Raspatory Exam

Question 1

General

Answer 1

Conduct general observation and palpation in seated position on all aspects, then focus on posterior thoracic wall (palpation, percussion, auscultation). Reposition Pt to supine at 45 degrees and repeat the same steps on anterior and lateral wall.

Question 2

Observation

Answer 2

Hands/fingers/nails:
* Temperature
* Colour: cyanosis, nicotine stains, erythema, carotenemia
* Nail beds: capillary return, splinter haemorrhages
* Clubbing: Shamroth’s sign – loss of diamond shape when two fingers held against each other

Face:
* Note respiratory rate
* Respiratory effort: use of accessory muscles
* Eyes:
o Sclera: jaundice, anaemia
o Xanthelasma: yellow cholesterol deposits around eyes
* Malar flush (red cheeks): pulmonary HT, mitral stenosis
* Teeth infections: source of endocarditis
* Tongue and lips: central cyanosis

Chest:
* Respiratory effort: retraction of interspace
* Scars – defibrillator box, pacemaker
* Skeletal abnormalities – kyphoscoliosis, pectus excavatum, barrel chest
* Symmetry of respiratory movements, tracheal deviation

Question 3

Palpate

Answer 3

Neck:
* Cervical nodes
* Tracheal deviation

Thorax:
* Generally for tenderness
* Thoracic expansion: AP, lateral
* Local superficial lymph nodes: supraclavicular, axillary

Posterior wall: predominantly lower lobes (RLL, LLL)
* Tactile fremitus (99):
o increased = excess tissue (mass/consolidation)
o decreased = excess air (asthma/emphysema)

Anterior & lateral wall
* Upper lobes (RUL, LUL)
* R middle lobe (RML)

Question 4

Percussion

Answer 4

Posterior wall:
* Intercostal spaces: dull/flat/resonance/hyperresonance/tympany
* Diaphragm excursion
o Ask pt to exhale and use percussion to measure lowest point of diaphragm
o Asp pt to inhale and use percussion to measure lowest point of diaphragm

Anterior & lateral wall
* Upper lobes (RUL, LUL)
* R middle lobe (RML)

Question 5

Auscultation

Answer 5

Posterior wall:
* Breath sounds
o Using the same intercostal spaces as percussion
o Vesicular/bronchovesicular/bronchial
o Adventitious breath sounds: crackles, rhonchi, wheeze, friction rub
* Vocal fremitus
o Bronchophony (repeat 99), egophony (repeat eee), whispered pectoriloquy (whisper 1, 2, 3)

Anterior & lateral wall
* Upper lobes (RUL, LUL)
* R middle lobe (RML)