Respiratory Flashcards
(91 cards)
1
Q
How do you set up for a resp exam? (6)
A
WIPPPE:
- Wash hands
- Introduce yourself and identify patient
- Permission (gain from patient after explaining exam)
- Position (45 degrees for CVS/resp)
- Pain (check if patient has any pain)
- Exposure (adequately expose patient)
2
Q
What are the two patient identifiers? (2)
A
- Name
- DOB
3
Q
What are the end of bed observations that can be made in a resp exam? (7)
A
- Oxygen mass
- Walking aids
- Drip stand
- Nebuliser
- Urinary catheter
- Snacks
- Sputum pots
4
Q
What features of a patient can be seen from their general appearance relevant to a resp exam? (9)
A
- In pain?
- Unwell?
- Breathless?
- Breathing observations?
- Cyanosis?
- Age?
- Scars?
- O2 sats?
- Cachexia?
5
Q
What breathing observations can be made from a patient from their general appearance relevant to a resp exam? (8)
A
- Using accessory muscles of respiration?
- Leaning forward and using arms in breathing to brace chest? Tripod position?
- Pursed lips?
- Intercostal muscle recession?
- Nasal flaring?
- Cough? Dry/productive?
- Wheeze (expiratory)?
- Stridor (inspiratory?
6
Q
What resp conditions do young patients tend to get? (2)
A
- Asthma
- Cystic fibrosis (CF)
7
Q
What resp conditions do older patients tend to get? (3)
A
- COPD
- Interstitial lung disease (ILD)
- Malignancy
8
Q
What does O2 around the bed indicate? (2)
A
- ILD
- COPD
9
Q
What do inhalers/nebulisers around the bed indicate? (2)
A
- Asthma
- COPD
10
Q
What do sputum pots around the bed indicate? (2)
A
- COPD
- Bronchiectasis
11
Q
What does cachexia indicate in a resp exam? (3)
A
- Malignancy
- Cystic fibrosis
- COPD
12
Q
What does a dry cough indicate? (2)
A
- Asthma: younger
- ILD: older
13
Q
What does a productive cough indicate in older patients? (2)
A
- Bronchiectasis
- COPD
14
Q
What does a productive cough indicate in younger patients?
A
Cystic fibrosis
15
Q
What does an expiratory wheeze indicate? (3)
A
- Asthma
- COPD
- Bronchiectasis
16
Q
What does an inspiratory stridor indicate?
A
Upper airway obstruction
17
Q
What is the order of a resp exam? (23)
A
- General observation
- Hands
- Pulse
- Temp
- Resp rate
- Tremors
- Face
- Mouth
- Eyes
- JVP
- Trachea + cricosternal distance
- Thorax inspection
- Apex beat palpation
- Heave
- Expansion
- Percussion
- Auscultation
- Vocal resonance
- Repeat for posterior chest
- Lymph nodes
- Sacral oedema
- Legs and calves
- Investigations
18
Q
What are looked for in hands in a resp exams? (5)
A
- Tar staining
- Clubbing
- Peripheral cyanosis
- Rhematological disease - joint swelling/tenderness
- Bruising/thinning of skin
19
Q
What are the resp causes of clubbing? (5)
A
- Bronchial carcinoma
- Empyema/abscess (chronic lung suppination)
- Bronchiectasis (chronic lung suppination)
- Cystic fibrosis (chronic lung suppination)
- Fibrosing alveolitis
20
Q
Why are signs of a rhematological disease checked for in a resp exam? (2)
A
- Pleural effusion association
- Pulmonary fibrosis association
21
Q
What is bruising/thinning of skin associated with? Give 3 examples
A
Long term steroid use e.g in ILD/asthma/COPD
22
Q
What does a reduced temperature suggest? (2)
A
- Peripheral vasoconstriction
- Poor perfusion
23
Q
What is assessed in pulse palpation? (2)
A
- Rate
- Rhythm
24
Q
When is a resp rate of up to 20 still normal?
