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y2s1 > CLIN Resp Exam - Week 2 > Flashcards

CLIN Resp Exam - Week 2 Flashcards

1
Q

fResp Exam Intro

A
  1. HH
  2. Greet pt
  3. Introduce yourself
  4. Identify pt
  5. Explanation of examination & confidentiality
  6. Discuss exposure – to the waist (w gown for female pts)
  7. Obtain consent
  8. Clarification – ask give the pt the opportunity to ask any questions
  9. Position – sitting & later lying at 45 degrees/lying at 45 degrees
  10. Privacy – gown suitable
  11. Ask whether the pt is comfortable
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2
Q

Resp Exam GI

A

a. Respiratory distress (particularly breathing through pursed lips or accessory muscle use).
b. Stridor/wheeze
c. Cough
d. Hoarseness
e. Dyspnoea
f. Cyanosis
g. ‘Noting body habitus’ (particularly any weight loss)
h. Posture
i. Aids – sputum mug, O2 mask, nebuliser, peak flow meter, inhaler
& complete vital signs prior to next stage.

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3
Q

Breathing through pursed lips/accessory muscle use may indicate

A

Severe COPD.

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4
Q

Stridor may indicate

A

May indicate obstruction of the larynx/trachea - due to foreign body, tumour, infection, inflammation.

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5
Q

Bovine cough character & may indicate

A

Lack of usual explosive beginning - ‘bovine cough,’ may indicate vocal cord paralysis.

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6
Q

Muffled, wheezy, ineffective cough may indicate

A

Muffled, wheezy, ineffective cough - may indicate obstructive pulmonary disease.

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7
Q

Loose, productive cough may indicate

A

Loose, productive cough - may indicate excessive bronchial secretions due to chronic bronchitis, pneumonia, bronchiectasis.

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8
Q

Dry, irritating cough may indicate

A

Dry, irritating cough - may occur w chest infections, asthma, carcinoma of the bronchus, left ventricular failure, interstitial lung disease, ACE inhibitor use.

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9
Q

Barking or croupy cough may indicate

A

Barking or croupy cough - may indicate problem w upper airway (pharynx/larynx), pertussis infection.

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10
Q

Hoarseness may indicate

A

May indicate recurrent laryngeal nerve palsy associated w lung carcinoma, laryngeal carcinoma, laryngitis, use of inhaled corticosteroids, hypothyroidism.

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11
Q

Clubbing may indicate

A

Commonly indicates hypertrophic pulmonary osteoarthropathy (HPO) (especially when combined w wrist tenderness) - may be caused by primary lung carcinoma, pleural fibromas, infective endocarditis. HPO does not occur as a result of COPD.

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12
Q

Normal range for pulse ox.

A

> 95%

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13
Q

Muscle wasting may be caused by

A

Pancose tumour compressing on brachial plexus nerve roots.

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14
Q

Weakness of hand muscles may be caused by

A

Can be caused by lung tumours compressing the lower trunk of the T1 nerve root.

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15
Q

Asterixis/flapping tremor indicates

A

Indicates severe CO2 retention (e.g., in severe COPD pts).

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16
Q

Signs of severe CO2 retention

A

Patients with severe CO2 retention may be confused and typically have warm peripheries, a bounding pulse, positive asterixis.

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17
Q

Resp Exam Hands

A

a. Look
i. Clubbing
ii. Peripheral cyanosis
iii. Capillary refill
iv. Pulse oximetry
v. Tar staining
vi. Muscle wasting
vii. Weakness of hand muscles(via finger abduction)
viii. Asterixis/flapping tremor
1. Ask pt to hold out arms
2. Spread fingers
3. Dorsiflex wrists
4. Hold for 30secs.

