Clinical Skills

Question 1

Basic structure of a Resp Exam is…

Answer 1

1) Wash hands
2) Intro
3) Explain examination and gain consent
4) ‘End of bed’ examination
5) Hands
6) Arms, pulse and Resp Rate
7) Face
8) Lymph nodes
9) Chest examination
10) Percuss
11) Ausclutate
12) DVT
13) Conclude findings

Question 2

Give an example of a non-variable oxygen mask,

Answer 2

A Venturi mask - a venturi filter is added to the simple mask and delivers a specified value of inspired oxygen to the patient. Values = 24, 28, 40 & 60.

Question 3

What is the FiO2 of the Simple mask?

Answer 3

Variable. Approx - 40-60%

Question 4

What is the Flow rate required for a Nasal Cannulae?

Answer 4

2-5L/min

Question 5

What signs are you looking for when examining the hands?

Answer 5

Hold hands out,
Examine fingers for peripheral cyanosis, tar staining and curvature of nails
Turn hands over and check for Palmar Erythema
Hold arms out in front of body with palms facing down to check for tremours (indicates B2 agonist inhaler)
Cock hands upwards and ask to stay in position for 10s - check for flapping of hands = CO2 retention

Question 6

What vital sign should you check whilst taking pulse?

Answer 6

Respiratory rate = normal range is 12-20 (20 being slightly high)

Question 7

What is Peripheral Cyanosis?

It’s caused by?

Answer 7

It is cyanosis which can be seen in the fingers and toes. Usually presents itself as blue colouring of finger tips and toes.

Caused by low levels of Oxygen saturation in the blood. Termed Hyopaxemia

Question 8

What is Palmar Erythemia?

Answer 8

Redness on either side of the palms. On the thenar and hypothenar eminences.

Question 9

Name all the lymph nodes you check in a general examination?

Answer 9

Submental
Sub-mandibular 
Anterior Triangle 
Posterior Triangle
Pre-auricular 
Post Auricular 
Occiptal 
Supraclavicular

Question 10

How many times should you auscultate the back?

Answer 10

5 times on each side

Question 11

How should you finish the consultation?

Answer 11

Recap your findings for the patient and say you’ve not found anything of concern. You are just going to relay this information to the consultant and will be back later.

Question 12

What signs are you looking for in the face?

Answer 12

Eyes - Gently pull down the base of the eye to look for pallor or jaundice. Pallor may suggest anaemia.
Mouth - as patient to open mouth and inspect for any blue colouring, check under the tongue as well. A blue appearance would indicate central cyanosis.

Question 13

How do you check for DVT?

Answer 13

Expose patients legs. Look for any asymmetry and any redness. Wrap both hands around the leg and feel for a warm temperature. Ask if they have noticed any numbness in their legs.