Upon general inspection, what signs might you find to show that a patient is struggling to breathe?
- Accessory muscle usage
- Tripod position
- Pursed lip breathing
- Intercostal muscle recession
What lung conditions would you give supplementary O2 for?
- Interstitial lung disease
- COPD
What lung conditions would you give inhalers or nebulisers for?
- Asthma
- COPD
When would you get sputum pots from a patient - when you suspect which conditions?
- COPD
- Bronchiectasis
At what O2 sats would you usually see peripheral cyanosis in patients?
- <85%
What might a resting fine tremor suggest?
- Beta-2 agonist use
Give 3 respiratory causes of clubbing
- Lung cancer
- Interstitial lung disease
- Bronchiectasis
What is the normal amount of time for capillary refill?
- Roughly 2 secs
When would you see a CO2 retention flap?
- Type 2 respiratory failure e.g. COPD
Why might a patient be cold to touch?
- Peripheral vasoconstriction
- Poor perfusion
What are the signs of Horner’s syndrome?
- Ptosis
- Miosis
- Annhidrosis
- Enopthalmos
- Red eye
What does conjunctival pallor suggest?
- Anaemia
What would elevated JVP suggest + positive hepatojugular reflex suggest?
- Pulmonary HTN
- Fluid overload
Tracheal deviation
Give 2 things that trachea deviates away from and 3 things it deviates towards
Deviates away from:
- Tension pneumothorax
- Pleural effusion
Deviates towards:
- Lobar collapse
- Pneumonectomy
- Consolidation caused by endobronchial obstruction
Give 2 common scars you might come across in the respiratory examination and what procedures they might have been caused by
- Mid-axillary scars - chest drains
- Horizontal postero-lateral scars - thoractomy from e.g. lobectomy / pneumonectomy
Give 3 chest deformities you might see in the respiratory exam, and give a cause for one of these
- Pectus excavatum
- Pectus carinatum
- Barrel chest - COPD - emphysema
Why might you see chest asymmetry in the patient?
- Pneumonectomy
- Thoracoplasty
Causes of reduced lung expansion?
- Lung collapse
- Pneumonia
Lung sounds
When would you hear the following lung sounds:
1) Resonant
2) Hyper-resonant
3) Dull
4) Stony dull
1) Normal
2) Pneumothorax
3)
- Consolidation
- Fluid
- Tumour
4)
Lung sounds
When would you hear the following sounds on auscultation?
1) Vesicular
2) Bronchial
3) Reduced breath sounds
4) Wheeze
5) Coarse crackles
6) Fine crackles
1)
- Vesicular = normal
2)
- Bronchial = consolidation
3)
- Consolidation
- Collapse
- Pleural effusion
4)
- Asthma
- COPD
5)
- Pneumonia
- Bronchiectasis
- Fluid overload
6)
- Pulmonary fibrosis
What can you determine from vocal fremitus auscultation?
- Increased volume over an area suggests increased tissue density - consolidation / tumour / lobar collapse
- Decreased volume over an area - pleural effusion
Give 3 causes of lymphadenopathy upon cervical lymph node examination
- Infection
- Malignancy
- Sarcoidosis
When would you get sacral oedema?
- Fluid overload in cor pulmonale
What further examinations would you suggest upon concluding the respiratory examination?
- Obs
- Peak flow
- Sputum pot
- Check inhaler technique
- CXR
- ABG