Resp Exam

Question 1

Give an overview of the steps involved

Answer 1

Introduction
Inspection + palpation
Palpation of neck + chest
Percussion and Auscultation
Other areas 
Conclusion

Question 2

What is involved in the introduction step?

Answer 2

Hands and stethoscope cleaned
Appropriate introduction
Explain procedure and get consent (any discomfort)
Position ptx (45 degrees)

Question 3

What is involved in inspection and palpation?

Answer 3

Gen inspection of area and ptx (at end of bed - ptx with hands on hips)

Inspect hands appropriately (warmth, finger clubbing, tar staining and palmar erythema)

Check for tremors and flap (ptx pull wrist back - if tremor then CO2 retention)

Assesses and states pulse/rhythm
States resp rate (Regular rhythm normal)

Inspects face appropriately (ptosis: drooping eyelid.
Horners syndrome/oculosympathetic paresis - ipsilateral myosis, ptosis and anhydrosis (damage to sympathetic trunk).
Conjucrtival palor - anaemia.
In mouth: Central cyanosis and inspect tonsils and pharynx

Close inspection of the chest

Question 4

What is involved in palpation of neck and chest?

Answer 4

Assess JVP

Palpates trachea (3 finger cricosternal distance (>3 = hyperinflation)

Palpates Apex beat (changes in tension pneumothorax)

Place hand on L sternal edge to asses for right ventricle heave

Assess chest expansion (do inferior and superior - bring thumbs to midline but don’t let them rest on the wall)

Question 5

What is involved in percussion and auscultation

Answer 5

Anterior chest percussion
Percussion laterally
Auscultates as above - looking for breath sounds that are even + added sounds (wheeze or crackles)
If abnormal do vocal resonance (more loud over consolidation - muffled in area of collapse/effusion. Whisper pectoriloquy is heard over consolidation only)

Posteriorly:
Palpate lymph nodes - anterior and posterior triangles + supraclavicular fossa (from neck to under jaw + behind and in front of ears)

Inspection
Expansion
Percussion
Auscultation

Question 6

What is involved in other areas?

Answer 6

explain role of vocal resonance
Feels for ankle oedema 
Obs chart and sputum
Performs peak flow
Consider referral for spirometry

Question 7

What is involved in the conclusion?

Answer 7

Appropriate conclusion
Summary
(vesicular breath sound with no added crepitation or wheeze) (No cervical lymphadenopathy)