A
Patients with anxiety
25
How is resp rate counted?
Breaths in 15 secs x 4
26
What two types of tremor are assessed for?
- Fine tremor
| - Flapping tremor
27
How is fine tremor assessed?
Ask patients to hold out arms outstretched
28
What is a fine tremor associated with?
Beta agonist medications
29
How is flapping tremor assessed?
Cock wrists back
30
What is flapping tremor associated with?
- CO2 retention - type 2 resp failure e.g COPD
31
What signs are checked for in the face in a resp exam? (3)
- Central cyanosis on lips/under tongue
- Pursed lip on expiration
- Dusky appearance and swelling
32
What does a dusky appearance and swelling in the face indicate? And how (2)
SVP compression
- Mediastinal tumour
- Puenmothorax
33
What signs are checked for in the eyes in a resp exam? (2)
- Conjunctival pallor
| - Horner's syndrome
34
What does Horner's syndrome look like in the eyes? (3)
- Unilateral miosis (pupil constriction)
- Ptosis (falling of upper eyelid)
- Enophthalmos (posterior eyeball placement in orbit)
35
What are the signs of Horner's syndrome in the face?
Anhidrosis (inability to sweat) on affected side
36
What does a raised JVP indicate in resp? (4)
- Cor pulmonale
- SVC obstruction
- Acute: tension pneumothorax
- Acute: PE
37
How is the trachea palpated? (6)
- Warn
- Relaxed neck musculature: chin downwards
- Place 3 fingers gently
- Into sternal notch
- Central: trachea under middle finger
- Compare space between trachea and sternocleidomastoid on each side: difference = deviation
38
What does the trachea deviate away from? (2)
- Pnuemothorax
| - Large pleural effusion
39
What does the trachea deviate towards? (2)
- Lobar collapse
| - Pueumonectomy (surgical lung part removal)
40
What scars are inspected for on the chest? (2)
- Small mid axillary scars
| - Horizontal postero-lateral scars (on back)
41
What do horizontal postero-lateral scars indicate?
Thoracotomy from e.g. lobectomy/pneumonectomy
42
What do small mid axillary scars indicate?
Chest drains
43
What surgeries does asymmetry of the chest wall indicate? And why? (2)
- Pneumonectomy: cancer
| - Thoracoplasty : rib removed for TB
44
What is inspected for in the chest wall? (4)
- Scars
- Asymmetry
- Shape
- Intercostal recession due to rapid inspiration
45
What conditions cause intercostal recession due to rapid inspiration? (2)
- Acute infection
| - Asthma
46
What does a displaced apex beat indicate in a resp exam?
Mediastinal mass
47
What does an absent apex beat indicate in a resp exam? (2)
- Large pleural effusion
| - Pneumothorax
48
What are the two ways an apex beat can be changed in a resp exam? (2)
- Displaced?
- Absent?
- Difficult to feel/hear?
49
What might make the apex beat difficult to feel/hear in a resp exam?
Hyperinflation due to COPD
50
What is felt for on the chest? (2)
- Apex beat
| - Right ventricular heave
51
What deformities can be seen in chest wall shape?
- Barrel chest
- Pectus excavatum
- Pectus carinatum
52
What does barrel chest indicate?
Hyperinflation due to COPD
53
What is pectus excavatum?
Genetic caved in chest, deformity of anterior thoracic wall
54
What are the dangers of pectus excavaum? (2)
- Can lead to difficulty of lung expansion
| - Compression can squeeze heart
55
What is pectus carinatum?
"Pigeon chest"
| Genetic chest jutting out due to unusual rib and sternum protrusion growth
56
What can pectus carinatum cause?
Shortness of breath esp on exertion
57
How is chest expansion assessed? (7)
- Cup hands
- Fingers spread
- Around upper anterior chest
- Press finger tips into mid axillary line
- Bring thumbs together in midline touching
- See how much thumbs move as patient breathes in: should move apart equally
- Look for asymmetry
58
Where should chest expansion be assessed? (3)
- Upper anterior chest
- Lower anterior chest
- On back
59
What is asymmetry of chest expansion?