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18
Q

Resp Exam Wrists & Elbow

A

a. Palpate/Perform
i. Pulse
1. Rate
2. Rhythm
ii. Respiratory rate & character
iii. Wrist swelling/tenderness
iv. Blood pressure
v. Temperature

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19
Q

Tachycardia & pulsus paradoxus are strong indicators for what condition

A

Asthma

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20
Q

Pulsus paradoxus

A

Severe weakening of pulse on inspiration

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21
Q

Tachypnoea range

A

> 25

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22
Q

Bradypnoea

A

<8

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23
Q

RR normal range

A

16-25

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24
Q

Wrist swelling/tenderness may indicate

A

HPO

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25
Q

Resp Exam Face

A
  1. Face
    a. Look
    i. Facial plethora
    ii. Cyanosis
  2. Eyes
    a. Look
    i. Jaundice
  3. Pull eyelids up & ask pt to look down
  4. Comment on colour
    ii. Horner’s syndrome
    iii. Pallor
  5. Pull eyelids down
  6. Comment on pallor of conjunctiva
  7. Nose/nostrils
    a. Look (use torch)
    i. Polyps
    ii. Engorged turbinates
    iii. Deviated nasal septum
    b. Palpate
    i. Frontal sinus
    ii. Maxillary sinus
  8. Ears
    a. Look
    i. Infection
    ii. Perforation
  9. Oral cavity
    a. Look
    i. Central cyanosis
    ii. Dentition
    iii. Crowding of the pharynx
    iv. Inflammation of the pharynx
    b. Palpate
    i. Front & maxillary sinuses
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26
Q

Signs of Horner’s syndrome

A

Ptosis (drooping of one eyelid), miosis (unilateral pupil constriction), anhydrosis (dry skin around one eye).

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27
Q

Potential cause of Horner’s syndrome

A

Pancoast’s tumour - apical lung carcinoma which may compress the sympathetic nerves in the neck.

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28
Q

Polyps are associated with what respiratory condition

A

Asthma

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29
Q

Engorged turbinates are associated with what respiratory condition

A

Allergic respiratory conditions

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30
Q

What respiratory condition may a broken or rotten tooth predispose a patient to?

A

Lung abscess or pneumonia.

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31
Q

Crowding of the pharynx is a potential risk factor for

A

OSA

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32
Q

Inflammation/redness of the pharynx indicates

A

Infection.

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33
Q

Tenderness over the front &/ maxillary sinuses may indicate

A

Sinusitis.

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34
Q

In what condition does the JVP appear raised?

A

R-sided Heart Failure.

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35
Q

Resp Exam Neck

A

a. Look
i. JVP
1. Ask pt to look towards the left
2. Measure
ii. Prominent veins
iii. Pemberton sign
1. Ask pt to lift arms
2. Wait
3. Look for signs of obstruction
i. Trachea
1. Feel for any deviation (in the suprasternal notch)
2. Tracheal tug
a. Ask pt to breathe in.
ii. Cervical lymph nodes
* Submental: Behind the tip of the mandible
* Submandibular: Midway between the tip and the angle of the mandible
* Tonsillar : At the angle of the mandible
* Preauricular: In front of the ear
* Postauricular: Superficial to the mastoid process/behind the ear
* Occipital: Base of skull - posteriorly
* Superficial cervical: Superficial to the sternomastoid (one side at a time)
* Deep cervical: Hook your fingers around each side of the sternomastoid muscle (one side at a time)
* Posterior cervical: Along the anterior edge of the trapezius – in line w ear
* Supraclavicular: In the angle between the clavicle and the sternomastoid.

36
Q

Signs of obstruction elicited by Pemberton’s sign

A

Plethora, cyanosis, distended veins, stridor, dyspnoea.

37
Q

Normal deviation of trachea

A

Slight right

38
Q

What conditions cause the trachea to deviate towards the affected area?

A

Atelectasis, upper lobe collapse, upper lobe fibrosis, pneumonectomy.

39
Q

What conditions cause the trachea to deviate away from the affected area?

A

Pneumothorax, massive pleural effusion.

40
Q

Other conditions which may cause the trachea to deviate in variable direction?

A

Retrosternal goitre, upper mediastinal mass.

