respi physical exam

Question 1

general inspection (respi)

Answer 1

Aids (inhalers, O2 delivery device, sputum bags)
Breathing (use of accessory muscles, through pursed lips), body build
Cough/cyanosis
Distress (wheeze, stridor, dyspnoea)

Question 2

hands (respi)

Answer 2

TTCCWW
1. tar staining
2. flapping tremor (CO2 retention in severe COPD)
3. cyanosis (nail beds)
4. clubbing
5. weakness (assess finger abduction)
6. wasting

Question 3

wrists (respi)

Answer 3

tenderness, swelling

Question 4

face (respi)

Answer 4

facial plethora (swelling) and cyanosis
1. eyes: pallor, jaundice, horner’s syndrome (miosis, ptosis, anhidrosis)
2. nose: engorged turbinates, nasal septum deviation, polyps
3. tongue: central cyanosis, oral thrush, ulcers
4. teeth: dentitian
5. pharynx: crowding of pharynx, red
6. palpate sinuses: maxillary, frontal

Question 5

neck (respi)

Answer 5

1. JVP: check for elevation
2. thyroid: enlarge thyroid
3. trachea: deviation, tracheal tug
4. palpate cervical lymph nodes: submental, submandibular, tonsillar, pre-auricular, post-auricular, occipital, posterior cervical, superficial and deep cervical, supraclavicular
5. pemberton sign: facial plethora, cyanosis, distension of neck veins, stridor, dyspnoea

Question 6

inspection of chest

Answer 6

scars, swelling, prominent veins, erythema, rash, etc.
1. chest deformaties
- barrel chest (look from side)
- funnel, pigeon chest (look from front)
2. spinal deformities
- kyphosis, lordosis (look from side)
- scoliosis (look from back)
3. subcostal recession of ribs (harrison’s sulcus)
4. symmetry of movement of chest wall
- use of accessory muscles
- retraction of intercostal muscles during inspiration

Question 7

palpation of chest

Answer 7

1. tenderness, swelling
2. locate apex beat
3. chest expansion
4. hoover’s sign

Question 8

percussion of chest

Answer 8

1. clavicle (directly)
2. three other points below clavicle (left and right)
3. 4 points on the back (left and right)

note if resonant or dull on percussion

Question 9

auscultation of chest

Answer 9

ask patient to breath in more deeply and more slowly

listen for:
- breath sounds (normal vesicular or bronchial breath sounds)
- vocal resonance (4 anterior, 4 posterior, 2 lateral)

1. bell above clavicles
2. diaphragm for rest of chest
   - posterior –> lateral –> anterior
   - top to bottom