Clinical 12: Respiratory examination and peak flow

Question 1

How should the patient be exposed for the respiratory examination?

Answer 1

Expose chest (bra on)
Ask to lie to 45 degrees

Question 2

What equipment is needed for a respiratory examination?

Answer 2

Stethoscope
Peak flow meter and mouthpiece
Thermometers
Pulse oximeter

Question 3

What further investigations should be offered at the end of the respiratory examination?

Answer 3

Sputum and spiromtert
Temperature
Oxygen saturations
Peak flow
Arterial blood gas
Chest X-ray

Question 4

What is part of the general inspection of the respiratory examination?

Answer 4

Observe patient from end of bed - resp rate, use of accessory muscles, pursed lips (severe COPD), cough, malnoursihed
Patient surroundings - sputum pot, oxygen, inhlaers or acapella device

Question 5

What do you look for in the hands during a respiratory examination?

Answer 5

Nails for clubbing
Peripheral cyanosis
Tar stains
Wasting of small muscles (lung cancer)

Question 6

What do you do int eh wrist and arms of the respiratory exam?

Answer 6

Radial pulse - rate and rhythm
CO2 retention flap

Question 7

What do you do in the face of the respiratory exam?

Answer 7

Look for conjunctival pallor (anaemia)
Horner syndrome (apical lung cancer)
Facial plethora (swelling) - smoker, SVC obstruction
Mouth - look under tongue for central cyanosis

Question 8

What do you do in the neck during the respiratory exam?

Answer 8

Look for JVP - raised in cor pulmonale
Tracheal displacement
Lymphadenopathy -

Question 9

What do you look for on the chest during the respiratory exam?

Answer 9

Pectus carinatum
Pectus Excavatum
Barrel chest
Scars - thoractomy, pneumonectomy, previous chest darin
Radiotherapy - tatoos or skin changes

Question 10

What are you palpating for on the anterior chest during the respiratory exam?

Answer 10

Apex beat - position and character
Expansion of chest - range and symmetry

Question 11

What areas should you percuss on the chest?

Answer 11

Compare at least three zones anteriorly and posteriorly
Also take supraclavicualr areas, axillae and costophrenic angles

Question 12

What are you listening for when ausculatating the chest?

Answer 12

Normal vesciular breath sounds
Any added sounds
Vocal resonance (say 99)
Include supraclavicular, axillae and costrophrenic angles.

Question 13

What do you do on the back of the chest during the respiratory exam?

Answer 13

Inspect - scars, shape, skin changes
Palpate - chest expansion, sacral oedema
Percuss - three zones
Ausculate - three zones - normal, added, vocal resonance (99)

Question 14

What do you do to the legs in the respiratory exam?

Answer 14

Feel for temperatures differences and squeeze calves for tenderness
Pitting oedema - start ankle if present work up

Question 15

What are the clinical signs of a normal lung on examination?

Answer 15

Equal expansion
Normal percussion
Vesicular breath sounds
Muffled vocal fremitus

Question 16

How does consodilation of the lung present on respiratory examination?

Answer 16

Reduced expansion on affected side
Dull on percussion
Bronchial breath sounds
Increased vocal fremitus.

Question 17

How does pleural effusion present during the respiratory exam?

Answer 17

Expansion is reduced on affected side
Stony dull on percussion
Reduced or absent breath sounds
Reduced or absent vocal fremitus

Question 18

How does a pneumothorax present on clinical examination?

Answer 18

Reduced on affected side
Hyper-resonant on percussion
Absent or reduced breath sounds
Reduced or absent vocal fremitus

Question 19

How does a collapse lung present on clinical respiratory examination?

Answer 19

Lung expansion is reduced on affected side
Is dull on percussion
Breath sounds are reduced
Vocal fremitus is reduced.