3. Resp examination Flashcards

1
Q

general inspection respiratory exam

A

patient (colour, breathing, comfort, position, purse-lipped
breathing in COPD, nutritional state (obesity may suggest obstructive sleep apnoea,
Pickwickianism))

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2
Q

hand signs resp exam

A

Clubbing
Tar staining
Wasting of the intrinsic muscles (T1 nerve invasion by an apical lung cancer)
Tremor (flapping asterixis in respiratory failure, fine with beta-agonists e.g.
salbutamol)

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3
Q

pulse CO2 retention

A

bounding pulse

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4
Q

what does a raised JVP indicate resp exam

A

cor pulmonale

A raised non-pulsatile JVP may be
seen in superior vena cava (SVC) obstruction due to a lung cancer, in which case there
will be oedema of the face and neck.

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5
Q

face respiratory signs

A

Horner’s syndrome
● Chemosis (conjunctival oedema may be seen with hypercapnia 2° to COPD)
● Look for respiratory disease in the face and mouth:
● Facial swelling is seen in SVC obstruction
● Dental caries (may cause lung abscess by inhalation of debris)
● Central cyanosis

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6
Q

inspection of the chest resp exam

A

Shape
● Barrel chest (hyper inflated in emphysema)
● Severe kyphoscoliosis
● Severe pectus excavatum (funnel chest)
● Pectus carinatum (pigeon chest) +/- Harrison’s sulci

Symmetry
● Scars
● Muscle wasting
● Chest versus abdominal (diaphragmatic) breathing
● Use of accessory muscles
● Recession (more common in children, but can be seen in adults with partial
laryngeal/tracheal obstruction)

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7
Q

what does tactile vocal fremitus test for

A

Transmission of vibrations is
increased in consolidation as sound travels quicker through solid than air.

Transmission is decreased with an effusion or pneumothorax as the lung tissue becomes separated from the chest wall

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8
Q

tracheal deviation causes? which way would it go?

A

The trachea deviates away from tension pneumothorax and large pleural effusions.

The trachea deviates towards lobar collapse and pneumonectomy.

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9
Q

cause of symmetrical reduction in chest expansion

A

pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion.

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10
Q

causes of asymmetrical reduction in chest expansion

A

pneumothorax, pneumonia and pleural effusion can all cause ipsilateral reduced chest expansion.

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11
Q

cause stony dullness

A

typically caused by an underlying pleural effusion.

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12
Q

cause dullness to percussion

A

suggests increased tissue density (e.g. cardiac dullness, consolidation, tumour, lobar collapse).

Stony dullness: typically caused by an underlying pleural effusion.

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13
Q

what is bronchial breathing

A

harsh-sounding (similar to auscultating over the trachea), inspiration and expiration are equal and there is a pause between. This type of breath sound is associated with consolidation.

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14
Q

what is wheeze? causes?

A

a high-pitched, musical, adventitious lung sound produced by airflow through an abnormally narrowed or compressed airway(s)
Wheezing can be either expiratory, inspiratory, or both. Expiratory wheezing is more common and may mean that a person has a mild blockage causing the wheezing.

asthma, COPD and bronchiectasis.

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15
Q

what are coarse crackles?

A

discontinuous, brief, popping lung sounds typically associated with fluid/secretions

pneumonia, bronchiectasis and pulmonary oedema.

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16
Q

what are fine crackles? causes?

A

sounding similar to the noise generated when separating velcro. Fine end-inspiratory crackles are associated with pulmonary fibrosis.

17
Q

what are reduced breath sounds? causes?

A

diminished or absent breath sounds

  • pleural effusion
  • pneumothorax
18
Q

what are crackles? general definition

A

Crackles are high-pitched discontinuous sounds during inspiration not cleared by a cough and further defined as fine and coarse

19
Q

what is pleural friction rub? causes?

A

Pleural friction rub occurs during inhalation and exhalation, may be continuous or broken and creaking or grating. Pleural friction rubs are the squeaking or grating sounds of the pleural linings rubbing together[1] and can be described as the sound made by treading on fresh snow.

  • pleurisy
  • pneumonia
  • PE
20
Q

what does vocal resonance help you distinguish between

A

This technique allows discrimination between dullness to percussion from pleural effusion and that from consolidation. Voice sounds, which are created in the larynx,
are transmitted more effectively across an area of consolidation. Transmission is reduced across a pleural effusion or pneumothorax.)

21
Q

if you suspect consolidation, what other test should you do resp

A

If you suspect an area of consolidation, perform whispering pectoriloquy (whisper “two-two-two”). (Whispers are transmitted more loudly across an area of consolidation.)

22
Q

to complete resp exam

A

Check sputum pot (volume, consistency, colour, odour, any haemoptysis)

Assess peak flow (state that you would do this in the OSCE)

23
Q

presenting resp exam

A

I completed a respiratory examination on xyz.

On inspection there was xyz (run through from bed area then top to toe) / no signs of respiratory disease. the pulse rate was x with a normal rhythm. The respiratory rate was x.

On examination of the chest my positive findings were…/there were no positive findings on palpation/percussion or auscultation.