41
Q

Tracheal tug is caused by

A

Downward displacement of the trachea during inspiration.

42
Q

Rubbery presentation of lymph nodes on palpation may indicate

A

Cancer

43
Q

Tender presentation of lymph nodes on palpation may indicate

A

Inflammation/infection

44
Q

One-sided swelling of lymph nodes may indicate

A

TB.

45
Q

Resp Exam Thorax

A
  1. Thorax (Ant, Lat, Post).
    a. Inspection
    i. Scars
    ii. Swelling
    iii. Prominent veins
    iv. Erythema
    v. Rash
    vi. Bruising
    vii. Apex beat (should observe when pt lying down at 45)
    viii. Shape & symmetry
  2. Barrel chest
  3. Pigeon chest
  4. Funnel chest
  5. Spinal deformities
  6. Harrison’s sulcus
    ix. Symmetry of chest wall movement during breathing
  7. Use of accessory muscle of respiration in the neck (e.g., sternocleidomastoid, scalenus & trapezius mms.).
  8. Retraction of the intercostal space during inspiration.
  9. Chest expansion of upper chest.
    a. Assess from behind & above.
    b. Palpation
    i. Tenderness/pain
    ii. Crepitus
    iii. Swelling
    iv. Cracking sensation
    v. Vocal fremitus
  10. Use two hands to assess simultaneously.
  11. Ask pt to say 99 on each repositioning of the hands.
    a. On lateral side, ask pt to raise arms upwards (like chicken wings).
    b. On posterior side, ask pt to hug themselves.
    i. NB: Never go beyond 6th rib anteriorly, 8th rib laterally, 10th rib posteriorly.
    vi. Apex beat (pt lying at 45)
  12. Locate first
  13. Compare to expected location of 5th intercostal space on mid-clavicular line
    vii. Chest expansion
  14. Anterior - place thumbs on either side of sternum, but ensure that thumbs are not in contact with the sternum.
  15. Posterior – place thumbs on either side of spine, but ensure that thumbs are not in contact with the spine.
    viii. Hoover’s sign
    c. Percussion (side to side)
    i. Clavicle (without base index).
    ii. Rest of chest – between intercostal spaces
  16. On lateral side, ask pt to raise arms upwards (like chicken wings).
  17. On posterior side, ask pt to hug themselves.
  18. Note hyperresonance, normal, dull or stony dull resonance.
    d. Auscultation (top to bottom, side-to-side) – ask pt to breathe in & out via mouth
    i. Lung apices – above clavicles (bell)
    ii. Rest of the chest (diaphragm)
  19. On lateral side, ask pt to raise arms upwards (like chicken wings).
  20. On posterior side, ask pt to hug themselves.
    a. Listen for:
    i. Breath sounds
    ii. Intensity of breath sounds
    iii. Bronchial breath sounds
    iv. Adventitious/additional sounds
  21. Crackles
  22. Wheezes
  23. Stridor
  24. Pleural friction rub
    v. Vocal resonance
  25. Ask the pt to say 99
    vi. Whispering pectoriloquy
  26. Ask the pt to whisper 64.
46
Q

Typical cause of prominent veins in the thoracic region.

A

Pts w SVC obstruction.

47
Q

Barrel chest often presents in pts with

A

Severe asthma/emphysema.

48
Q

Pigeon chest often indicates

A

Severe childhood asthma or rickets.

49
Q

Funnel chest may indicate

A

Congenital abnormality.

50
Q

Harrison’s sulcus describe appearance

A

Linear depression of the lower ribs (like funnel w largest part @ xiphoid process).

51
Q

What may Harrison’s sulcus indicate?

A

Severe childhood asthma or rickets.

52
Q

Crepitus on palpation of the thoracic region may indicate

A

Subcutaneous emphysema.

53
Q

Crackling sensation on palpation of the thoracic region may indicate

A

Subcutaneous emphysema.