One of thumbs moving less - reduced expansion on that side
60
What can reduced chest expansion on one side indicate? (2)
- Lung collapse
| - Pneumonia
61
What are the resp causes right sided heart failure causing right ventricular heave be secondary to? (2)
Chronic hypoxic lung diseases:
- COPD
- ILD
62
Describe good percussion technique (4)
- Middle finger of non-dominant hand
- Along an intercostal space - Tap with flexed index/ middle finger of dominant hand
- On middle finger middle phalanx non dominant hand
63
What areas should be percussed side to side anteriorly? (4)
- Supraclavicular (lung apices)
- Infraclavicular
- Chest wall (3-4 locations bilaterally)
- Axilla
64
What is the normal percussion note?
Resonant
65
Posterior lung ausculation (3)
- 4 rows
- Around borders of scapula
- Then borders of back
66
Cricosternal distance? (2)
- Distance between suprasternal notch and cricid cartilage
| - Healthy: 3-4 patient fingers
67
What does reduced cricosternal distance suggest?
Lung hyperinflation
68
What does a dull percussion note suggest? Give 4 examples
Increased tissue density
- Consolidation
- Fluid
- Tumour
- Collapse
69
What does a stony dull percussion note suggest?
Pleural effusion
70
What does a hyperresonant note suggest? Give an example
Decreased tissue density
| Puenmothorax
71
What insructions should be given to a patient for auscultation?
Deep breaths in out through mouth
72
What position should the patient be in for auscultation of the back? (3)
- Lean forward
- Hunched over
- Cross arms
73
Describe vesicular breath sounds (4) Where should they be heard?
- Lower pitch
- Shorter expiration
- No pause between inspiration and expiration
THORAX
74
Describe bronchial breath sounds (4) Where should they be heard normally? (4)
- Higher pitch
- Louder/harsher
- Inspiration and expiration equal
- Pause between inspiration and expiration
TRACHEA
75
What are bronchial breath sounds over the thorax associated with?
Consolidation
76
What should be assessed in auscultation? (3)
- Quality: vesicular/bronchial?
- Volume: reduced?
- Added sounds: Stridor? wheeze? Coarse/fine crackles?
77
What do reduced breath sounds suggest? (3)
- Consolidation
- Collapse
- Pleural effusion
78
When is a wheeze heard? And what conditions is it associated with? (2)
Expiration
- Asthma
- COPD
79
What are coarse crackles associated with? (3) Inspiratory vs expiratory
- Puenmonia (inspiratory)
- Fluid overload (inspiratory) (e.g oedema/HF)
- Bronchiectasis (expiratory and inspiratory)
80
What are fine crackles associated with?
Pulmonary fibrosis
81
What are crackles that don't clear after a cough associated with?
Bronchiectasis
82
What should you do if you hear crackles?
Ask patient to cough
83
How is vocal resonance assessed?
Ask patient to say 99
84
What does increased vocal resonance suggest? Give 3 examples
Increased tissue density
- Consolidation
- Tumour
- Lobal collapse
85
What does decreased vocal resonance suggest?
Fluid outside the lung - pleural effusion
86
What does lymphadenopathy indicate in resp exam? (3)
- Lung cancer
- TB
- Sarcoidosis
87
Why is sacral oedema relevant to a resp exam?
Fluid overload in cor pulmonale
88
What should be inspected for in the legs in a resp exam? (3)
- Pitting oedema
- Calves: DVT
- Erythema nodosum: Sacroidosis
89
Further investigations? (5)
- Peak flow
- O2 sats
- Chest x ray
- ABG
- Cardio exam
90
What should be assessed with crackles? (3)
- Fine/coarse?
- Change with breath?
- Change with cough?
91
Reduced chest expansion? (5)
- Fibrosis
- Consolidation
- Effusion
- Collapse
- Pneumothorax.
