Objective Examination

Question 1

What are the physical components?

Answer 1

Look, listen and feel

Question 2

What other investigations do we do?

Answer 2

Pulmonary function tests, CXR, ABG, pulse oximetry, exercise test

Question 3

What do we look for in terms of general appearance?

Answer 3

• awake, asleep, drowsy
• mental state
• restless, distressed
• body size
• requiring assistance for tasks
• wounds/scars

Question 4

What do we look for in position and posture?

Answer 4

• in bed, in chair
• sitting, slumped, supine
• leaning forward
• bracing with arms

Question 5

What do we look for in terms of colour?

Answer 5

General - pink, flushed, yellow, cyanosis

Question 6

What do we look for with digital clubbing?

Answer 6

Loss of angle between nail and nail bed, associated with chronic respiratory conditions, possibly due to chronic hyperaemia or poor perfusion

Question 7

What do we look for in terms of chest shape, what are the different types?

Answer 7

• barrel chest = increased AP diameter due to increased resting lung vol - hyperinflation
• pectus carinatum = pigeon chest, hyperinflation, may be congenital or possibly asthma as child
• pectus excavatum = funnel chest, congenital
• kyphosis/ kyphoscoliosis = increased flexion of thoracic spine which is increased risk of infection and complications

Question 8

What do we look for in terms of accessory mm use?

Answer 8

SCM, scalenes, traps, pecs and abs overworking. Prominence in mms

Question 9

What is the normal rate of breaths?

Answer 9

12-16 breaths/mins

Question 10

What should you see and feel in lower chest on inspiration?

Answer 10

Lateral basal expansion

Question 11

What is the inspiration to expiration ratio?

Answer 11

1:2

Question 12

With the breathing pattern what do we need to note?

Answer 12

Symmetry, RR, breathing through nose, accessory mm use, breath holding, where movement is happening

Question 13

What is the benefits of pursed lip breathing?

Answer 13

Slows down expiration and creates small positive pressure in airways which prevent unstable airways from collapsing - increased airflow

Question 14

What is local rib age paradox?

Answer 14

Section of rib cage moves in inspiration, fracture of ribs at 2 points - flail segment

Question 15

What is abnormal paradox?

Answer 15

Abdomen moving in on inspiration, diaphragm fatigue

Question 16

What is rib indrawing?

Answer 16

Bottom ribs drawn I by diaphragm contraction, occurs in COPD - hyperinflation causes low flat diaphragm - cannot effectively contract and descend

Question 17

What is costal indrawing?

Answer 17

Intercostal spaces sucked in during inspiration due to forceful inspiration

Question 18

What is abdominal release?

Answer 18

At end of expiration patient contracts abdominal mms to push abdominal contents up to dome diaphragm, the release ab mms,diaphragm flattens and let’s air in

Question 19

What do we palpating an examination?

Answer 19

~ during quiet and deep breathing 
~ compare sides, symmetry 
~ chest expansion
~ tracheal position, normally midline 
~ see if breath holding 
~ feeling LBE