54
Q

Under what circumstances is vocal fremitus increased or decreased

A

Increased - object present in lungs (e.g., pneumonia)
Decreased - increased barrier btw lungs & ribs (e.g., pneumothorax, pleural effusion…).
Remember solids conduct vibrations better than air.

55
Q

When may the apex beat be impalpable?

A

Chest that is hyperexpanded due to COPD.

56
Q

Normal chest expansion measurement

A

> 5cm.

57
Q

Hoover’s sign may indicate

A

COPD.

58
Q

Describe Hoover’s sign

A

Diaphragm compensates for chest -> thumbs & sternum pulled upwards.

59
Q

Percussion is hyperresonant over

A

Hollow structures.

60
Q

Percussion is dull over

A

Consolidations.

61
Q

Percussion is stony dull over

A

Fluid-filled cavities.

62
Q

Hyperresonance on percussion of the thoracic cavity may indicate

A

Pneumothorax or COPD.

63
Q

Decreased dullness over the heart may be observed in what conditions

A

Emphysema or asthma.

64
Q

Stony dull resonance on percussion of the thoracic cavity may indicate

A

Pleural effusion.

65
Q

What must you ask pts to do during auscultation?

A

Breath in & out via mouth.

66
Q

What is asymmetric reduction of breath sounds on auscultation a sign of?

A

Bronchial obstruction - potential causes include COPD (esp. emphysema), pleural effusion, pneumothorax, pneumonia, large neoplasm, pulmonary collapse.

67
Q

Bronchial breath sounds on auscultation may indicate.

A

Lung consolidation, localised pulmonary fibrosis, pleural effusion (above), collapsed lung.
(Caused by turbulence in large airways, which occurs when air cannot be filtered by the alveoli).

68
Q

Early inspiratory crackles suggest

A

Disease of the small airways (e.g., COPD).

69
Q

Late or pan-inspiratory crackles suggest

A

Disease confined to the alveoli.

70
Q

Fine crackles suggest

A

Interstitial lung disease (e.g., pulmonary fibrosis).

71
Q

Medium crackles suggest

A

L Ventricular Heart Failure.

72
Q

Coarse crackles suggest

A

Pools of retained secretions (e.g., bronchiectasis).

73
Q

Pleural friction rub indicates

A

Pleurisy, spontaneous pneumothorax, pleurodynia or rarely, malignant pleural involvement.

74
Q

High pitched wheezes usually arise from

A

Small bronchi (e.g., asthma).

75
Q

Low pitched wheezes usually arise from

A

Larger bronchi (e.g., COPD).

76
Q

Wheezes tend to be louder on…

A

Expiration, but may be heard on inspiration or expiration or both.

77
Q

An inspiratory wheeze implies

A

Severe airway narrowing.

78
Q

Stridor is always heard on…

A

Inspiration.

79
Q

Where is a stridor heard loudest on auscultation?

A

Trachea.

80
Q

On vocal resonance, numbers will become clearer over

A

Regions of consolidation.

81
Q

When is whispering pectoriloquoy used

A

Confirm consolidation.

82
Q

Resp Exam Ending

A
  1. Examine CVS, liver & LLs.
  2. Thank pt
  3. HH
  4. Present findings.
83
Q

Sharp chest pain on inspiration may indicate

A

Pneumonia.

84
Q

Define pulsus paradoxus. Describe process on how to check for it?

A

Pulsus paradoxus = a fall of systolic blood pressure of >10mmHg during the inspiratory phase.
To check for pulsus paradoxus:
1. Look for first Kortokoff sound which appears then disappears during inspiration.
2. Listen for when first Kortokoff sound no longer disappears w inspiration.

85
Q

Pulsus paradoxus is commonly associated with what conditions?

A

May be present in cardiac tamponade, constrictive pericarditis, asthma/COPD exacerbations, PE, tension pneumothorax, pleural effusion.

86
Q

Reduced breath sounds may indicate

A

COPD (esp emphysema), pleural effusion, pneumothorax, pneumonia, large neoplasm, pulmonary collapse.

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