Examination of the Respiratory

Question 1

What are the basics for a respiratory examination?

Answer 1

• Introduction and explanation, - Inspection, - Palpation - Percussion - Auscultation.

Question 2

What is Stridor?

Answer 2

• Loud, harsh, high pitched respiratory sound which usually occurs on inspiration. Usually occurs because of airway obstruction.

Question 3

What is erythema nodosum?

Answer 3

Swollen fat under the skin causing red bumps and patches

Question 4

What are the respiratory causes of clubbing?

Answer 4

• Bronchial Carcinoma, - Mesothelioma, - Chronic suppurative lung disease (Bronchiectasis, lung abscess and empyema), - Pulmonary fibrosis, - Cystic fibrosis.

Question 5

What is a ruddy complexion cause by?

Answer 5

Polycythaemia

Question 6

What is Horner’s syndrome?

Answer 6

Damage to sympathetic nerves caused by a Pancoast tumour. Clinical features are unilateral miosis, partial ptosis and facial anhydrosis.

Question 7

What are the different hand tremors

Answer 7

Fine tremor - excessive use of B-agonists. Flapping tremor - caused by severe ventilatory failure with CO2 retention. When wrists cocked-back look for a flapping tremor.

Question 8

What is pectus excavatum?

Answer 8

Where the breast bone is sunken into chest

Question 9

What is kyphoscoliosis

Answer 9

Abnormal bending of spine.

Question 10

How do you examine for subcutaneous emphysema?

Answer 10

It will feel like a crackling sensation due to air in subcutaneous tissue.

Question 11

What is a pneumothorax?

Answer 11

Collection of air in the pleural cavity between the lungs and chest wall resulting in a collapsed lung on affected side.

Question 12

How do you examine tracheal position?

Answer 12

Right middle finger 2cm superior to the suprasternal notch. Gently press down and palpate space to either side. It should be central.

Question 13

What are some of the causes of a deviation of trachea

Answer 13

Displacement towards the lesion - Lobar collapse, pneumonectomy and pulmonary fibrosis. Displacement away from the lesion - Large pleural effusion and tension pneumothorax.

Question 14

How do you check for chest expansion?

Answer 14

With patient sitting anteriorly and posteriorly, hands on either side of chest. Ask patient to breath deeply, thumbs should move apart equally.

Question 15

Where are the percussion sites

Answer 15

Question 16

What are the causes of hyper resonant and dull/ very dull percussion?

Answer 16

Hyper resonant - Emphysema, large bullae or pneumothorax. Dull - Collapse, consolidation or fibrosis. Very dull - Pleural effusion or haemothorax.

Question 17

How did you feel for tactile vocal fremitus

Answer 17

• Use the ulnar border of hand in the intercostal space. Ask patient to say ‘99’ and feel for vibration.

Question 18

What does increased and decreased fremitus mean?

Answer 18

Increased - consolidation or fibrosis. Decreased - pleural effusion, pneumothorax or collapse

Question 19

Describe normal/vesicular breath sounds?

Answer 19

Longer inspiration, soft expiratory sound, low pitch and over most lungs.

Question 20

What can cause diminished vesicular breath sounds?

Answer 20

Obesity, pleural effusion, pneumothorax, collapse or hyperinflation

Question 21

What are bronchial (abnormal) breath sounds?

Answer 21

Expiratory sounds last longer, high pitch, loud and the similar sound over trachea as in large airway.

Question 22

Describe crackles and what they are caused by

Answer 22

• High-pitches, discontinuous sounds. It is caused by pulmonary oedema, pulmonary fibrosis, bronchial secretions, COPD, pneumonia, lung abscess and TB

Question 23

Describe pleural rub and what it is caused by?

Answer 23

Sounds like a creaking, low pitched noise which may be associated with pleuritic pain. It is caused pulmonary embolism, pneumonia or vasculitis.

Question 24

Describe wheeze and what it is caused by

Answer 24

Continuous oscillation of opposing airway walls. It is louder in expiration and caused by asthma and COPD, localised wheeze is caused by lung tumour.

Question 25

Describe what vocal resonance is

Answer 25

• If there is any dullness on percussion then use the stethoscope over the area and ask the patient to whisper ‘one, one one’.

Question 26

What are the other areas to examine?

Answer 26

Ankle oedema, sputum pot, observation chart, peak flow and spirometry.