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Year 3 OSCE > Respiratory Assessment > Flashcards

Respiratory Assessment Flashcards

1
Q

What scars could be on a patient’s chest and what could they indicate?

A
  1. Upper left anterior scar - Pacemaker
  2. Central CABG scar - Cardiac surgery
  3. Axilla scars - Chest drainage
  4. Scapula scar - lung surgery
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2
Q

What could barrel chest indicate?

A

CO2 retention or COPD
Due to chronic hyperinflation

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3
Q

What could pigeon chest or funnel chest indicate?

A

They are congenital abnormalities that can affect the underlying organs, therefore can cause respiratory distress or affect the cardiovascular system

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4
Q

If chest expansion is higher than 5cm, what can this indicate?

A

A well conditioned athlete

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5
Q

If chest expansion is lower than 3cm, what can this indicate?

A

Respiratory distress or COPD

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6
Q

What can a deviated trachea indicate?

A
  1. A pneumothorax - as the trachea deviates away from the affected lung
  2. A tumour or mass (thyroid)
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7
Q

If you can feel something hitting your finger during a tracheal tug exam, what does this indicate?

A

This is the cricoid cartilage of the trachea hitting the finger due to the lungs pulling it down - indicating respiratory distress

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8
Q

If you are just feeling the thoracic cavity and there is pain or tenderness, what can this indicate?

A

Fractured Rib
Costacondritis (inflammation of the cartilage that joins the ribs to the sternum)

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9
Q

What 3 nodes to we palpate and why?

A

Supraclavicular (Virchow’s node/Trosier sign)
Infraclavicular
Axilla

We palpate these 3 specifically as they drain the thoracic cavity, so if these nodes are felt then this could be the start of the infection process in the lungs, or malignancy

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10
Q

Why should vibration decrease as you move down on anterior tactile fremitus?

A

Because if the vibration increase, then this could indicate consolodation, such as a solid, blood, mucous etc, as it is getting further away from the larynx where vibrations derive from

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11
Q

(1) What could hyperressonance indicate?
(2) What could hyporesonance indicate?

A

(1) More air in the lungs than there should be - pneumothorax
(2) Consolodation such as solid, mucous, haemothorax, pulmonary oedema

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12
Q

Why do we auscultate in more places posteriorly than anteriorly?

A

The lungs are more inferior posteriorly than anteriorly

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13
Q

What does flail chest indicate?

A

Two or more contiguous rib fractures with two or more breaks per rib

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14
Q

What adventitious sounds might you find on auscultation and what do these indicate?

A
  1. Expiratory wheeze - Asthma or COPD
  2. Inspiratory stridor - Upper airway obstruction
  3. Coarse lobar crackles - Consolodation - Pneumonia
  4. Basal/fine crackles - Pulmonary oedema secondary to HF
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15
Q

What could moveable and non-moveable nodes mean?

A

Moveable could be a sign of infection, non-moveable could be a sign of a malignancy

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16
Q

What do you say at the beginning of the respiratory examination?

A

“I have done my history taking and general assessment and have ascertained that I need to do a respiratory examination.

“I may consider starting posteriorly on a female if she has a lot of breast tissue”

“If you wouldn’t mind exposing the chest for me, if you need a blanket for dignity then please let me know, or if you need a chaperone please let me know”

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17
Q

What respiratory patterns are you looking at?

A
  1. Tachypnoea? - asthma, allergies, sepsis
  2. Bradypnoea? - opioid usage
  3. Kussmaul breathing? - DKA
  4. Cheyne-Stokes?
18
Q

If a patients breathing is shallow when counting a resp rate, what should you do?

A

Place a hand on the patients chest to feel rise and fall

19
Q

How do you measure chest expansion?

A
  1. Place hands on the chest - you should see the thumbs pushed apart when the patient breaths and lungs expand.
  2. Measure with tape measure - Under the nipple line with patient sat forward. Get patient to breathe out and measure, get patient to breathe in and measure.
20
Q

Chest expansion should be between __-__ cm

A

3-5cm

21
Q

How do you check for tracheal deviation and what could this indicate?

