Problem Based Learning Session Mr Robinson is a 67 year old man. He visits the GP as he has had a cough and fever for 5 days. The GP takes a history from him and examines his chest. Over the left base of his chest, there is dullness on percussion and crepitations on auscultation. From this information, she comes to the conclusion that Mr Robinson is likely to be suffering a lower respiratory tract infection. She advises Mr Robinson to ensure that he takes antibiotics for the full course and to return if his symptoms do not improve as he may require a chest X-ray. Unfamiliar Word(s) Possible Definition
Mind Map Lower respiratory tract infection Learning Objectives: 1. 2. 3. 4. 5.
Respiratory Examination 1. Introduction - Consent 2. Inspection (LOOK) - Are they comfortable? - Are they distressed or breathless? - Respiratory rate 3. Palpation (FEEL) - Is it reduced? throughout or locally - Is it symmetrical? 4. Percussion (TAP) - Resonant - Hyper-resonant - Dull - Stony dull 5. Auscultation (LISTEN) - Normal (vesicular) breath sounds - Reduced breath sounds - Bronchial breathing - Crepitations or crackles - Wheeze
Respiratory Diseases Pleural Effusion There is a membrane called the pleura covering the chest wall and the lungs. Between these two membranes is fluid which acts as a lubricant during respiration. Normally only a small amount of fluid is present. However, the amount of fluid in this pleural space can increase in certain situations and this build-up of fluid is called a pleural effusion. This often occurs as a complication of certain conditions such as a chest infection, heart failure or cancer. The larger the amount of fluid is, the more the lung is compressed and subsequently the patient is more likely to develop breathlessness due to reduced capacity for expansion during inspiration. In some situations, this fluid will need to be drained by using a chest drain, where a needle is used to guide a drain into the pleural cavity. Pneumothorax Pneumothorax is when air becomes trapped between the lung and the chest wall. This is similar to a pleural effusion, but with the difference that it is air that is trapped rather than fluid. This air may arise from the lungs or from outside of the body. It most commonly occurs without any triggers in young healthy individuals. It has been hypothesised that this may be due to a tear in the lung in areas of weakness called bullae. People with existing lung diseases are also at risk as some areas of their lungs may be weakened due to their disease, such as in chronic obstructive pulmonary disease (COPD). Air may also enter from outside the body due to traumatic injury. If the amount of trapped air increases, the lung begins to collapse and the patient is likely to complain of chest pain and difficulty breathing. Asthma Asthma is a condition where the airways become obstructed in response to certain triggers, such as cold weather and exercise. When the body is exposed to a trigger, the airways become inflamed and the smooth muscles around the airways contract. As a result, the airways become narrow and the patient may experience breathlessness, chest tightness and wheeze. Patients can take inhalers which have anti-inflammatory actions in order to reverse this airway obstruction.
Respiratory Diseases Table Palpation Percussion Auscultation Normal Symmetrical Resonant Vesicular Pneumonia (infection) Asthma Pleural Effusion Pneumothorax