic recoil