Objective assessment

Question 1

General Examination

Answer 1

how does patient look 
level of distress (resp/gen)
level of consciousness 
any supporting adjuncts  (Oxygen/ventilation/lines/drains/leads)
colour (Jaundice/Pallor/ Cyanosis)
level of mobility (speech/activity)

Question 2

General condition

Answer 2

Body temp (norm-36.5-37.5)
Fever >37.5)
Heart rate/pulse rate 
Bp
RR
how the patient looks

Question 3

What to look for in the patient (appearance)

Answer 3

clubbing
jugular venous pressure (JVP) - norm range 3-4cm above sternum
peripheral oedema

Question 4

Observation of the chest look for…

Answer 4

oblique fissure T2 post 6th costochondral junction ant

horizontal fissure (right) 4th IC space to mid axillary line

Diaphragm 6th rib ant, 8th rib midaxillary line, 10th rib post

trachea bifurcates just below manubriosternal junction

apices of both upper lobes extend 2.5cm above clavicle

Question 5

What to look for in chest shape

Answer 5

Kyphosis 
Kyphoscolosis 
Pectus excavatum 
Pectus Carinatum 
Hyperinflation

Question 6

What to talk about for breathing pattern

Answer 6

Normal I;E ration 1:1,5-1.2 
Prolonged expiration 1:3-1:4
pursed lip breathing 
Apnoea - no breath for >10 secs 
Cheyne-Stokes respiration - cycles of breathing moving from shallow to deep breaths

Question 7

Chest movement

Answer 7

use of accessory muscles - inspirations and expiration

Bucket and pump handle

Question 8

Palpation of chest check if? (5)

Answer 8

Trachea - is it central?
Chest expansion - is it equal?
Paradoxical breathing (flail segment) 
Surgical emphysema 
Vocal fremitus

Question 9

Vocal Fremitus what does it show

Answer 9

increase vibration - consolidation

reduce vibration - pneumothorax, pleaural effusion

Question 10

Percussion

Answer 10

Dull - consolidation

Resonant - pneumothorax, bullae

Question 11

Observation can also include (2)

Answer 11

Auscultation

exercise capacity - 6 min walk test, shuttle walking test