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Respiratory Exam Flashcards

(63 cards)

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1
Q

Two components of a respiratory exam

A
  1. Extra pulmonary portion

2. Pulmonary portion

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2
Q

Extrapulmonary examination- areas of examination

A

1) Detection of cyanosis
2) Clubbing of fingers
3) Trachea
4) Accessory respiratory muscles
5) Lymph nodes
6) Ears
7) Noses
8) Sinuses
9) Mouth/throat

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3
Q

Meaning of cyanosis

A

-bluish coloured skin

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4
Q

Types of cyanosis

A
  • central

- peripheral

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5
Q

Cause of peripheral cyanosis

A
  • usually normal

- related to constriction of vessels in the extremities (ex due to cold)

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6
Q

Cause of central cyanosis

A

Low oxygen in blood

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7
Q

Sign of central cyanosis

A

Lips and face?? really thought the lips were not included -want to look orally

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8
Q

Haemoglobin in blood to see cyanosis

A

-must be 5gm/dl of deoxygenated haemoglobin present to see cyanosis

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9
Q

Clubbing of fingers -in which patients do see

A
  • chronically hypoxemic patients (but also in patients with normal O2 levels)
  • congenital heart disease
  • lung cancer
  • lung absces
  • empyema
  • cystic fibrosis
  • gi causes (rare)
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10
Q

Recognizing clubbing

A

Curving of the fingernails
Softening of the nail bed
Loss of angle between the nail and dorsum of the finger

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11
Q

Shifting of trachea with age

A

May be shifted slightly to the right in older people

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12
Q

Pathological shifting of the trachea

A

1) Pushed to the opposite side by a large pneumothorax or pleural effusion
2) Drawn towards the side of extensive atelectasis
3) Thyroid enlargement may shift it either way

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13
Q

Examination of trachea

A

Patients head in mild flexion by the one or two finger method
Compare distance from lateral tracheal wall to the bony medial border of the suprasternal notch

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14
Q

Accessory respiratory muscles-when do see

A

Normally not seen unless the patient is very short of breath

in a patient with obstructive lung disease -seeing this correlated with FEV1 <30%

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15
Q

Accessory resp muscles -which is the most evident in the dyspnoeic patient

A

-sternocleidomastoid

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16
Q

Lymph nodes -which to palpitate

A

1) Occipital
2) Pre and post auricular nodes
3) Sub-mandibular nodes
4) Anterior and posterior cervical nodes

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17
Q

Lymph nodes -what to note

A
  • soft, tender, mobile nodes = associated with infection

- firm/hard “matted down” nodes -signify malignancy

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18
Q

Lymph node in neck most frequently involved wiht lung cancer

A

Supraclavicular nodes (node may feel like a hard pea)

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19
Q

Ears examination

A
  • examine auricle of ear
  • check behind ear for nodes
  • check the lobule and helix for infected piercings from earrings
  • using ototscope look at auditory canal - note wax and other foreign bodies
  • look for redness/swelling of otittis externa
  • assess tympanic membrane for perforations, redness and bulging
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20
Q

Nose

A

1) examine the nose looking for foreign bodies
2) assess health of mucosa (redness, swellling, bleeding/scabbing of Little’s area
3) Assess for deviation of the septum

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21
Q

Sinuses

A

1) Press up on the frontal sinues from under the bony brows

2) Press up on maxillary sinuses

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22
Q

Mouth/throat

A
  • examine the teeth, gingiva, tongue and pharynx

- note presence/absence of tonsils

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23
Q

4 components of pulmonary exam

A

1) Inspection
2) Palpation
3) Percussion
4) Auscultation

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24
Q

Inspection

A

1) observe patient for extrapulmonary signs - cyanosis, dyspnoea, accessory muscles
2) antero-posterior diamter
3) Deformities
4) Thoracic and/or abdominal breathing - is it symmetrical/regular

