Objective Examination Flashcards
What are the physical components?
Look, listen and feel
What other investigations do we do?
Pulmonary function tests, CXR, ABG, pulse oximetry, exercise test
What do we look for in terms of general appearance?
- awake, asleep, drowsy
- mental state
- restless, distressed
- body size
- requiring assistance for tasks
- wounds/scars
What do we look for in position and posture?
- in bed, in chair
- sitting, slumped, supine
- leaning forward
- bracing with arms
What do we look for in terms of colour?
General - pink, flushed, yellow, cyanosis
What do we look for with digital clubbing?
Loss of angle between nail and nail bed, associated with chronic respiratory conditions, possibly due to chronic hyperaemia or poor perfusion
What do we look for in terms of chest shape, what are the different types?
- 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
What do we look for in terms of accessory mm use?
SCM, scalenes, traps, pecs and abs overworking. Prominence in mms
What is the normal rate of breaths?
12-16 breaths/mins
What should you see and feel in lower chest on inspiration?
Lateral basal expansion
What is the inspiration to expiration ratio?
1:2
With the breathing pattern what do we need to note?
Symmetry, RR, breathing through nose, accessory mm use, breath holding, where movement is happening
What is the benefits of pursed lip breathing?
Slows down expiration and creates small positive pressure in airways which prevent unstable airways from collapsing - increased airflow
What is local rib age paradox?
Section of rib cage moves in inspiration, fracture of ribs at 2 points - flail segment
What is abnormal paradox?
Abdomen moving in on inspiration, diaphragm fatigue
What is rib indrawing?
Bottom ribs drawn I by diaphragm contraction, occurs in COPD - hyperinflation causes low flat diaphragm - cannot effectively contract and descend
What is costal indrawing?
Intercostal spaces sucked in during inspiration due to forceful inspiration
What is abdominal release?
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
What do we palpating an examination?
~ during quiet and deep breathing ~ compare sides, symmetry ~ chest expansion ~ tracheal position, normally midline ~ see if breath holding ~ feeling LBE