A

Two finger technique on either side of the trachea to confirm its midline. If there is deviation - this could indicate a pneumothorax or a tumour.

22
Q

How do you check for tracheal tug and what does it indicate if you feel it?

A

1 finger below the larynx, ask patient to breathe in. You should not feel any tapping on the finger when breathing in.

If you feel tapping - this is the cricoid cartilage hitting the finger as the lungs are expanding - indicating respiratory distress

23
Q

What is trosier sign?

A

Inflammation of the left supraclavicular node - known as Virchow’s Node when inflamed. Can indicate gastric cancer.

24
Q

How do you test for anterior tactile fremitus (palpate)?

A

Place ulnar aspects of the hands on either side of the patient’s chest/sides. Ask the patient to say “99”. Feel for equal vibrations. You should feel the vibrations get less strong as you go down.

25
Q

If you feel increased vibrations as you go down the chest when testing for tactile fremitus, what can this indicate?

A

That there may be consolidation in the chest - like pneumonia, blood, fluid, haemothorax

26
Q

What joint of the finger do we hit when we percuss?

A

The distal interphalangeal joint

27
Q

How many spaces do we percuss and auscultate anteriorly?

A

6 spaces and one on each side

28
Q

How many spaces do we percuss and auscultate posteriorly?

A

8 spaces and one on each side

29
Q

How do you test diaphragmatic excursion?

A

Ask patient to empty lungs and percuss down until you hear dull sounds - tape.

Ask patient to take a deep breath in and percuss again until you hear dull sounds - tape.

Measure the distance between the two pieces of tape. 3-5cm is normal, 7-8cm can be a well conditioned athlete.

30
Q

What is a normal and abnormal finding in spoken resonance?

A

Normal - sound of indicreet, mumbled “99”
Abnormal - Clear “99” sound that could indicate consolidation of fluids / solids in the lungs

31
Q

What should you tell a patient to do during a posterior chest exam?

A

Hug themselves to open up their scapula’s and open up the thoracic cavity more

32
Q

What do you do in the “Inspect” section of the respiratory assessment?

A
  1. Anterior and posterior chest examination
  2. Checking the respiratory pattern
  3. Checking the respiratory rate
33
Q

What do you do in the “Palpate” section of the respiratory assessment?

A
  1. Chest expansion (hands and tape)
  2. Trachea examination (deviation and tug)
  3. Chest palpation (lumps and tenderness) and node palpation
  4. Tactile fremitus
34
Q

What do you do in the “Percuss” section of the respiratory assessment?

A
  1. Anterior and posterior percussion for normoresonance
  2. Diaphragmatic excursion
35
Q

What do you do in the “Auscultation” section of the respiratory assessment?

A
  1. Auscultation for vesicular sounds
  2. Spoken resonance
  3. Whispered resonance
36
Q

What is included in the anterior and posterior chest examination?

A

“Row Down By Sandbanks, Sunny All Day”
1. Rise and fall? (asymmetry = pneumothorax)
2. Deformities? (flail chest)
3. Bruising/swelling?
4. Scars?
5. Shape?
6. Accessory muscle use? Sub/intercostal recession?
7. Depth/rate/efficacy

37
Q

Vesicular breath sounds can be described as…

A

Soft and low-pitched sounds that are heard over most of the lung tissue.

They are heard through inspiration and continue without pause through to expiration, but fade away about one third of the way through expiration

38
Q

If diaphragmatic excursion is <3cm,what can this indicate?

A

COPD, pleural effusion, pain, abdominal changes such as tumours or ascites

39
Q

What patterns of breathing might you note?

A
  1. Males & children breathe abdominally or diaphragmatically
  2. Females breathe intercostally or thoracically
40
Q

Where do you place your finger to test for tracheal tug?

A

Supra-sternal notch

Year 3 OSCE (5 decks)

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