Clinical Skills 2 - Respiratory Examination Flashcards
Outline the relevant parts of the respiratory examination. (9)
General inspection
Set of basic observations
Hands Inspection
Face Inspection - eyes, nose, mouth
Chest Inspection
Palpation - Trachea, Lymph nodes, Chest
Lung Auscultation
Chest Percussion
Additional CHecks
Perform the respiratory general inspection on a patient. (6)
Environment
General health of the patient
Obvious pain
Effort of breathing/respiratory rate.
Use of accessory muscles (COPD)
Colour - cyanosis/pallor
Perform the respiratory hands inspection to a patient. (7)
Temperature (infection/perfusion)
Clubbing (pulmonary fibrosis/chronic disease)
Capillary refill (perfusion)
CO2 flap (CO2 retention)
Tremor ( oversuse of beta2 agonist)
Tar staining (smoking)
Radial pulses (both/compare) for rate and rhythm.
Perform the respiratory face inspection to a patient. (6)
Including general, eyes, nose and mouth.
Cyanosis/pallor (poor perfusion)
Eyes: pale conjunctiva (anaemia)
Jaundice
Nasal flaring
Tongue for central cyanosis
Pursed lip breathing (COPD)
Perform the respiratory chest inspection to a patient. (5)
Expose chest and assess respiratory rate.
Inspect anterior, lateral and posterior chest for:
- Chest wall deformities and scars (Pacemakers / previous surgery)
- Chest wall/ breathing symmetry.
- Bruising/trauma (chest wall injury)
Perform the respiratory chest palpation to a patient. (3)
Starts with lymph nodes, trachea then anterior, lateral and posterior of the chest.
Lymph nodes: Cervical, Supraclavicular, Axillary (not done in OSCE but mentioned it’s done in practice)
Trachea: Position = if deviated (haemothorax, pneumothorax, tumour), tracheal tug = COPD.
Chest: Apex beat (displaced due to collapse, pneumothorax, tumour), palpate for any tenderness, chest expansion, tactile fremitus (asks pt to repeat 99 over all lung areas), anterior/lateral and posterior.
Perform the respiratory lung auscultation to a patient. (4)
Identify normal/abnormal breath sounds and causes (vesicular, bronchial, crepitations, wheeze, pleural rub.)
Appropriate auscultation points will depend on size of the patient.
- Ask patient to breath through their mouth and listen through a full respiratory cycle.
Vocal resonance: as per vocal/tactile fremitus.
Anterior/lateral/posterior.
Perform the respiratory chest percussion to a patient. (7)
Identify areas of tympany/resonance and dullness:
- Tympany/resonance = normal
- Hyper-resonance = pneumothorax, hyperinflation (COPD)
- Dullness (Collapse)
- Stoney Dull (Fluid)
Compare side to side
Anterior, lateral & posterior.
Explain the steps of performing a chest percussion to a patient. (4)
Place your non-dominant hand on the patient’s chest wall.
Position your middle finger over the area you want to percuss, firmly pressed against the chest wall.
With your dominant hand’s middle finger, strike the middle phalanx of your non-dominant hand’s middle finger using a swinging movement of the wrist.
The striking finger should be removed quickly otherwise you may muffle the resulting percussion note.
Perform the respiratory additional checks to a patient. (7)
Sacral oedema (HF)
Inspect both legs:
- Calf pain (DVT)
- Leg swelling (DVT)
- Palpate calves for tenderness (DVT)
- Increased temperature of leg (DVT)
- Inflammation (DVT)
- Pitted oedema (HF)
Risk of DVT/PE.
What are the common s/s of acute bronchitis? (8)
Chest pain
Warm to touch
Breathlessness
Crackles evident
Productive cough
Green sputum evident
Dullness on percussion
Change in vocal/tactile fremitus
What are the common s/s of pneumonia? (7)
Chest pain
Rusty brown sputum
Breathlessness
Productive cough
Dullness on percussion
Change in vocal/tactile fremitus.
Hands hot to touch.
What are the common s/s of asthma? (5)
Chest pain
Use of accessory muscles
Non-productive cough
Expiratory wheeze
Breathlessness
What are the common s/s of COPD? (9)
Chest pain
Use of accessory muscles
Finger clubbing
CO2 flap
Nasal Flaring
Breathlessness
Productive cough
Change in vocal/tactile fremitus.
Pursed lips.
What are the common s/s of Pulmonary Embolism (PE)? (8)
Chest pain
Breathlessness
Unilateral calf swelling/heat
Calf tenderness
Productive cough
Haemoptysis
Dullness on percussion
Change in vocal/tactile fremitus.
