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Imperial College London Surgical Society Junior Anatomy Series CPA SUMMARY GUIDE Respiratory Examination Jessica Lancaster Defne Artun (CPA Lead) Anya Nanchahal (Phase 1a Lead) Andrea Perez Navarro (Phase 1b Lead) Imperial College London Surgical Society Junior Anatomy Series Respiratory Pathology - Palpation Causes of Trachealdeviation away from the side of the lesion: • Extensive pleural effusion • Tension pneumothorax • Chest expansion Causes of Trachealdeviation towards the side of the lesion: • Upper lobe collapse • Upper lobe fibrosis • Pneumonectomy Causes of unilateral decrease in chest expansion: • Pneumothorax • Pleural effusion • Collapsed lung • Consolidation Causes of symmetrical decrease in chest expansion: • Asthma • COPD • Fibrosis • Rib Fracture Defne Artun (CPA Lead) Jessica Lancaster Imperial College London Surgical Society Junior Anatomy Series Respiratory Pathology - Percussion Causes of hyper-resonantpercussion: • Pneumothorax • Hollow bowels • COPD • Acute Asthma Causes of dull percussion: • Bone • Tumour • Consolidation • Collapse • Normal liver Causes of stoney dull percussion: • Pleural effusion • Haemothorax Defne Artun (CPA Lead) Jessica Lancaster Imperial College London Surgical Society Junior Anatomy Series Respiratory Pathology – Auscultation When are bronchial breath sounds heard over lung parenchyma: • Consolidation • Pleural effusion • Pulmonary fibrosis • Collapsed lung Wheeze- High pitched sound due to airway narrowing, loudest on expiration. Polyphonic • Asthma • COPD • Heart failure • Bronchiectasis Monophonic • Carcinoma • Foreign body Stridor- High pitched sound due to upper airway obstruction. Crackles- High pitched, discontinuous popping sounds from air being forced through a collapsed or fluid, pus or mucus filled airway. Fine crackles- Velcro like sound during late inspiration originating from small airways. Caused by fluid or fibrosis. Coarse crackles- Heard in early inspiration originating from large airways Have a listen!: http://www.3m.com/healthcare/littmann/lung.html Defne Artun (CPA Lead) Jessica Lancaster Imperial College London Surgical Society Junior Anatomy Series Respiratory Pathology Causes of increased tactile vocal fremitus: • Consoldiation pneumonia • Tumour • Lobe collapse Causes of decreased tactile vocal fremitus: • COPD • Pleural effusion • Pneumothorax Causes of Lymphadenopathy: • Infection • Inflammation • Malignancy • Medication • Benign idiopathic Jessica Lancaster Defne Artun (CPA Lead) Imperial College London Surgical Society Junior Anatomy Series Presentations of Respiratory Conditions COPD: • Bilaterally decreased chest expansion • Hyper-resonant percussion • Polyphonic wheeze • Prolonged expiratory phase • Decreased tactile vocal fremitus • Hyperinflated chest Pneumothorax: • Decreased chest expansion ipsilaterally • Tracheal deviation away from lesion if tension pneumothorax • Hyper-resonant percussion over pneumothorax • Decreased intensity of breath sounds on affected side • Decreased tactile vocal fremitus on affected side Lobar Collapse: • Tracheal deviation towards lesion • Decreased chest expansion ipsilaterally • Dullness percussion • Reduced breath sounds over affected area • Increased tactile vocal fremitus Jessica Lancaster Defne Artun (CPA Lead) Imperial College London Surgical Society Junior Anatomy Series Consolidation: • Decreased chest expansion ipsilaterally • Dullness to percussion • Bronchial breath sounds over consolidation • Increased tactile vocal fremitus Pleural Effusion: • Decreased chest expansion ipsilaterally • Tracheal deviation away from lesion if extensive effusion • Stoney dull percussion • Reduced intensity breath sounds • Bronchial breath sounds • Reduced tactile vocal fremitus Fibrosis: • Bilateral decrease in chest expansion • Fine end inspiratory crackles Acute Asthma: • Bilateral decrease in chest expansion • Hyper-resonant percussion • Expiratory wheeze • Prolonged expiratory phase Jessica Lancaster Defne Artun (CPA Lead) Imperial College London Surgical Society Junior Anatomy Series X-Rays a Systematic Approach Airway: • Is the trachea central? • Carina • Trace the bronchi and hilar structures Breathing: • Lung borders • Pleural borders - vasculature is not seen peripheral to this Cardiac: • The heart should be no more than half the width of chest cavity • Right border: right atrium • Left border: left Atrium and left ventricle Diaphragm: • Shape • Assess costophrenic and cardiophrenic angles, note any blunting Everything else: mediastinal contours, bones, soft tissues and devices. Jessica Lancaster Defne Artun (CPA Lead) Imperial College London Surgical Society Junior Anatomy Series https://twitter.com/radiologistpage/status/1184855705884516352 Defne Artun (CPA Lead) Jessica Lancaster Imperial College London Surgical Society Junior Anatomy Series WE HOPE YOU ARE ENJOYING OUR SERIES! Feedback Please fill out the following feedback form. Let us know if there is anything we can improve on: ✓ Are we missing anything? ✓ Want to see more of something? ✓ What are we doing well? ✓ Finding anything confusing? Jessica Lancaster jl2719@ic.ac.uk Defne Artun (CPA Lead) da1019@ic.ac.uk Anya Nanchahal(Phase 1a Lead) sn1119@ic.ac.uk Andrea Perez Navarro (Phase 1b Lead) ap6418@ic.ac.uk
