Respiratory Exam Flashcards
Major pulmonary symptoms
Dyspnea
Hemoptysis
Cough
Chest pain
Dyspnea
Shortness of breath or windedness out of proportion for the activity.
As opposed to fatigue or tiredness
Dyspnea differential diagnosis
Respiratory:
- Airways (upper/lower)
- Parenchyma (fluid, fibrosis, inflammation)
- Circulation (blood clot)
- Pleura (fluid, malignancy, pneumothorax)
- Chest wall (kyphoscoliosis)
- Muscles (generalized, diaphragm)
Cardiac:
- Heart failure
- Silent angina
Other:
- Anemia
- Acidosis
- Psychogenic
Ways to ask about dyspnea
What to ask about a cough?
What causes a cough?
Cough receptors line the entire respiratory tract from sinuses to pleura.
May begin as a URI or post-nasal drip, but may also be reflective of life threatening diseases ranging from cancer to pneumonia.
White (mucoid) or clear sputum differential diagnosis
Asthma
Chronic bronchitis
Purulent sputum differential diagnosis
Pneumonia
Acute bronchitis
bronchiectasis
____ is not the same as no sputum.
Swallowing sputum is not the same as no sputum. Just because you don’t cough it up doesn’t mean it isn’t there.
What to ask about hemoptysis?
Hemoptysis vs Hematemasis
Hemoptysis: Coughing up blood or bloody mucus (respiratory origin)
Hematemasis: Vomitting up blood (gastric origin)
Angina differential diagnosis
Hemoptysis differential diagnosis
Infection
Infarction
Cancer
Vasculitis
Heart failure
Barrel chest
Percussion technique
Where to percuss?
Lung auscultation technique
What to ask about angina?
Character
Location
Precipitants
Elements from history (allergies, smoking, environmental triggers, genetics, etc.)
Only ____ or above is normal for O2 saturation.
Only 95% or above is normal for O2 saturation.
Basic pulmonary exam
Breathless from walking? Do you need to sit up to breathe?
Coughing? Wheezing?
Any chest discomfort?
Wearing oxygen? Inhalers by bedside?
Vital signs should inform questions.
Egophony
Have the patient say “Eee” or “Aah” while listening to different areas of lung to see where voice is transmitted.
Heard where air travels in airways surrounded by consolidated lung tissue (like pneumonia)
Only done if clinical suspicion is high.
Respiratory exam for a general practice visit
For every patient:
- Vital signs
- Inspection
- Percuss and auscultate posteriorly (>4 locations bilaterally)
- Auscultate anteriorly
For indicated patients (refer to history):
- Transmitted voice sounds
- Fremitus
- Assessing diaphragmatic movement
- More thorough anterior exam
Typical healthy lung report
Lungs clear to auscultation anteriorly and posteriorly and resonant to percussion posteriorly.
Typical abnormal lung report
Left lung resonant to percussion and clear to auscultation. Over the RLL there is dullness of percussion, crackles, increased fremitus, bronchial breath sounds, and egophony
Bronchophony
– the normal voice sounds heard over a healthy large bronchus or abnormal voice sounds auscultated more loudly and clearly with high pitch over more distal lung regions. It is a type of pectoriloquy.
Inspiratory To Expiratory Ratios
the ratio of inspiratory to expiratory time during spontaneous breathing, usually 1:2 in normal circumstances
Pectoriloquy
voice sounds auscultated with increased resonance through the chest wall, common examples of which are egophony, bronchophony, and whispered pectoriloquy (see below definitions). It usually represents a consolidation process in that region of the lung tissue
Whispered Pectoriloquy
an increased loudness of whispering noted on auscultation
Tactile Fremitus
– the palpation of vocal sound transmission - fremitus is increased when the chamber through which the sound is traveling (lung alveoli) is filled with a fluid, but is decreased when there is some other solid in between the vibrating chamber and the examining hand (such as the heart border in the path of the sound, or a pleural effusion in that location).
Lung surface anterior
Lung surface posterior
Lung surface right lateral
Lung surface left lateral
Diaphragmatic Excursion
– the movement of the thoracic diaphragm during breathing (usually 3-5 cm)
