Respiratory history examination

Question 1

What is important in examination?

Answer 1

Don’t unduly put them in pain or discomfort

Question 2

What do overal in examination?

Answer 2

Study hand and inspect whole patient, examine extremites oedema esp, expose chest wiht privicy in mind, expose the chest, inspect front and back of chest, examin the back of chest percussion palpation auscultation

Question 3

What to look for wiht initial impression?

Answer 3

Cough, Wheeze stridor, laboured breathing pursed lipped breathing COPD, nutritional state obestiy, paraphernala inhalers nebulisers sputum pots

Question 4

How to expose paitnet?

Answer 4

Dont need to take bras off

Question 5

What is clubbing?

Answer 5

loss of nail bed angle, spongines of nailbed, increased curvature in 2 planesCommonest cause is lung cancer, PF chronic suppurative lung disease bronchiectasis empyema,

Question 6

What tremors are there for respiratory causes?

Answer 6

Flapping asterixis in resp failure. Fine tremor from beta2-agonists

Question 7

What can you see on hands?

Answer 7

Warmth oedema tobacco stains coal dust tatoos

Question 8

What is bounding pulse?

Answer 8

High volume pulse with warm peripheries CO2

Question 9

What to think about when taking breathing?

Answer 9

need to see natural breathing so don’t make it obviously

Question 10

What to inspect in chest?

Answer 10

Rate rhythm pattern prolonged expiration symmetry chest vs abdominal use of accessory muscles assess expansion with your chest wall

Question 11

What to palpate?

Answer 11

Neck lymph nodes trachea, apex beat axillae and expansion

Question 12

What is tactile vocal fremitus?

Answer 12

Say 99 feel vibrations with the side of my hands

Question 13

What should you here with percussion?

Answer 13

Compare left vs right and one space to the next heard should be dull should be resonant everywhere else. resonance implies aerated lung do axillae as well put finger horizontally

Question 14

How to use the stethoscope?

Answer 14

direct auscultation can put ear on chest but not acceptable.

Question 15

How to auscultate?

Answer 15

Traezius 2-5 times each side posteriorly

Question 16

What are bronchial breathing?

Answer 16

higher pitched distinct inspiratory and expiratory phases heard over fibrotic or consolidated lung and above pleural effusion associated with whispering pectoriloquy when whispering

Question 17

What are the crackles?

Answer 17

crackles crepitation crackles are more noticable at the bases can be caused by seretions in airways coughing consolitation fibrotic lung disease and heard faulure

Question 18

What are wheezes?

Answer 18

Rhonchi sugest airflow obstruction

Question 19

What are cautions for spirometry?

Answer 19

Haemoptysis unknown cause, pneumothorax, recent surgery, thoracic abdominal cerebral aneurism, unstable cardiovascular incident, recent acute exacerbation of infection, six weeks usually adequate to carry out test

Question 20

What are main issues with spirometry?

Answer 20

Effort dependant. need to get reproducible results. needs to have age sex height and ethnic origin

Question 21

How is spirometry used?

Answer 21

Diagnostice and monitoring of COPD astratifying severeity, also help with asthma evidence and can see fibrosis if there is restriction

Question 22

What are normal FVC values/

Answer 22

Vital Capacity total volume should be 80% of predicted
FVC same
FEV1 forces expiratory volume should get 80% of predicted and FEV1/FVC ration is ration should be more than 70% less shows obstruction

Question 23

What can cause obstruction how ot identify?

Answer 23

Asthma reversible COPD not reversible Bronchiectasis foreing body tumour mucous plugging

Question 24

What is mild COPD?

Answer 24

FVC is normal but with obstruction

Question 25

What can cause restriction?

Answer 25

Fibrosis, obesity, hyphosis/scoliosis neromscluar disorders need specialist follow up

Question 26

What does KCO?

Answer 26

Gas transfer per unit of lung surface

Question 27

What is FENO test?

Answer 27

Airways inflammation can be affecte by diet and allergies

Question 28

What is aim of oxygen?

Answer 28

aim to restore oxygen in hypoxia, not used for breathlessness alone

Question 29

What to consider with oxygen therapy?

Answer 29

safeguarding airway, enhancing circulating volume correcting severe anaemia enahacning cardiac output increase FIO2

Question 30

What is important to consider with type 2 respiratory failure?

Answer 30

they are at risk of CO2 retention like COPD and kyphosis

Question 31

What to look at in patient's neck and face?

Answer 31

Complexion cyanosis eyes neck Jugular venous pressure elevated with peripheral oedema vena cava obstruction when fixed, trachea deviation/

Question 32

What are signs of respiratory failure?

Answer 32

Central cyanosis tongue lips bottom of tongue, peripheral cyanosis much less reliable, reaction ot cold poor perfusion anxiety

Question 33

What to look for in chest wall?

Answer 33

deformity under and over inflation, yphosis barrel chest COPD,AP diameter lateral diameter flattening, Scars radiotherapy chances aspiration wounds dilated veins

Question 34

What is importance of resonance?

Answer 34

lost in pleural effusion, consolidation, collapse fibrosis raised diaphragm, over the iver hear except in emphysema increases in pneummothorax and emhyseme