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39 Cards in this Set
- Front
- Back
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What does a barking/brassy/hollow cough suggest?
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Barking - Epiglottis infection
Brassy - Tracheal compression (by tumour) Hallow - Recurrent nerve palsy |
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What does a cough worse at night suggest?
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Possibly asthma or congestive heart failure
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What does a cough coming on immediately after eating/drinking suggest?
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GORD - aspiration of reflux material
Tracheo-oesophageal fistula |
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What does yellow/green sputum suggest?
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Bronchiectasis or lobar pneumonia
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What does Foul smelling dark coloured sputum suggest?
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Lung abscess with presence of anaerobic organisms
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What are the sources of dyspnoea?
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1. Airway
2. Lung parenchyma 3. Pulmonary Circulation 4. Chest wall/pleura 5. Cardiac 6. Anaemia 7. Acidosis 8. Of course, psychogenic |
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How can you clinically assess whether chest pain + fever are caused by bacteria or a virus?
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The prodrome (malaise, fever, myalgia) for bacteria normally occur hours before the chest pain where as viral prodrome occurs days before the pain
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What shud yu immediately consider in patients that have chest pain, and night fevers?
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1. Tuberculosis (night sweats)
2. Pneumonia 3. Mesothelioma |
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What should you consider when a patient presents with a hoarse voice?
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Laryngitis (Malaise, possible fever)
Vocal cord tumour Recurrent laryngeal nerve palsy |
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What are the symptoms of a patient suffering an anxiety attack?
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Dyspnoea (harder to breath in than out)
Tachypnoea Parasthesia of fingers and around the mouth, light headedness, chest pain and feeling of impending collapse (due to respiratory alkalosis) |
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What are the 2 main types of cough and what are the causes?
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Wet (productive) cough
- Infection - Asthma - Brochiectasis (large volumes of purulent sputum) - Pulmonary Oedema (pink frothy) Dry Cough - Acid Regurgitation Irritation - ACE inhibitor use - Epiglottitis (barking cough) - Trachea compression (brassy cough) - Recurrent laryngeal nerve palsy (hollow cough) |
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What can be associated with a cough? (8)
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Sputum
Haemoptysis Dyspnoea Wheeze Chest pain/tightness Fever Hoarseness Night sweats |
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When suspecting respiratory tract infection, how can you differentiate between a bacterial or viral cause clinically?
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Bacterial - Fever and prodrome usually occur fairly close together
Viral - Prodrome often comes days before fever |
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What does dark foul-smelling sputum suggest?
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Lung Abscess with anaerobes
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What are the causes of haemoptysis? (7)
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Pulmonary Infarction
Foreign Bodies Infection (Pneumonia, TB, Lung Abscess) Bronchitis Bronchial Carcinoma Cystic Fibrosis Mucosal blood from coughing |
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What should you ask about the past history in a respiratory patient?
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Previous cardio/respiratory illness
Previous CXR/investigation results including peak flow for asthmatics Immunodeficiency conditions (AIDS) |
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What are some abnormal breathing patterns and their implications?
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Sleep apnoea (Cessation of airflow >10s >10 times a night, obstructive - obesity, URT narrowing due to inflammatory or endocrine changes i.e. hypothyroidism, acromegaly)
Cheyne Stokes (periods of apnoea alternating with periods of hyperpnoea, due to medullary delay in chemoceptor response, LVF, Brain damage, High altitudes) Kussmaul's (deep rapid respiration due to stimulation of respiratory center, metabolic acidosis - DM, CRF) Hyperventilation (results in tetany, alkalosis, Anxiety) Ataxic (irregular timing + depth, Brain stem damage) Apneustic (Post-inspiratory pause in breathing, brain pontine damage) Paradoxical respiration (abdominal wall sucks inwards, diaphragmatic paralysis) |
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What should the respiratory occupational history involve?
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Exposure to dust, allergens, toxic chemicals
Industrial (mining, metal work) Agricultural (animals, pesticides) Possible improvement of symptoms in the absence of work? Do they have family members that work in the above fields? |
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What should the social history of the respiratory system involve?
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SMOKING + passive smoking (Cancer, COPD, spontaenous pneumothorax, good pastures syndrome)
Due to chronic nature of some respiratory conditions, ask about housing arrangements/ADL's IV drug use (PE's, drug related pulmonary oedema, Infection/abscess) Alcohol binge (aspiration pneumonia) |
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What do you need to ask in a respiratory Family history?
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Asthma
Cystic Fibrosis Emphysema (alpha-1 antitrypsin deficiency) |
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How should you position the patient in the respiratory exam?
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Exposure from the waste up
Patient sitting down on the edge of the bed or chair (unless patient is acutely unwell to do so) |
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What should you look during general inspection in a respiratory examination? (8)
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Environment (O2 therapy, ECG)
Dyspnoea (RR 16-25, accesory muscle use) Cyanosis Character of cough Sputum (colour volume blood) Stridor (croaking rasping noise on inspiration due to URT obstruction) Hoarseness Obesity |
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What would you observe when someone is using accesory muscles to breath?
