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Respiratory Block: Clinical Examination > The Respiratory Examination > Flashcards

Flashcards in The Respiratory Examination Deck (41):
1

The lungs are protected by a cylinder made up of:

- Ribs
- Vertebra
- Diaphragm

2

What does pleural effusion mean?

Accumulation of fluid within the pleural cavity

3

What makes up the Mediastinum?

The heart, trachea, oesophagus and great blood vessels and nerves sit between the lungs and make up a structure called the mediastinum

4

Left lung structure

Apex of the heart points to the left, making the left lung smaller:
- 2 lobes
- separated by the oblique fissure

5

Right Lung Structure

- Both horizontal (upper) and oblique (lower) fissures
- 3 lobes

6

Muscles of respiration are:

1. Diaphragm
2. Intercostal muscles

7

Normal Respiratory Rate

16-25 breaths / minute

8

Tachypnoea is defined as:

Rapid respiratory rate: >25 breaths per minute

9

Bradypnoea is defined as:

Respiratory rate below 8
- a level associated with sedation and adverse prognosis

10

In normal relaxed breathing, what muscles are active?

The diaphragm is the only active muscle, and is active only in inspiration
- expiration is a passive process

11

What is a sign of an increase in the work of breathing?

The use of accessory muscles of inspiration

12

The use of accessory muscles in respiration are a characteristic sign of what condition?

COPD

13

What are the accessory muscles?

- Sternocleidomastoids
- Platysma
- Strap muscles of the neck

14

What does use of the accessory muscles characteristically cause?

Elevation of the shoulders with inspiration - aid respiration by increasing chest expansion

15

Contraction of the abdominal muscles during expiration may occur in:

Patients with obstructed airways

16

What is often seen in patients with severe COPD on inspiration?

In-drawing of the intercostal and supraclavicular spaces - this is due to a delayed increase in lung volume despite the generation of large negative pleural pressures

17

What is a characteristic breathing pattern seen in COPD?

Pursed-lips breathing

18

Tracheal tug is seen in:

1. COPD
2. Severe asthma - especially in kids

19

What is a tracheal tug?

Increased diaphragmatic movements may cause downward displacement of the trachea during inspiration: tracheal tug

20

What is the benefit of pursed-lips breathing in COPD?

This manoeuvre reduces the patient's breathlessness possibly by providing continuous positive airway pressure and helping to prevent airway collapse during expiration

21

What makes patients with severe COPD feel more comfortable?

Leaning forward with their arms on their knees
- this position compresses the abdomen and pushes the diaphragm upwards partly restoring its normal domed shape and improving effectiveness during inspiration

22

Central cyanosis becomes evident at what point?

When the absolute concentration of deoxygenated Hb is 50g/L of capillary blood

23

Cyanosis is usually obvious when arterial oxygen saturation falls below what point?

Below 90% in a person with normal Hb

24

What are examples of lung diseases serious enough to cause central cyanosis?

- pneumonia
- COPD
- pulmonary embolism

25

Cough character: lack of the usual explosive beginning may indicate what?

Vocal cord paralysis (the bovine cough)

26

Cough character: A muffled, wheezy, ineffective cough suggests what?

Obstructive pulmonary disease

27

Cough character: A very loose, productive cough suggests what?

Excessive bronchial secretions due to:
- chronic bronchitis
- pneumonia
- bronchiectasis

28

Cough character: A barking or croupy cough suggests what?

Suggests a problem with the upper airway:
- the pharynx / larynx or pertussis infection

29

Cough character: What may cause a dry, irritating cough?

Occurs with:
- chest infection
- asthma
- carcinoma of the bronchus
- sometimes with LV failure or interstitial lung disease

30

What causes stridor?

Obstruction of the larynx or trachea:
- foreign body
- tumor
- infection
- inflammation

31

Causes of hoarseness (dysphonia):

- may indicate recurrent laryngeal nerve palsy associated with carcinoma of the lung (usually left sided)
- most common cause = laryngitis or use of inhaled corticosteroids for asthma
- non respiratory: hypothyroidism

32

What is Hypertrophic Pulmonary Osteoarthropathy?

An uncommon but important association with clubbing:
- characterized by the presence of periosteal inflammation at the distal ends of long bones, the wrists, the ankles, the metacarpal and metatarsal bones.
- swelling and tenderness over the wrists and other involved areas

33

Causes of HPO

- primary lung carcinoma
- pleural fibromas

34

What can cause wasting of the small muscles of the hand and weakness of finger abduction?

Compression and infiltration by a peripheral lung tumor of a lower trunk of the T1 nerve

35

What are important cardiac signs of severe asthma?

Tachycardia and pulsus paradoxus

36

Why is tachycardia seen in asthma?

- tachycardia is a common SE of the treatment of asthma with beta-blockers
- and accompanies dyspnoea or hypoxia of any cause

37

Clinical signs of severe CO2 retention

- confusion
- warm peripheries
- bounding pulse

38

A flapping tremor with a 2- to 3- second cycle may occur in what conditions?

In severe CO2 retention (usually due to COPD)
- also seen in liver and renal failure

39

Clinical examination of the nose (nostrils) what could polyps indicate?

Asthma

40

Clinical examination of the nose (nostrils) what could enlarged turbinates indicate?

Various allergic conditions

41

Clinical examination of the nose (nostrils) what could a deviated septum indicate?

Nasal obstruction