Examination: Respiratory

Question 1

(R) Step 1:

Answer 1

Prepare the Patient:

Question 2

(R) Step 2:

Answer 2

Hand Hygiene

Question 3

(R) Step 3:

Answer 3

General Inspection:

- mental state, alertness, respiratory effort, coughing, wheezing, stridor, oxygen, sputum in a cup etc.

Question 4

(R) Step 4:

Answer 4

Inspection of the hands:

- clubbing (spongey nail bed, diamond in fingers caused by chronic CO2 buildup or malignancy)

Question 5

(R) Step 5:

Answer 5

Measurement of the pulse and Respiratory Rate

Question 6

(R) Step 6:

Answer 6

Examination of the Head and Neck:

• conjunctivae
• lips and tongue (Put your tongue back in now, thank you)
• position of trachea (deviated?)

Question 7

(R) Step 7:

Answer 7

Inspection of Ant. and Lat. Chest walls:

• shape of chest
• scars
• pattern of respiration
• use of accessory muscles?

Question 8

(R) Step 8:

Answer 8

Measurement of Chest Expansion:

• Lower rib cage (5cm)
• upper anterior chest wall (2cm)

Question 9

(R) Step 9:

Answer 9

Percussion of Ant. Lat. Chest wall:

• compare R and L
• Clavicle
• Mid-Clav Line every 2 intercostal spaces
• 2 positions on mid-axillary line

Question 10

(R) Step 10:

Answer 10

Auscultation of Ant. Lat. chest wall:

• open mouth by patient
• listen for normal vesicular breath sounds
• same positions as percussion and above scapula for lung apex
• Then say 99 or every position as well

Question 11

(R) Step 11:

Answer 11

Examination of the posterior chest:

• Look
• Expansion
• Percuss (two positions in the upper zone b/t scapula and spine and then two positions between lateral chest wall and spine in the lower zone)
• Auscultate
• 99

Question 12

(R) Step 12:

Answer 12

Measurement of Peak flow:

• indicator faces upwards
• set to zero to begin with
• deepest breath possible
• place lips tightly around mouthpeice
• blow as hard & fast as you can
• best out of three

Question 13

(R) Step 13:

Answer 13

Conclude Examination

Question 14

Where is the trachea located?

Answer 14

• lies behind the manubrium and bifurcates at the level of the manubriosternal junction.

Question 15

Where are the apex of the lungs located?

Answer 15

• 2.5 cm above the medial 3rd of the clavicles

Question 16

Where are the oblique fissure and horizontal fissure of the lungs situated?

Answer 16

Oblique: join the spinous process of T2 to the 6th costal cartilage Anteriorly. –> coincides with the medial border of the scapula when hands are behind the head

Horizontal: extends from the 4th costal cartilage back to intersect with the oblique fissure (on the right lung)