What - respiratory

Question 1

WHAT might you observe in general observation in the respiratory patient?

Answer 1

Rate, depth and pattern of respiration, breathlessness, use of accessory muscles, pallor or cyanosis, hoarse voice,
coughing, tissue for sputum, wheezing, stridor, use of O2, inhalers

Question 1

WHAT is the significance of the patient’s head/neck positioned at 45 degrees?

Answer 1

When the patient is lying at 45 degrees, the sternal angle is roughly in line with the base of the neck and this provides a convenient
zero point from which to measure the vertical height of the venous blood in the jugular vein

Question 2

WHAT is Tachypnoea? Bradypnoea?

Answer 2

Tachypnoea is a rapid respiratory rate of over 25 breaths per minute
Bradypnoea is a reduced respiratory rate below 8 breaths per minute

Question 3

WHAT are three signs of respiratory disease found in the nails, hands, eyes, face and mouth?

Answer 3

Nails – clubbing, poor capillary refill, peripheral cyanosis
Hands – tar staining, muscle wasting of small hand muscles, flapping tremor
Eyes – conjunctival pallor (anaemia), scleral icterus (jaundice), Horner’s syndrome (ptosis, miosis, anhydrosis)
Face – cyanosis, flushing, skin changes (scleroderma, marks from CPAP machine)
Mouth – cyanosis, poor dentition, high arched palate (Marfan’s)

Question 4

WHAT is the point of measuring JVP in a respiratory examination?

Answer 4

A raised JVP indicates abnormal right heart dynamics which may lead to left heart problems. Hence, a raised JVP in respiratory
examination may indicate primary or secondary cardiac causes.

Question 5

WHAT are some causes of a deviated trachea?

Answer 5

Trachea deviated TOWARDS the side of the lesion (common) = upper lobe collapse, upper lobe fibrosis, pneumonectomy
Trachea deviated AWAY from the lesion (uncommon) = massive pleural effusion, tension pneumothorax
Trachea deviated either way or just generally displaced = upper mediastinal masses such as retrosternal goitre

Question 6

WHAT might you observe on the posterior chest wall in respiratory patients?

Answer 6

Abnormal shape and chest movement, kyphoscoliosis, scars from lung surgery, skin changes or tattooing from radiotherapy

Question 7

WHAT is normal CE in centimetres and what might reduction of CE indicate?

Answer 7

Normal chest expansion is at least 5cms; bilateral reduction might indicate COPD or interstitial lung; unilateral reduction might
indicate localised lung fibrosis, consolidation, collapse, pleural effusion or pneumothorax

Question 8

WHAT are some causes of dull percussion?

Answer 8

Consolidation and collapse cause dullness; pleural effusion causes ‘stony’ dullness

Question 9

WHAT are some causes of decreased breath sounds? Bronchial breath sounds?

Answer 9

Decreased breath sounds - collapse, pleural effusion (over fluid), pneumothorax (often absent) and severe asthma
Bronchial breath sounds - Consolidation and often above the pleural effusion, localized pulmonary fibrosis, collapse next to pleural
effusion

Question 10

WHAT is the difference between wheezes and stridor?

Answer 10

Wheezes are continuous sounds heard in expiration (mainly) but sometimes inspiration, due to acute or chronic airflow
obstruction, high-pitched in asthma and low-pitched in COPD
Stridor sounds similar to wheeze but is louder over the trachea and is ALWAYS inspiratory, due to multiple serious conditions (eg
anaphylaxis, acute epiglottis, inhaled foreign body, tracheal pathology, bilateral vocal cord palsy)

Question 11

WHAT is normal forced expiratory time?

Answer 11

Forced expiratory time is three seconds or less. It is a useful bedside test that may indicated airway obstruction eg smokers with
COPD