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Year 2 Clinical skills > Resp > Flashcards

Resp Flashcards

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1
Q

Tracheal Displacement towards the side of lung lesion

A

Upper lobe collapse
Upper lobe fibrosis
Pneumonectomy

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2
Q

tracheal deviation away lesion

A

Extensive pleural effusion
Tension pneumothorax
Chest Expansion

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3
Q

chest expansion on healthy individuals

A

least 5 cm

bilateral

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4
Q

why would unilateral decreased expansion occur?

A

Pneumothorax
Pleural effusion
Collapsed lung
Consolidation

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5
Q

what does percussion of lung sound like?

A

hollow, drum-like sound as it is over air-filled space

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6
Q

Hyper-resonant

A

Pneumothorax
Hollow bowels,
COPD

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7
Q

hyporesonant

A

Fluid filled such as pleural effusion you will hear a hypo-resonant (low) note such as muffled sound sometimes commented as “stoney dull”. With solid tissue such as a lung tumour, consolidation or collapse of the lung or normal liver you will hear also a flat/dull note

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8
Q

what are normal breath sounds

A

air turbulence in the airways

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9
Q

Bronchial sounds

A

harsh sounding
associated with consolidation
high pitched
inspiration and expiration are equal and there is a pause between

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10
Q

vesicular sound

A

The lung tissue filters the sounds of air turbulence, which results in the low pitch vesicular sound
normal breath sounds

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11
Q

what does vesicular sound like?

A

Soft, low pitched, and rustling in quality
Inspiratory phase lasts longer than the expiratory phase
Intensity of inspiration is greater than that of expiration
Inspiration is higher pitch than expiration
No pause between inspiration and expiration §

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12
Q

normal resp rate?

A

12-20

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13
Q

reduction in intensity of vesicular breath sound due to?

A

pneumothorax, pleural effusion, airway obstruction

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14
Q

what do we mean by reduction in intensity of sound?

A

reduced if there is poor sound generation in the airways or poor sound transmission through the tissues

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15
Q

decrease in the tactile vocal fremitus?

A

decrease in density; air in pneumothorax

increase in the distance between the chest wall and the lung- pleural effusion; fluid

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16
Q

increase in density- increased tactile vocal fremitus

A

consolidation in pneumonia, or tumour tissue in cancer

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17
Q 
Submental nodes 
Submandibular nodes 
Preauricular/parotid nodes 
Postauricular nodes
Occipital nodes 
Superior deep cervical nodes 
Inferior deep cervical nodes 
Supraclavicular nodes
A

–inferior to the chin
–inferior to the angle of the mandible
–anterior to the ear (technically the preauricular and parotid nodes are two separate sets of nodes, but because of their close proximity, they are usually palpated at the same time.)
- posterior to the ear
- base of the occipital
-superior part of the sternocleidomastoid
- inferior part of the sternocleidomastoid
- superior to the clavicle

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18
Q

Respiratory causes of cervical lymph node lymphadenopathy

A

Lung cancer metastasising to the lymph nodes
Tuberculosis
Sarcoidosis
Respiratory tract infection

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19
Q

lung examination?

A 
Position and exposure: Patient lying at 45 degrees, exposed from the waist upwards
Inspection: General inspection
Palpation: Tracheal position
Anterior chest expansion
Anterior chest percussion
Anterior chest auscultation
Anterior tactile vocal fremitus
Position: Patient leaning forwards
Posterior chest expansion
Posterior chest percussion
Posterior chest auscultation
Posterior tactile vocal fremitus
Position: Patient sitting across couch
Cervical lymph node palpation
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20
Q

pleural effusion
symptoms
clinical signs

A 
is the build-up of excess fluid between the layers of the pleura outside the lung
symptoms: 
Breathlessness
Cough
Pleuritic chest pain
examination signs : reduced chest movement, stony dull percussion note
tracheal deviation away
reduced/ absent sounds when auscultating
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21
Q

