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Resp exam Flashcards

1
Q

General Inspection - patient wellbeing - what are you looking for? (6)

A
  1. Well/Unwell
  2. Alert
  3. Comfortable
  4. Breathless
  5. Cachexic
  6. Cushingoid
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2
Q

What are the causes of Cachexia in resp?

A

Malignancy

Emphysema

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3
Q

What are the causes of cushingoid in resp?

A

Steroid use

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4
Q

General Inspection - general breathing - what are you looking for? (2)

A
  1. Use of accessory muscles

2. Pursed lip breathing

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5
Q

What are the causes of use of accessory muscles in resp?

A
  1. COPD
  2. Pleural effusion
  3. Pneumothorax
  4. Severe asthma
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6
Q

What is the benefit of pursed lip breathing and in which conditions tend to cause this?

A

Prevents bronchial wall collapse by keeping airway pressure high in:

  1. severe airway obstruction
  2. emphysema
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7
Q

General Inspection - noises - what are you looking for? (7)

A
  1. Speech abnormalities
  2. Stridor
  3. Wheeze
  4. Cough
  5. Prolonged expiratory phase
  6. Clicks
  7. Gurgling
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8
Q

What are the resp causes of speech abnormalities? (1)

A

Recurrent laryngeal nerve palsy

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9
Q

What are the resp causes of stridor? (3)

A

Large airway obstruction

e. g.
1. Mediastinal masses
2. Bronchial carcinoma
3. Retrosternal thyroid

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10
Q

What 3 ways can you describe a cough?

A

Dry
Productive
Bovine

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11
Q

What is a bovine cough?

A

A non- explosive cough of someone unable to close their glottis

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12
Q

What causes a prolonged expiratory phase in resp?

A
  1. Asthma

2. COPD

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13
Q

What causes clicks in the resp exam?

A

Bronchiectasis

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14
Q

What causes gurgling in the resp exam?

A

Airway secretions

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15
Q

General Inspection - around the bed - what are you looking for? (4)

A
  1. Oxygen
  2. Medication
  3. Sputum pots
  4. Cigarettes
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16
Q

Give examples of resp medication you might see arounf the bed (2)

A
  1. Inhalers

2. Nebulisers

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17
Q

What should you do if you see a sputum pot?

A

Look at the sputum

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18
Q

Hands - tremor - what are the two types and what causes each (2)

A 
Fine tremor - beta-2 agonist 
Flapping tremor (asterixis) - CO2 retention
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19
Q

Hands- what can peripheral cyanosis indicate? (2)

A

Hypoxia or Hypoperfusion

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20
Q

Describe the hands of someone with CO2 retention? (3)

A
  1. Sweaty
  2. Clammy
  3. Warm
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21
Q

In what resp condition might you detect small muscle wasting in the hands?

A

Pancoast tumour

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22
Q

In resp, what causes clubbing of the nails? (4)

A
  1. Idiopathic pulmonary fibrosis
  2. Lung cancer
  3. Cystic Fibrosis
  4. Bronchiectasis
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23
Q

What causes tar stained fingers?

A

Smoking

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24
Q

Pulse - what respiratory conditions cause tachycardia? (3)

