Respiratory health assessment
40 important questions on Respiratory health assessment
What is the intensity and pitch of resonance?
- Intensity: Loud
- Pitch: Low
What is an example of origin for hyper-resonance?
- Example: Lung with emphysema
What does the second illustration (B) depict?
- Anterior chest percussion areas
- Important in respiratory exams
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What do breath sounds normally reveal?
- Presence of consolidation or fibrosis
- Bronchial breath sounds
- Pleural air or fluid (absent breath sounds)
Describe the quality and length of tympany.
- Quality: Drum like
- Length: Moderate
What is highlighted in the third illustration (C)?
- Posterior chest percussion sites
- Key for respiratory assessment
How are broncho-vesicular breath sounds different from vesicular and bronchial sounds?
- Inspiratory time (I) = Expiratory time (E)
- Upper 3rd of chest normal
- All lung fields normal
How is spoken sound detected over a healthy lung compared to a consolidated lung?
- Muffled and deadened over healthy lung
- Heard loudly and clearly over consolidation or fibrotic scarring
What intensity and pitch are associated with dullness?
- Intensity: Medium
- Pitch: Medium
What are coarse crackles (rales) and when do they occur?
- Described as "bubbling" sounds
- Occur during inspiration and expiration
What happens to vocal resonance over pneumothorax and pleural effusion?
- Absent or greatly diminished
What is the example of origin given for flatness?
- Example: Muscle, Bone, Thigh
What conditions are associated with coarse crackles?
- Chronic Bronchitis
- Bronchiectasis
- Pneumonia
- Severe Pulmonary Edema
What is 'whispering pectoriloquy' used for?
- Confirm changes in sound conduction
What causes the sound of rhonchi during auscultation?
- Caused by thick secretions
- Located in large airways or bronchi
- Sound clears with coughing
How do coarse crackles differ from fine crackles?
- Coarse crackles are longer in duration
- Fine crackles lack duration specified
How is whispering speech affected over normal lungs versus consolidated lungs?
- Muffled to silence by normal lung
- Heard over consolidated or scarred lung
What sound is associated with a pneumothorax during a respiratory exam?
- Percussion: Hyperresonant sound
- Indicates: Presence of air in pleural space
What are the history features of acute bronchitis in respiratory disease?
- Wheeze
- Cough
- Sputum
What sound is heard in consolidated lung, organ, or pleural effusion?
- Percussion: Dull sound
- Indicates: Fluid or solid mass in lung area
What investigations are appropriate for respiratory infections?
- Chest X-ray
- O₂ saturation or ABG
- Sputum and blood culture
- Respiratory function
- WCC, CRP
What history feature suggests exacerbation of chronic obstructive pulmonary disease?
- Acute-on-chronic dyspnoea
What is the diagnostic value of a chest X-ray for infections?
- Consolidation in pneumonia
- Assessment of respiratory failure
- Causal infection
What are the examination features of pneumonia if lobar?
- Dull to percussion
- Bronchial breathing
What are initial investigations for malignancy in the respiratory system?
- Chest X-ray
- CT scan thorax + abdomen
- Bronchoscopy if central
- CT-guided biopsy if peripheral
- Respiratory function
What are the history features of malignancy in respiratory disease?
- Insidious onset
- Weight loss
- Persisting pain or cough
How can malignancy be diagnosed from a chest X-ray and CT scan?
- Identification of masses
- Staging of extent
- Diagnostic pathology
- Biopsy if abnormal
What examination features suggest malignancy in respiratory disease?
- Cervical lymphadenopathy
- Clubbing
- Signs of lobar/lung collapse
- Effusion
What investigations are recommended for pulmonary fibrosis/interstitial lung disease?
- Chest X-ray
- High-resolution CT thorax
- Respiratory function
- Autoantibodies
What are examination features of pulmonary fibrosis?
- Tachypnoea
- Inspiratory fine crackles at bases
- Cyanosis
What diagnostic value does respiratory function testing have for pulmonary fibrosis?
- Extent and type of disease
- Quantification; restrictive pattern
- Identification of associated disease
What is a history feature of pleural effusion?
- Progressive dyspnoea
What are the initial investigations for pleural effusion?
- Chest X-ray
- Ultrasound-guided aspiration
What are the examination features of pleural effusion?
- Unilateral basal dullness
- Reduced breath sounds
What diagnostic values are found using ultrasound-guided aspiration for pleural effusion?
- Dense basal fluid pool
- Culture for infection
- pH level for empyema
- Glucose for infection
What are history features of a large pulmonary embolism?
- Sudden, severe dyspnoea
- Episodes of pleural pain
- Haemoptysis
What tests are performed to diagnose pulmonary embolism?
- d-Dimer
- CT pulmonary angiogram
- Echocardiogram
- O₂ saturation or ABG
What are the examination features of asthma?
- Polyphonic expiratory wheeze
- Eczema
How is normality determined in a d-Dimer test for pulmonary embolism?
- Normal if not pulmonary embolism
What investigations are done for asthma diagnosis?
- Respiratory function
- Peak flow diary
- FEV₁ /reversibility
- O₂ saturation or ABG
- IgE, allergen skin tests
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