respiratory exam

Question 1

what are the general principles of an exam (general resp, cardio)

Answer 1

inspection (including suroundings)
palpatations
percussion
auscultation

Question 2

what is the normal respiratory rate

Answer 2

12- 15 breaths per minute

Question 3

what things are looked for on inspection of the patient

Answer 3

respiratory rate 
respiratory rhythm 
use of accessory muscles (sternocleidomastoids, scalene - laboured breathing)
sound
chest movement - symmetrical?

chest shape

Question 4

what chest shapes are to be looked out for

Answer 4

barrel chest

Pidgeon chest - sever child hood asthma

sternal depression - congenital - not clinically significant

Question 5

`what are the types of percussive notes

Answer 5

hyper-resonant - more air than normal
dull or impaired - more solid ie pus
stony dullness - fluid/ puss

Question 6

what are the type of sounds heard on auscultation

Answer 6

wheeze

crackles

pleural friction rub

bronchial breathing

Question 7

what position should a patient be in the exam

Answer 7

45 degrees

Question 8

what should be done first after introduction

Answer 8

initial assessment

Question 9

what are you looking for in the initial assessment

Answer 9

immediate intervention
patient well enough for exam
check the environment around the patient - open pots
news chart

Question 10

what are the time capillary refill is held for - how long is refill time normally

Answer 10

do in both hands

hold for 5 seconds

refill is normally 2 seconds or under

Question 11

what shoud be looked at on the hands in the resp exam

Answer 11

tar staining

warmth of hands - compare

peripheral cyanosis or anaemia

finger clubbing

tremor

Muscle wasting

Capillary refill time

Question 12

how do you check for peripheral cyanosis or anaemia in the hands

Answer 12

inter-lace your fingers and compare colour

Question 13

what are you looking for on the arms

Answer 13

IV track marks

Question 14

what tremors are we looking for - how long?

Answer 14

fine - hold arms out

flapping - hold and raise arms for 15 seconds

Question 15

what must you do after the hand and arm examination

Answer 15

take the pulse and respiratory rate

Question 16

what are the signs of finger clubbing

Answer 16

loss of nail bed angle

increased nail bed fluctuation

increases bulk of soft tissue over the terminal phalanges

Question 17

how long should the pulse be taken for

Answer 17

15 seconds and multiplied by 4

Question 18

how long should respiratory rate be taken for

Answer 18

a full minute

Question 19

what should be looked at for the head

Answer 19

the conjunctivae of the eyes

tongue and lips

face in general

Question 20

what are you looking for at the conjunctivae of the eyes

Answer 20

check for anaemia - normal conjunctivae are pink

Question 21

what are you looking for in the tongue and lips

Answer 21

signs of central cyanosis - blue discolouration of the tongue/lips

Question 22

what are you looking for in the face

Answer 22

no sing of redness, swollen tonsils or white patches

Question 23

what things are you looking at in the neck for the respiratory exam

Answer 23

tracheal position

measure crico-sternal distance

check lymph nodes

Question 24

how should tracheal position be measured

Answer 24

chin along mid line and neck slightly extended

warn patient about discomfort

place finger lightly in supra sternal notch and gently feel for the trachea

Question 25

how do you measure the crico-sternal notch

Answer 25

it should be between 2 to 3 fingers wide between the supra sternal notch and the cricoid cartilage

Question 26

how should lymp nodes be examided

Answer 26

ask patient to sit forward feel nodes -- sholders to neck ``` suprclavicular anterior cervical chain tonsillar nodes submandibular nodes sub mental - right to chin ``` pre and post auricular post cervical chain

Question 27

what should be done after lymph node exam - why

Answer 27

back of chest exam - to stop over-movement of patient

Question 28

what is in the back of chest exam

Answer 28

inspection palpitation percussion auscultation

Question 29

what are you looking for when inspecting the back of the chest

Answer 29

are there any scars looking for visual abnormalities - scoliosis/ kyphosis

Question 30

what are you doing on palpation of the back of the chest - where

Answer 30

checking lung expansion - 3 times apices, midway and bases

Question 31

where on the back are you percussion

Answer 31

5 zones aperies upper middle lower axilla (mid auxiliary line)

Question 32

where do you auscultate

Answer 32

the 5 zones you've just done

Question 33

for respiratory exam what part of the stethoscope do you use

Answer 33

the diaphragm

Question 34

what should you be listening for on auscultation

Answer 34

breathing is vesicular or bronchial intensity added sounds

Question 35

what added sounds might you hear on auscultation

Answer 35

crackles wheeze pleural rubs

Question 36

what do you do after auscultating the 5 zones

Answer 36

check vocal resonance by getting the patient to say 99

Question 37

what position should the patient be in for the front of chest respiratory exam

Answer 37

45 degrees

Question 38

what is the only different procedure of the front of chest respiratory exam compared to the back

Answer 38

checking the position of the mediastinum

Question 39

how is the position of the mediastinum checked

Answer 39

check tracheal position is correct feel for the apex beat and see if it is the correct position

Question 40

where should the apex beat be felt

Answer 40

the 5th intercostal space in the mid clavicular line

Question 41

how should the consultation be closed

Answer 41

thank patient tell them you've finished get the patient comfortable again