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25
Where see antero-posterior diameter changes
With severe obstructive lung disease
26
Deformities seen
1) Kyphosis (increase in thoracic convexity) 2) Scoliosis (lateral curve of spine) 3) Kyphoscoliosis (combined kyphosis and scoliosis) 4) Pectus excavatum -severe retraction f sternum 5) Pectus carinatum - anterior protrusion of the sternum
27
Palpation of chest wall
- feel for masses and tenderness in the ribs and carilage | - feel for nodes in the axillae
28
Chest wall exercusion
- feel for decreased movement | - with a breath lung begins to move later and move less than the normal one
29
Chest wall exercusions movement of a) lower lobe b) upper and middle lobes
a) lower lobe - lateral movement | b) upper & middle lobe - anterior movement
30
Methods assessment of lower lobes
- place palms on posterolateral chest with fingers apart - patient takes deep breath in - watch movement of your thumbs OR - place fingers tightly in the interspaces - Try to restrict the movement of the chest - Have patient inhale and feel any variation in thoracic excursion
31
Upper lobe and middle lobe -method of assessment
Place hands lightly over anterior chest between clavicle and coastal margin Have patient inhale -feel chest move anteriorly
32
Modified hoovers sign
-Normally the lateral ribs flare and the costal margin widens with a deep inspiration -If the lungs are over-inflated with a low flat diaphragm the lateral chest wall may be drawn inwards with inspiration Very common in patients with severe COPD
33
Tactile fremitus
Vibrations from a patients voice detected by examiners hand on patients chest
34
Method of assessing tactile fremitus
-use palms or fingers or ulnar border of hand -compare sies Posteriorly: -upper 1/3 (upper lobe) -middle 1/3 (superior segment of lower lobe) -lower 1/3 (basal segments) a) medial to mid scapular line b) lateral to mid scapular line -axillae Anteriorly -place hand in area between clavicle and rib margin
35
In which disorders is tactile fremitus increased
-where lung is more dense --> consolidation of pneumonia or atelectasis
36
In which disorders is tactile fremitus absent
Pneumothorax | Pleural effusion which decreases the transmision of vibrations
37
Techique for percussion -position of patient
Patient should be sitting up | When percussing posteriorly have patients cross arm across anterior of chest
38
Locations to percuss
- same as tactile fremitus | - percuss about 3x at each site comparing side for side
39
5 types of percussion note and meaning
1) Normal resonance - normal lung 2) Dullness- over consolidation/similar to note over liver 3) Flat - over large pleural effusion / similar to note over thigh 4) hyper-resonance - over large pneumothorax 5) Tympanic -a hollow sound - as over stomach bubble
40
percussion of the diaphragm - location
Level of 9th posterior rib in mid scapular line | May be 1-2 cm higher on right
41
Assessing diaphragmatic exercusions
Compare position and maximum expiration and inspiration Normal exercuion 5--7 cm (only do so if suspect diaphragmatic weakness)
42
Stridor
The sound of partial upper airway obstruction | Heard in inspiration
43
Things to hear without a stethoscope
1) Hoarse voice 2) Stridor 3) Wheeze 4) Normal breathing > 1 m away at rest
44
Using the stethoscope to assess breath sounds
- patient take deep breaths with mouth open | - compare equivalent sites ver each lung in same areas as tactile fremitus and percussion
45
Types of breath sounds
1. Normal/vesicular breathing - inspiratory phase 3x expiratory phase - abnormal if these sounds not present 2. Bronchial breath sounds - high pitched and loud, inspiratory = expiratory phase - gap between inspiration and expiration - heard over consolidation (i.e. pneumonia) 3. Broncho-vesicular sounds - a little louder than vesicular - heard over the right upper lobe anteriorly or between the scapulae 4. Tubular breath sounds -very harsh, normally heard over the trachea or sometimes over consolidation
46
Crackles
Due to opening of small airways o secretions | Sounds like velcro coming apart
47
Types of crackles
- coarse - fine - early - late - continuous
48
Causes of early crackles
- bronchiectasis | - asthma (occasionally)
49
Causes of late crackles
- pulmonary fibrosis | - congestive heart failure
50
Causes of continuous crackles
Pneumonia
51
Wheezes
a continuous sound in expiration
52
Causes of wheezes
- bronchospasm - secretions - airway collapse or obstruction
53
Pleural rub
- due to inflamed surface of the pleura rubbing against each other - present in inspiration & expiration - sounds like squeaky door - dissapears with fluid formation
54
Causes of pleural rub
Pleuritis usually due to pneumonia or pulmonary infarct
55
If lung cancer is suspected what should do
Feel for - supraclavicular nodes - bony tenderness
56
If sarcoid is suspected what should do
Feel for all lymph nodes
57
Normal lung a) Tracheal shift b) percussion c) breath sounds d) fremitus e) adventitious sounds
a) none b) N c) N d) N e) O
58
Consolidation a) Tracheal shift b) percussion c) breath sounds d) fremitus e) adventitious sounds
a) none b) dull c) bronchial d) increased e) crackles
59
Pleural effusion a) Tracheal shift b) percussion c) breath sounds d) fremitus e) adventitious sounds
1) to opposite side 2) dull/flat 3) decrease 4) absent 5) O
60
Pneumothorax a) Tracheal shift b) percussion c) breath sounds d) fremitus e) adventitious sounds
1) to opposite side 2) hyper resonant 3) Decreased 4) Absent 5) O
61
Atelectasis a) Tracheal shift b) percussion c) breath sounds d) fremitus e) adventitious sounds
1) To same side 2) Dull 3) Decreased 4) Increased/decreased 5) crackles
62
Asthma a) Tracheal shift b) percussion c) breath sounds d) fremitus e) adventitious sounds
1) none 2) N 3) N or decreased 4) n 5) Wheezes
63
Emphysema a) Tracheal shift b) percussion c) breath sounds d) fremitus e) adventitious sounds
1) None 2) Hyper resonant 3) Decreased 4) Decreased 5) variable

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