A
  1. Hypoxia in severe asthma or COPD
  2. Pulmonary embolism
  3. Infection
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25
Pulse - What causes a bounding pulse in resp?
CO2 retention
26
What in resp causes tachypnoea? (5)
1. Lung disease 2. Infection 3. Hyperventilation 4. Fever 5. Pulmonary Embolism
27
What causes bradypnoea? (1)
Central nervous system depression
28
Head and Neck - Face - what are you looking for? (6)
1. Cushingoid 2. Plethoric 3. Telangiectasia/microstomia 4. Butterfly rash 5. Lupus pernio 6. Lupus vulgaris
29
What in resp can cause a plethoric face? (3)
1. Secondary Polycythaemia 2. Cushing's syndrome 3. Superior Vena Cava Obstruction if facial swelling
30
What might telangiectasia and microstomia indicate?
Systemic sclerosis
31
What is microstomia?
A small sized mouth
32
Why is systemic sclerosis relevant to resp?
If severe can cause SOB and pulmonary hypertension
33
What is the significance a butterfly rash in resp?
It can indicate SLE
34
What are the pulmonary signs of SLE? (3)
Pleuritic chest pain Coughing SOB
35
What can lupus pernio indicate?
Sarcoid
36
What the resp symptoms of sarcoid? (4)
Persistent dry cough Wheezing SOB Chest pain
37
What does lupus vulgaris indicate?
TB
38
Head and Neck - Eyes - what are you looking for? (2)
1. Conjunctival Pallor | 2. Horner's syndrome
39
What does conjunctival pallor indicate?
Anaemia of chronic disease
40
What is the triad of Horner's syndrome?
1. Ptosis 2. Miosis 3. Anhydrosis
41
What tumour is Horner's syndrome associated with?
Pancoast tumour
42
Head and Neck - Mouth - what are you looking for? (1)
Central cyanosis under tongue
43
What does central cyanosis under tongue indicate?
Hypoxia
44
Head and Neck - Neck - what are you looking for? (3)
JVP height Tracheal deviation Cricosternal distance
45
In what resp condition is JVP elevated?
Cor Pulmonale
46
What is Cor Pulmonale?
When a disorder of the lungs (pulmonary HTN) causes right sided heart dysfunction leading to RHF
47
Which 2 conditions cause deviated trachea and state which side each causes the trachea to move
Tension Pneumothorax and large pleural effusion- trachea is deviated away from the lesion Collapsed lung and pneumonectomy- trachea is deviated towards the lesion
48
What does a cricosternal distance of less than 3 fingers indicate?
Hyperinflated lungs
49
What is pulsus parodoxicus?
When the pulse wave volume decreases significantly during the inspiratory phase
50
What are causes of pulsus paradoxus?
1. late sign of cardiac tamponade, | 2. severe acute asthma and 3. severe exacerbations of COPD
51
What is a normal Resp rate?
12-20 breaths per min
52
What are the causes of a displaced apex beat?
1. RV hypertrophy e.g. Pulmonary HTN, COPD, interstitial lung disease 2. Large pleural effusion 3. Tension pneumothorax
53
What causes symmetrical reduced chest expansion?
pulmonary fibrosis (reduced lung elasticity
54
What causes asymmetrical reduced chest expansion?
Pneumothorax Pleural effusion Pneumonia
55
What can dull percussion indicate?
Consolidation Tumour Lobar collaspe Pleural effusion (stony dullness)
56
What can hyper-resonance indicate?
Decreased tissue density e.g. pneumothorax
57
When you auscultate the lungs, what are you assessing?
Quality of breath sounds Volume of breath sounds Added sounds
58
What are the 2 types of quality of breath sounds?
Vesicular | Bronchial
59
What are bronchial breath sounds ?
Harsh-sounding | Inspiration and expiration are equal and there is a pause between
60
What is bronchial breath sounds associated with?
Consolidation
61
What can caused quiet breath sounds?
Reduced air entry (however present it as reduced breath sounds) - pneumothorax - pleural effusion
62
Describe coarse crackles
Discontinous, brief, popping lung sounds
63
Describe fine crackles
Sounds like separating velcro
64
What causes coarse crackles?
Pneumonia Bronchiectasis Pulmonary oedema
65
What crackles do you get in pulmonary fibrosis?
Fine end-inspiratory crackles
66
What are respiratory causes of lymphadenopathy?
Lung cancer with mets TB Sarcoidosis
67
How do you complete a resp exam?
``` Bedside: CV examination (cor pulmonale) Basic obs Sputum sample PEFR Bloods: ABG Imaging: CXR ```

Year 6 (18 decks)

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