Week 3.2 and 3.3 Objective Examination and Effects of Anaesthesia

Question 1

When doing observations what should you look at?

Answer 1

• General Appearance
• Position/posture
• Colour - may be indicative of cyanosis
• Clubbing - (in the finger)
• Thoracic shape
• Accessory muscle use
• Breathing pattern
• Attachments

Question 2

The inspiration to expiration ratio is approximately?

Answer 2

1:2

Question 3

Associated with O/E of the chest and leads to increase AP diameter associated with increase resting lung volumes (FRC, RV - hyperinflation)

Answer 3

Barrel chest

Question 4

This is the loss of angle between nail and the nail bed and is typically associated with chronic respiratory conditions.

Answer 4

Digital clubbing (affects the hands)

Question 5

Accessory muscles shouldn’t be used on quiet breathing. True or false?

Answer 5

True

Question 6

What is Pectus carinatum?

Answer 6

• pigeon chest
• Associated with hyperinflation
• May be congenital

Question 7

Happens when a section or part of the ribcage moves in on inspiration. - can be due to #ribs, flail segment. There is a loss of structural integrity of the chest wall.

Answer 7

Local rib cage paradox

Question 8

What is pectus excavatum?

Answer 8

“funnel chest”
- congenital
A restrictive type of pattern for breathing

Question 9

O/E - chest shape, this is an increased flexion of the thoracic spine +/- lateral curvature of the spine

Answer 9

Kyphosis/kyphoscoliosis

Question 10

What do you call when intercostal spaces sucked in during inspiratory due to forceful inspiration?

Answer 10

Costal Indrawing

Question 11

Happens when abdomen moves in on inspiration. Diaphragm gets fatigue (Really really short of breath)

Answer 11

Abdominal Paradox

Question 12

What is the normal rate of breathing?

Answer 12

12-16 breaths/min

Question 13

Part of O/E abnormal breathing patterns. It is adopted spontaneously by some patients and is also used as a treatment by physios. Usually happens in expiration.

Answer 13

Pursed lip breathing

Question 14

The bottom ribs is drawn in by diaphragm contraction is called?
- Occurs in patients with COPD - hyperinflation causes low flat diaphragm - can’t actively contract and descend.
“Hoovers sign”

Answer 14

Rib indrawing

Question 15

what are the O/E you can find in an ADULT patient with respiratory distress?

Answer 15

• SOB
• increased RR
• Abnormal breathing pattern eg abdominal paradox
• use of accessory muscles
• leaning forward
• sitting up
• single word sentences
• stridor

Question 16

what are the O/E you can find in a CHILD patient with respiratory distress?

Answer 16

• indrawing of sternum, intercostal spaces, abdomen
• Nasal flaring
• Grunting
• Stridor

Question 17

Puts the underlying structures in motion and results in resonance
- can help localise a pathology in the thorax

Answer 17

Percussion Note

Question 18

This is the transmission of sound through the chest wall
- Vibration felt on the chest wall as the patient speaks - a buzzing sensation

Answer 18

Vocal (Tactile) Fremitus

Question 19

When palpating and there is air under the skin what do you call this? it may also be palpated as a popping or crackling sensation.

Answer 19

Subcutaneous emphysema (SCE)

Question 20

“A drug-induced reversible depression of the CNS that results in the loss of physiologic response and perception to all external stimuli.”

Answer 20

General Anaesthesia

Question 21

A component of General Anaesthesia which reduces stress and anxiety, and increases sedation. Eg midazolam

Answer 21

Premed

Question 22

What is induction? (component of General anaesthesia)

Answer 22

• its aim is to quickly initiate anaesthesia.
• IV short acting coma-inducing drug (Eg Propofol, barbiturates)
• can be induced via intubation and mechanical ventilation (or laryngeal mask airway in some cases)

Question 23

A component of General Anaesthesia were the anaesthesia is maintained for the duration of the surgical process.
- a combination of inhaled anaesthetic agents, neuromuscular blockade, and analgesics

Answer 23

Maintenance

Question 24

A component of general anaesthesia were the concentration of anaesthetic agents are reduced, patient is given drugs that reverse muscle blockade.

Answer 24

Reversal

Question 25

A regional anaesthesia where a catheter is inserted into subarachnoid or epidural space.
- Blocks motor, sensory, pain and spymathetic

Answer 25

Spina/epidural anaesthesia

Question 26

What is local anaesthesia?

Answer 26

• can be used for peripheral procedures
• for short term procedures of extremities
  may block a bundle of nerves

Question 27

A surgical complication wherein the wound ruptures due to failure proper wound healing

Answer 27

Dehiscence

Question 28

Is a significant cause of mortality and morbidity. Prolongs stay in the hospital and affects 20-30% of patients after a major UAS (upper abdominal surgery) and CT (cardiothoracic) surgery.

Answer 28

PPC (Postoperative Pulmonary Complication)

Question 29

What is a clinically significant PPC?

Answer 29

• respiratory failure
• pneumonia
• collapse/consolidation
• secretion retention

Question 30

An Intraop factor that affects the respiratory system by reducing the FRC by 30-40% when induced by ________.

Answer 30

Anaesthesia

Question 31

Is always assumed to be the major factor in post op pulmonary dysfunction.
It reduces the ability to increase tidal volume and take deep breath - it may also change the breathing pattern and may reduce one’s ability to cough

Answer 31

Pain