t3

A

level of medial part of spine of scapula

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22
Q

t7

A

inferior angle of scapula

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23
Q

l4

A

highest point of iliac crest

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24
Q

s2

A

level of posterior superior iliac spine

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25
surface mark the trachea
The trachea can be surface marked on the surface of the anterior thorax, between the boundaries of the inferior margin of the cricoid cartilage and the sternal angle”
26
how can breathing rate be described?
normal 12-20 bradypnea- less than 12 tachypnea- more than 20
27
pattern of breathing?
Normal/deep/shallow/use of accessory muscles/pursed lip breathing
28
why wouold you ask to breath through mouth?
Breathing deeply through the mouth rather than nose allows you to hear the inspiratory + expiratory sounds better.
29
surface marking of R. Lung
The apex of the right lung is 1 inch above the medial 3rd of the clavicle. The right lung then extends down to the right sternoclavicular joint, to the manubriosternal joint at the 2nd costal cartilage (CC), to the 4th CC at the sternal border, to the 6th CC at the sternal border, to the 6th rib at the MCL to the 8th rib at the MAL and finally to the 10th rib at the scapular line
30
surafce marking of left lung
: “The apex of the left lung is 1 inch above the medial 3rd of the clavicle. The left lung then extends down to the left sternoclavicular joint, to the manubriosternal joint at the 2nd costal cartilage (CC), to the 4th CC at the sternal border, to the 5th CC 2-3cm from the sternal border due to the cardiac notch, to the 6th CC at the sternal border, to the 6th rib at the MCL to the 8th rib at the MAL and finally to the 10th rib at the scapular line.”
31
Describe and demonstrate the surface markings of the oblique fissure
"The middle and lower lobe of the right lung are separated by the oblique fissure which curves between the 6th CC anteriorly to the vertebral level T3 posteriorly.”
32
Describe and demonstrate the surface markings of horizontal fissures of right lung
“The horizontal fissure runs upwards from the 4th CC at the sternal border to meet the oblique fissure at the MAL, separating the upper and middle lobe
33
Describe and demonstrate the surface markings of the oblique fissure left
“The upper and lower lobe of the left lung are separated by the oblique fissure which curves between the 6th CC anteriorly to the vertebral level T3 posteriorly
34
Describe and demonstrate the surface marking of the inferior margin of parietal pleura right/left are the same
“The surface markings of the inferior margins of the parietal pleural of the right/left lung are down from the 6th CC at the sternal border, to the 8th rib at the MCL, to the 10th rib at the MAL, to the 12th rib at the scapular line, to the transverse process of L1”
35
Describe and demonstrate the surface marking of the inferior margin of the visceral pleura of right/left lung
The surface markings of the inferior margins of the visceral pleural of the right/left lung are down from the 6th CC at the sternal border, to the 6th rib at the MCL, to the 8th rib at the MAL, to the 10th rib at the scapular line
36
insertion of chest drain
“The triangle of safety for insertion of a chest drain is bound by the base of the axilla superiorly, the lateral border of the Pec Major anteriorly, the 5th ICS inferiorly and the lateral border of the Lat Dorsi posteriorly. The needle should be inserted in the 2nd-5th ICS above the upper border of the rib to avoid the neurovascular bundle and should be pointed up and medially
37
DESCRIBE MEDIASTINAL PLEURA RIGHT LUNG
“The surface marking of the mediastinal pleura of the right lung is the portion of parietal pleura that adheres to the mediastinum on the right hand side. This goes from 1 inch above the medial 3rd of the right clavicle down to the 6th CC at the sternal border.”
38
DESCRIBE MEDIASTINAL PLEURA LEFT LUNG – remember cardiac notch
“The surface marking of the mediastinal pleura of the left lung is the portion of parietal pleura that adheres to the mediastinum on the left hand side. This goes from 1 inch above the medial 3rd of the left clavicle to the 4th CC at the sternal border, and then curves out to the 5th CC deviated from the midline by 2-3cm due to the cardiac notch and then curves down to the 6th CC at the sternal border.”
39
wheeze
asthma, bronchiectasis, copd
40
stridor
high-pitched extra-thoracic breath sound resulting from turbulent airflow through narrowed upper airways. Stridor has a wide range of causes, including foreign body inhalation (acute) and subglottic stenosis (chronic).
41
crackles
discontinuous, brief, popping lung sounds | pneumonia, bronchiectasis and pulmonary oedema.
42
pulmonary fibrosis crackles?
Fine end-inspiratory crackles
43
DVT > PE
swelling in legs visible superficial veins w SOB secondary to PE
44
Bradypneoa causes?
use of sedative | opiods
45
tachypneoa cause
compensation for DKA sepsis PE
46
Finger clubbing? | causes
lung cancer, interstitial lung disease, cystic fibrosis and bronchiectasis.
47
Ask the patient to place the nails of their index fingers back to back. In a healthy individual, you should be able to observe a small diamond-shaped window (known as Schamroth’s window what is this assessing?
finger clubbing
47
Ask the patient to place the nails of their index fingers back to back. In a healthy individual, you should be able to observe a small diamond-shaped window (known as Schamroth’s window what is this assessing?
finger clubbing
48
what can salbutamol use cause in a resp examination?
fine tremor because it is a beta-2-agonist
49
astrexis
cock hands back 30s palms face away observe for a tremor
50
causes of atrexis
hepatic encephalapthy c02 retention secondary to type 2 resp failure > COPD uraemia
51
excessively warm and sweaty hands?
C02 retention
52
heart rate | when do you measure pulse for full 60s ?
rate and rhythm | irregular rhythm to improve accuracy
52
heart rate | when do you measure pulse for full 60s ?
rate and rhythm | irregular rhythm to improve accuracy
53
Bounding pulse:
can be associated with underlying CO2 retention (e.g. type 2 respiratory failure).
54
Resp rate | the expiratory phase is often prolonged
in asthma exacerbations and in patients with COPD).
55
bradypnoea
opiate overdose hypothyroidism head injury exhaustion in severe airway obstruction
56
tachynpoea
``` airway obstruction - copd / asthma pneumonia pulmonary fibrosis PE pneumothorax cardiac failure ```
57
oral candiasis | caused by ?
decreased immune suppression > thrush inhaled corticosteroids amoxicilin
58
dilated veins?
hypercapnia
59
what common resp condition does not cause clubbing?
COPD
60
kind of scars ?
lateral thoractomy
61
pectus excavatus
connective tissue disease | Marfans syndrome
62
pectus carinatum
protruded chest
63
what can we tell when JVP is raised
- If a patient is hypervolaemic the JVP will appear raised due to - increased venous pressure within the right atrium causing a higher than normal column of blood within the IJV -
64
is JVP palpable
no must be carotid artery
65
causes of raised JVP
Right-sided heart failure Tricuspid regurgitation - infective endocarditis Constrictive pericarditis
66
fine crackles?
pulmonary fibrosis
67
tension pneumothorax management
cardiac arrest call immediate needle decompression - large bore cannula into pleural space 2 intercostal space MCL 4/5 MAL - hiss of air high flow oxygen - aim 100% sats chest drain and admit
68
sob pneumothorax >2cm
needle aspiration - cannula | if unsuccesful chest drain - correct clotting first
69
pleural effusion investigation and management
uss pleural aspirate- 21g needle and 50ml syringe pH, protein, lactate dehydrogenase contrast CT to look for a cause treat the cause pleurodesis aspiration

Year 2 Clinical skills (6 decks)

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