Respiratory Exam Flashcards
What do you ask for in a respiratory exam?
- Shortness of breath
- Cough
- Chest pain
- Wheeze
- Weight loss, fever, lethargy
- Atopy
- Past exposure to TB
- Recent medication and extensive social history
What do you ask for in shortness of breath?
- at rest/on exertion
- exercise limitation
- orthopnoea
- paroxysmal nocturnal dyspnoea
- leg oedema
What do you ask about in cough?
- productive/non-productive
- quantity
- colour
- mucus plugs
- timing
What do you ask about in chest pain?
pleuritic? (sudden intense sharp when inhale and exhale)
What information is important to ask about in social history?
- Occupation
- household pets
- smoking
- travel history
What position should the patient be in the respiratory exam?
lying on examination couch at 45 degrees
What exposure should the patient be in the respiratory exam?
waist upwards
What bedside paraphernalia would you look for?
- Medications: e.g. inhalers, nebulisers, oxygen, NIV masks
- Cigarettes / nicotine gum or patches
- Peak flow meter
- Sputum pot
- Mobility aids
What do you look for in closer inspection?
- Accessory muscle usage, pursed lip breathing
- Respiratory rate / obs chart
- Obvious scars / chest wall deformities
- Pallor
- Cachexia
- Drains
- Cushingoid appearance
What hand signs do you look for?
- Peripheral cyanosis
- Tar staining
- Finger clubbing
- Small muscle wasting
- Thin skin / bruising
- Bounding radial pulse
- Resting fine tremor
- CO2 retention flap
What observations do you ask for?
BP and oxygen sat
What face signs do you look for?
- Conjunctival pallor
- Horner’s syndrome (miosis, ptosis, enopthalmos, ipsilateral anhidrosis)
- Horner’s syndrome is relevant due to its inclusion as part of Pancoast’s syndrome (the association of Horner’s with a cancer at the apex of the lung)
What mouth signs do you look for?
- Central cyanosis
- Hydration status
- Oral candidiasis
What do you inspect and palpate in the neck?
- JVP (jugular venous pressure)
2. Tracheal deviation / tug
How do you measure JVP? When is JVP raised?
- patient should be sitting at 45 degrees with their head resting on a pillow and turned slightly to the left
- In this position, the right internal jugular vein should just be visible between the 2 heads of the sternocleidomastoid
- The JVP is raised if the vertical height of the pulse above the sternal angle is greater than 4cm
