Resp

Question 1

What are the stages to a respiratory examination?

Answer 1

Inspection
Peripheral 
Palpation 
Percussion 
Auscultation (repeat all on back) 
The rest

Question 2

What should be inspected on hand?

Answer 2

Clubbing, tar staining, wasting of intrinsic muscles (t1 nerve invasion by apical lung cancer)
Look for fine tremor with hands pronated (B2 agonist use)
Look for flapping asterixis in CO2 retention

Question 3

What should be inspected on the arms?

Answer 3

Pulse rate while simultaneously assessing resp rate
Pulsus paradoxus (decreased pulse volume on inspiration) seen in obstruction/ tamponade
Blood pressure (describe)

Question 4

What should be inspected on the head?

Answer 4

Eyes: Horner’s syndrome (pupil constriction and ptosis), chemosis (oedema of conjunctiva) caused by hypercapnia

Face: facial swelling seen in SVC obstruction

Mouth: dental caries (predisposes to lung abscess) and central cyanosis

Question 5

What should be inspected on neck?

Answer 5

JVP, raised in cor pulmonale
Tracheal deviation
Cervical lymph nodes

Question 6

What should be inspected on the chest?

Answer 6

Barrel chest= emphysema, kyphoscoliosis, severe pectus excavatum, pigeon chest??

Symmetry, scars, muscle wasting, chest versus abdominal breathing, use of accessory muscles, recession (?)

Question 7

What palpation should be carried out?

Answer 7

Check apex beat for deviation
Assess chest expansion (3-5cm normal)
Assess tactile vocal fremitus (say 99), increased in consolidation, decreased in pleural effusion/ pneumothorax
(trachea)

Question 8

How should one percuss the lungs

Answer 8

Anteriorly (mid clavicular line clavicle to 6th rib)
Laterally (mid axillary line, axilla to 8th rib)
Posterior (spine of scapula to 11th rib)

Question 9

How should one auscultate the lungs?

Answer 9

Anteriorly (mid clavicular line clavicle to 6th rib)
Laterally (mid axillary line, axilla to 8th rib)
Posterior (spine of scapula to 11th rib)

Note the presence of vesicular breathing, bronchial breathing, wheeze, crackles/ crepitus, assess for any change in these sounds after coughing,

Assess vocal resonance (say 99 while listening with stethoscope) increased in consolidation reduced in pleural effusion/ pneumothorax

Question 10

What else should you do?

Answer 10

Palpate cervical lymph nodes, 
Palpate ankles for oedema
Check sputum pot (volume, consistency, colour, odour, any haemoptysis)
Assess peak flow (describe only) 
Thank patient ask them to redress.