How to do the exam Flashcards
How do you start the exam?
WIPE!
Wash Hands
Introduce yourself
Patient ID and Age
Explain procedure, gain consent, chaperone, pain?
What do you look for at the end of the bed?
Surrounding area - drips, oxygen, O2 mask (venturi), medication - inhalers!, sputum pot (LOOK INSIDE)
Patient - body habitus, SoB, pursed lip breathing, comfort, colour, airway patency, cough, wheeze, cachexia, cushingoid appearance
What do you first when examining the peripheries?
Ask patient to stick arms out and look for fine tremor (i.e. due to nebulised Salbutamol). Then ask the patient to ‘cock wrists back’ and assess for flapping tremor.
What do you look for in the nails?
Clubbing, Koilonychia, Tar staining
What do you look for in hands?
Temperature & Capillary refill time
What else do you assess in peripheries?
Radial Pulse
Respiratory Rate - Offer and if you have to do it, do it over 1 minute
What do you look for in the face?
Conjunctival pallor - anaemia
Ptosis and Miosis - Horner’s due to pancoast tumour
Iritis, conjunctivitis - TB, Sarcoidosis
Cushingoid Appearance - Long-term steroid use
Mouth for central cyanosis
What do you look at in the neck?
JVP
How do you tell the JVP from the carotid?
JVP - POLICE
P - non-palpable O - occludable L - located between heads of SCM, lateral to ICA I - Drops with inspiration C - contour - biphasic waveform E - drops when sitting Erect
What do you look for in chest wall?
Look at the front, back and underarms. If it’s a woman wearing a bra, mention you would look under the bra strap.
Deformity & Symmetry Scars - Sternotomy, thoracotomy, pneumonectomy Respiratory pattern Intercostal drawing Use of accessory muscles
What do you palpate?
Trachea for Tracheal Deviation Tracheal tug Cricosternal distance - OFFER Expansion - 3 places with thumb floating Parasternal heave - cor pulmonale Apex beat
What do you do next?
Percussion - on the BACK, 3 places on each side, comment on note
What do you do next?
Auscultate - on the back, 6 places, ask the patient to take a deep breath in and out of mouth, comment on sounds.
Also, vocal resonance - ‘say 99 every time I place my stethoscope on your chest’. Increased - consolidation; Decreased - effusion, pneumothorax
What to do next?
Offer to do what I did on the back on the front of the chest wall (examiner will usually let you miss this)
Check for sacral and ankle oedema
CHECK FOR CERVICAL LYMPH NODES
How would you finish the exam?
Wash hands, thank patient, present findings
Measure oxygen saturations, peak flow, CXR
