Practical 2 - Respiratory

Question 1

A physical examination of the respiratory system typically involves the following procedures?

Answer 1

➢ General observations
➢ Palpation
➢ Percussion
➢ Auscultation

Question 2

Observations - What would you be looking for?

Answer 2

➢Thorax shape (barrel chest)
➢Symmetry (pneumothorax)
➢Pallor
➢Cyanosis

Question 3

Observations - What are you looking for with breathing?

Answer 3

➢Rate
➢Rhythm
➢Depth
➢Effort
➢Accessory muscles
➢Common pathological signs

Question 4

What is the normal respiratory rate?

Answer 4

A patient’s respiratory rate is a useful indicator for potential pathophysiology of the lungs.
What is a normal respiratory rate?
Normal respiratory rate = 12 – 20 breaths per minute.

Question 5

What is Bradypnoea?

Answer 5

= < 12 breaths per minute.
➢ Alcohol/Opioid overdose

Question 6

What is Tachypnoea?

Answer 6

= > 20 breaths per minute.
➢ Acute Asthma/Fever

Question 7

What is Palpation – Chest Expansion?

Answer 7

➢ Diaphragmatic expansion should be
3-5cm symmetrically
➢ A reduction may suggests pleural
effusion or diaphragmatic paralysis

Procedure
1. Introduce yourself.
2. Explain what you will be doing (gain verbal consent).
3. Position your hands on the posterior aspect (~7th rib)
4. Ask your partner to take a breath in and out.
5. Observe and record findings.

Question 8

What is Palpation – Tactile Fremitus?

Answer 8

Patient to repeat the phase “99” during
palpation.

Procedure
1. Introduce yourself.
2. Explain what you will be doing (gain verbal consent).
3. Position your hands on the superiorly
4. Ask you partner to cross their arms.
5. Ask your partner to repeat “99” every time you move
your hands inferiorly.
6. Observe and record findings.

Question 9

What is Increased fremitus?

Answer 9

➢ Consolidation (fluid), masses

Question 10

What is Decreased fremitus?

Answer 10

➢ Excess air (obstruction)

Question 11

What is the history of auscultation?

Answer 11

Auscultation can be dated back to ~400 BC (Hippocrates).
The first stethoscope was invited in 1816 by Rene-Theophile-Hyacinthe
Laennec and was made of wood.

Question 12

What is Respiratory Auscultation?

Answer 12

Vesicular breath sounds occur when the vocal cords vibrate during inspiration and expiration and transmit these sounds to through the trachea and bronchi.
These sounds are audible when auscultation is performed using a stethoscope.
Chest auscultation involves listening to these internal
sounds to assess airflow through the trachea and the
bronchial tree.

Question 13

What are your Preliminary actions?

Answer 13

1. Introduce yourself to the patient including
   your name and role.
2. Confirm the patient’s name and how they would
   like to be addressed.
3. Briefly explain what the examination will involve
   using patient-friendly language.
4. Gain consent to proceed with the examination.

Question 14

What is patient positioning?

Answer 14

6. Ask the patient to sit upright on the examination bed.
7. Ask the patient to remove their t-shirt (or raise) to
   adequately expose the patient’s back for the examination. If applicable, inform the patient there is no need to remove their bra.
8. Ask the patient if they are comfortable and warm enough (offer a blanket/gown if required) before proceeding with the clinical examination.
9. Ask the patient to cross their arms (moving the scapulae)

Question 15

Auscultation Regions - Where do we auscultate?

Answer 15

Respiratory auscultation uses the “step ladder” approach
to examine the anterior chest and the posterior chest.
➢ Listen for one full respiration cycle (inspiration and
expiration) for each site using the diaphragm.
➢ Repeat using the bell.

Question 16

What are Normal Auscultation Sounds?

Answer 16

The sounds heard via respiratory
auscultation are:
➢ Tracheal
➢ Bronchial
➢ Bronchovesicular
➢ Vesticular
Note any asymmetries in the
expiratory and inspiratory phases.

Question 17

What is the procedure to perform respiratory auscultation?

Answer 17

Procedure
1. Ensure equipment is sanitised and then introduce yourself.
2. Explain what you will be doing (gain verbal consent).
3. Ask your partner to remove their upper body clothing (dignity)
4. Perform auscultation on all regions with the diaphragm and the
stethoscope’s bell.
5. Assess for respiratory rate (brpm) and then any abnormalities.

Question 18

What are Abnormal Auscultation Sounds?

Answer 18

The abnormal sounds heard via respiratory auscultation are:
➢ Wheeze: a continuous, coarse, whistling sound produced in the respiratory airways
during breathing. Wheeze is often associated with asthma, COPD and bronchiectasis
(abnormal airways).
➢ Crackles: discontinuous, brief, popping lung sounds typically associated with
pneumonia, bronchiectasis and pulmonary oedema (fluid in the lungs).
➢ Stridor: a high-pitched extra-thoracic breath sound resulting from turbulent airflow
through narrowed upper airways. Stridor has a wide range of causes, including foreign
body inhalation (acute) and subglottic stenosis (chronic).
➢ Pleural rub: Low pitched, grating sound (walking on snow) caused by pleural
inflammation. Typically associated with injury or a pulmonary embolism.