Clinical Signs in Respiratory Disease Flashcards
(51 cards)
What are peripheral signs of respiratory disease?
- Mouth - pursed lip breathing, cyanosis
- Hands - clubbing, cyanosis
- Skin perfusion
- CO2 flap
- Lymph nodes
- JVP
- Chest
What is the difference between symptoms and signs?
Symptoms - what the patient feels, found by taking patient history
Signs - physical variations from the norm, found by examining the patient
What are signs of respiratory distress?
- Wheeze
- Stridor
- Orthopnoea
Why does shortness of breath not equal hypoxia?
Patient does not necessarily have hypoxia - they just have to work harder to keep oxygen saturation up
What is central cyanosis?
Blue tinge around the lips, mouth, tongue
Can be accompanied by secondary polycythaemia
What is peripheral cyanosis?
Blue tinge on the hands, feet, nose
What can peripheral cyanosis indicate?
- Cardiovascular collapse
* Peripheral vascular disease
Why does a CO2 flap occur?
Due to hypercapnic encephalopathy - CO2 retention
What is a CO2 flap?
Irregular flapping of hand when wrist hyperextended
Also happens in asterixis - liver flap
What are other symptoms of hypercapnic encephalopathy other than CO2 flap?
- Confusion
* Peripheral vasodilation
What are signs of respiratory disease to look out for on the skin?
- Yellow fingernails (nicotine, tar, fungus)
- Eczema (link between eczema and asthma in children)
- Erythema nodosum (sarcoidosis, TB)
- Lupus pernio (sarcoidosis)
- Cutaneous sarcoid (sarcoidosis)
What is sarcoidosis?
Inflammatory disease that can affect the lungs and cause the formation of granulomas
What is finger clubbing?
- Increased curvature of the nail
* Loss of nail bed angle
What are the causes of finger clubbing?
- Bronchial carcinoma
- Fibrosing alveolitis
- Lung suppuration (bronchiectasis, lung access, empyema)
- Cyanotic congenital heart disease
- Infective endocarditis (infection of endocardial surface of the heart)
- Malabsorption states (ulcerative colitis, Crohn’s disease, cirrhosis of the liver)
- Chronic lung infections (cystic fibrosis)
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What are signs of respiratory disease in the eyes?
- Horner’s syndrome (caused by interruption of cervical chain due to lung tumour) - small pupils, ptosis, exophthalmos, unilateral loss of facial sweating
- Uveitis - sarcoidosis, tuberculosis
- Dilated retinal veins/papilloedema - chronically raised PCO2
What are the lymph nodes in the neck used to check for respiratory disease?
- Submental
- Submandibular
- Anterior triangle
- Posterior triangle
- Pre-auricular
- Post-auricular
- Occipital
- Supra-clavicular
What can enlarged lymph nodes in the neck indicate?
Pathology in the chest
What is Cor Pulmonale?
Right heart failure due to chronic lung disease e.g. COPD
What are the symptoms of Cor Pulmonale?
- Cyanosis
- Raised JVP
- Pitting oedema
- Parasternal heave (pulsations of the chest wall)
- Loud P2 (sounds produced by heart upon closure of pulmonic valve)
What are the steps of examination of the chest?
- Inspection
- Palpation
- Percussion
- Auscultation
What does a chest inspection involve?
- Looking for chest wall deformities
- Operation scars
- Chest expansion
- Respiratory abdominal movement (e.g. paradoxical breathing movement)
- Superior vena cava obstruction (protrusion of veins on chest)
What are example of chest wall deformities?
- Kyphoscoliosis
- Pectus excavatum
- Hyperinflation (emphysema)
- Thoracoplasty
What is pectus excavatum?
Abnormal development of the rib cage where the sternum caves in, resulting in a sunken chest wall deformity
What are the clinical signs of pectus excavatum?
- Pulmonary artery flow murmur
- Right lower lobe CXR changes
- Diminished basal lung volumes lead to diminished lung sounds
