Lung Flashcards
Lung exam pneumonics
WIPER
PIPPA
Finish
Lung WIPER
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Hello I’m gwen Morgan I’m a second year medical student at imperial college London, before we get started could I please confirm your name and dob
So the doctors asked me today to do a lung examination on you, this involves you being exposed from the waist up and me having a look, listen and feel to your chest and neck area, as well as me examining your breathing. Does this sound okay to you?
Can I ask if your in any pain at all
So the examiner will act as your chaperone, if i could ask you to please remove your shirt will u need any help with that.
I can see the bed is at 45° if I could ask you to just lie back for me.
PIPPA locations
Inspect
Palpate
- Resp rate
- trachea
- ant and post chest expansion
- ant and post tactile vocal fremitus
- cervical lymph nodes
Percuss
- ant and posterior
Auscultate
- ant and posterior
For posterior
Ask patient to lean forwards
For lymph nodes
Ask patient to sit with legs dangling off the bed
Resp rate
White collar effect!
I’m going to take your pulse rate (radial) but look at anterior chest expansion
Measure for 30s x2
Normal 12-20breaths per minute
Bradypnoea <12
Tachypnoea >20
Tracheal palpation
I’m going to palpate your windpipe, this might be slightly uncomfortable. Ask to lean back and relax neck
Middle finger on suprasternal notch, move up toward trachea
Then move right left at few sections
Anatomical landmarks of trachea
Extends from larynx into thorax
Divides to left and right main bronchi at sternal angle - t4
Tracheal displacement towards side of lung lesion
Upper lobe collapse, fibrosis
Pneumonectomy
Tracheal displacement away from side of lung lesion
Extensive pleural effusion
Tension pneumothorax
Chest expansion
Chest expansion anterior
Ask patient to breathe all the way out
Wrap hands around chest wall (below 5th and 6th ribs) thumbs meeting at midline
Ask to take deep breathe in and out
Upper and middle lobes
Should be 5cm
Chest expansion posterior
Ask to breathe all the way out
Wrap hands around anterior chest wall below t10
Gives info ab lower lobes
Reduced chest expansion on one side
LESION ON THAT SIDE
pneumothorax
Pleural effusion
Collapsed lung
Consolidation
Reduced expansion on both sides
Asthma
COPD
General inspection
Asthma inhalers,
Cigarettes vapes
Cyanosis
Tarred fingertips
Clubbed nails
Tachypnoea
Coughing
Accessory muscles
Nasal flaring
Sweating
Tripod position
Percussion sounds
Air filled spaces hollow - drum sound
Solid/ fluid filled spaces - dull sound
Hyperresonant percussion
Too much air
Pneumothorax
COPD
Hyporessonant percussion
Too much fluid or solid
Pleural effusion
Anterior chest percussion
Compare each side as you go
apex - above clavicle
Infraclavicular
upper lobes - 2nd ICS
lower lobes - 6th ICS
Axilla (RML, LLL) Ask patient to put arm above head
Posterior chest percussion
Ask to give themselves a hug
Apex - above clavicle upper
Upper lobes - t4
Lower lobes - t7
Axilla - RML, LLL ask pt to put arm above head
Auscultation
I’m going to listen to your breathing now so if you could take a deep breathe in and out every time I place this on your chest
Bell for apex
Then 2nd ICS, 6th ICS, Axilla
Auscultating women
Not over breast tissue
Only place for middle lobes is under Axilla
Wheeze sign of
Asthma COPD
Stridor sound of
Airway obstruction
Tactile vocal fremitus
Chest wall vibrations during vocal sound
Both hands on chest either side
Can you repeat 99 for me every time my hands touch your chest
Decrease in tactile vocal fremitus
Pneumothorax
COPD
Increase in tactile vocal fremitus
Consolidation or tumour tissue (Inc density)
Cervical lymph nodes
Sit with legs dangling off , examine from behind
Both hands both sides simultaneously
Sub mental - under chin
Submandibular
Preauricular - ant ears
Postauricular - post ears
Occipital (base)
Superior deep cervical (SCM)
Inferior deep cervical (SCM)
Supraclavicular
Enlarged swollen nodes called
Cervical lymphadenopathy
Resp causes of cervical lymphadenopathy
Lung cancer metastasis
Resp tract infection
TB
End of exam
This concludes the examination, thank you very much, would u like any help getting redressed?
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