Flashcards in Exam - Resp Deck (13)
What should you look for in general inspection of a respiratory exam?
•“Sick or not sick”
•Orientated or confused or drowsy
•Respiratory distress (at rest or undressing)
–obvious respiratory effort (we are not usually able to see someone breathe), noisy breathing (eg stridor)
–sputum mug!!! (do not forget!)
•IV treatment, supplemental oxygen, Non-invasive ventilation
Causes of clubbing
- (3) resp
- (3) cardiac
- (3) others
–Suppurative lung disease (bronchiectasis, TB, lung abscess)
–Lung cancer (NSCLC)
NOTE: not in COPD
–Subacute bacterial endocarditis
–Congenital cyanotic heart disease
–Left atrial myxoma
–Inflammatory bowel disease
–Primary biliary cirrhosis
What are the 2 types of cyanosis & their mechanisms?
Peripheral: circulatory insufficiency -> high extraction of O2
Central: respiratory insufficiency -> low O2 saturation of Hb
What should you examine in the neck during resp exam?
•Jugular Venous Pressure (JVP)
–Stand behind the patient except when examining the supraclavicular LNs
What (3) could increased percussion mean in resp exam?
- lung cyst
What (6) could decreased percussion mean in resp exam?
-elevated hemidiaphragm (pulled-up, pushed-up or paralysed)
What (4) could reduced breath sounds be due to?
1.Airflow obstruction or hyperinflation
2.Pleural effusion or pneumothorax
3.Thick chest wall
What (5) could crepitations be due to?
More than how many seconds of forced expiratory time does it indicate significant airflow obstruction?
•Shift of mediastinum (depending on size)
• low movement (sometimes)
• high percussion note
• low breath sounds
• low vocal resonance
List (10) spectrum of signs in COPD
–Signs of hyperinflation
–Signs of pulmonary hypertension +/- right heart failure
–Prolonged forced expiratory time
(4) Pulmonary hypertension O/E
–Palpable RV heave and 2nd heart sound
–4th heart sound
–Pulmonary flow murmur