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Sternomastoid
Platsyma Strap muscles of the neck Elevation of the shoulders Tripod Position Contraction of abdominal muscles during expiration (if obstruction present) |
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How low must the O2 sats be before cyanosis can be observed?
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Less than 90%
5g/100mls of Deoxyhaemoglobin |
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What causes Flapping tremor (Asterixis)?
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Carbon dioxide retention as with COPD patients.
(note: late and unreliable sign) |
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What do you look for in the face when doing a respiratory examination?
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Horner's (contricted pupil, partial ptsosis, loss of sweating)
Scleroderma Nasal polyps/nasal bridge deviation, engorged turbinates Central cyanosis, tonsilar enlargement/URT obstruction Sinusitis Smoking facies (leathery skin, red, wrinkles) Plethora/cyanosis - SVC obstruction Obstructive sleep apnoea risks (bull neck, receding chin) |
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What does displacement of the trachea signify?
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Usually significiant displacement indicates disease of the upper lobes of the lung
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What is a tracheal tug?
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Its when the trachea moves inferiorly with inspiration. Its a sign of over expansion of the chest due to obstruction
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What do you look for when inspecting the chest?
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Anterior/posterior examination
Shape/symmetry - Barrel chest (AP diameter disproportionately larger than width) - thoracic ratio >0.9 is found in asthmatics, or emphysema - Barrel chest may be normal in the elderly - Pigeon chest (outward bowing of the sternum, manifestation of chronic respiratory illness as a child, also occurs in rickets) - Funnel Chest (depression of the sternum, may excacerbate lung disease) Scars (trauma, previous surgery/procedures) Radiotherapy (erythema, thickening, tatoo marks) Swelling (Air tracking from the lungs from pneumothorax) Prominant veins (SVC obstruction) Paradoxical abdominal movement (obstruction) |
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How do you palpate for chest expansion?
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Lower lobe expansion is assessed from the back. The remaining lobes are better guaged by inspecting the lower lobe expansion.
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What are the causes of the different percussion notes when percussing the chest?
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Dull - Consolidation
Stony dull - Fluid Resonant - Normal lung Hyperresonant- hollow structures |
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What are the signs you may find while ausculating a respiratory patient?
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Bronchial breath sounds (consolidation)
Reduced breath sounds (COPD, pneumothorax, pleural effusion, pneumonia, collapse) Wheezes (airway narrowing, generally louder on expiration so inspiratory wheeze = severe narrowing. Fixed sources produce monophonic wheeze) Crackles (early inspiratory = small airwar, LVF later in the resp cycle, late/pan inspiratory = alveoli, must differentiate between rales/crepitation) Pleural friction rub (Pulmonary infarction, pneumonia or just primary pleurisy) Vocal resonance (if percussion abnormal, clear speech heard when solid) |
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How do you palpate for chest expansion?
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Lower lobe expansion is assessed from the back. The remaining lobes are better guaged by inspecting the lower lobe expansion.
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What are the causes of the different percussion notes when percussing the chest?
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Dull - Consolidation
Stony dull - Fluid Resonant - Normal lung Hyperresonant- hollow structures |
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What are the signs you may find while ausculating a respiratory patient?
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Bronchial breath sounds (consolidation)
Reduced breath sounds (COPD, pneumothorax, pleural effusion, pneumonia, collapse) Wheezes (airway narrowing, generally louder on expiration so inspiratory wheeze = severe narrowing. Fixed sources produce monophonic wheeze) Crackles (early inspiratory = small airwar, LVF later in the resp cycle, late/pan inspiratory = alveoli, must differentiate between rales/crepitation) Pleural friction rub (Pulmonary infarction, pneumonia or just primary pleurisy) Vocal resonance (if percussion abnormal, clear speech heard when solid) |
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What are the signs of Pneumonia? (8)
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Reduced Expansion on effected side
Increased Vocal Fremitus Dull percussion note Inspiratory crackles (as pneumonia resolves) Increased vocal resonance Pleural Rub Bronchial Breath sounds |
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What are the types and causes of Pneumonia?
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Lobar (pneumococcal 90%, H influenzae, staphlococcal)
Broncho (H.Influ, S. pneumonia, adenovirus, measles, CMV) Atypical (Mycoplasma Pneumoniae, Chlamydia, legionella) |
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What are the signs of Lung collapse? (4)
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Trachea deviation towards effected lung
Reduced Expansion on effected side Dull to percuss Reduced breath sounds |
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What are the causes of lung collapse?
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Intraluminal (Mucus - asthma CF, foreign body, aspiration)
Mural (bronchial carcinoma) Extramural (peribronchial lymphadenopathy), aortic aneurym) |
