Respiratory

Question 1

Order

Answer 1

Observation
General appearance - pain, equipment, thin, cachexia, cyanosed, breathless, using accessory muscles
Hands and nails - clubbing, cap refill, tar staining, dupuytren’s contracture, peripheral cyanosis
CO2 flap (CO2 retention, liver failure)
Radial pulse, resp rate
Face - pallor, Horner’s syndrome (interruption of sympathetic chain, can be lung cancer)
Mouth - central cyanosis
Neck
Anterior chest
Posterior chest

Question 2

Neck

Answer 2

JVP

Dilated neck veins (SVC obstruction from lung cancer?)

Lymph nodes (from behind)

Question 3

Anterior chest

Answer 3

Inspection - barrel chest, symmetrical chest wall movement

Palpation - trachea (to see if central), cricosternal distance

• apex beat
• chest expansion (thumbs should move 5cm apart)
• tactile vocal fremitus (99)

Percussion - 4-5 areas each side, looking for dullness (pneumonia, collapsed lung) or hyper resonance (pneumothorax)

Auscultation (deep breath in each time stethoscope touches)
- 4-5 places each side, inc apices and axillae
(listen for crackles - fluid, wheeze - asthma/COPD, pleural rub - inflammation)
- vocal resonance (99)

Question 4

Posterior chest

Answer 4

Inspection

Palpation - chest expansion
- tactile vocal fremitus (99)

Percussion - 4-5 places each side

Auscultation - 5-6 places each side
- vocal resonance