respiratory exam

Question 1

observation

Answer 1

the hands:
-Examine for finger clubbing
-Nail changes, tar staining (smoking)
-Peripheral cyanosis
-Ask them to put their hand in front of them to check for flapping tremor
the face:
-Pupil size
-Pull eyelids down
-Rashes (butterfly)
-Blue discoloration of tongue
-Examine trachea for deviation
radial pulse:
-Rate= count
-Rhythm= regular, irregularly regular and regularly irregular
-Character= slow-rising (delayed upstroke and occurs in aortic stenosis), bounding (increased up stroke and down stroke Is a sign of co2 retention) or jerky (hypertrophic cardiomyopathy)
-Palpate both pulses and check for inequality (radio-radial delay or radio femoral delay)

Question 2

anterior chest palpation

Answer 2

-Examine chest expansion (bucket handle, pump handle and caliper)
-Palpate apex of heart
-Back of hands over top of chest- feel for heaves and thrills
-Reduced expansion= fibrosis, consolidation, effusion, collapse and pneumothorax

Question 3

anterior chest inspection

Answer 3

-Shape of chest- barrel shape (airflow obstruction due to dorsal kyphosis and sternal prominence), pigeon shape (localized deformity of sternum and costal cartilage that bulges out) and funnel shape (localized depression of inferior sternum)
-Spinal deformities may impinge respiration and may be associated with systemic disease
-Look for scars that may indicate breast surgery

Question 4

anterior chest percussion

Answer 4

-Place middle finger of hand against chest wall- strike finger with index finger against it
-Should sound hollow and resonant
-Cardiac dullness could be consolidation, collapse or effusion

Question 5

anterior chest auscultation

Answer 5

-Use bell of stethoscope on supraclavicular fossae- patient open mouth breaths
-Diaphragm on the anterior and lateral chest
-Get patient to say Scooby doo to assess vocal resonance with ulnar border of hand
-Increased vocal resonance- consolidation, lobar collapse, tumour
-Decreased vocal resonance- pleural effusion
-Listen for quality of breath sounds, loudness of breath and any added sounds
-inspiratory stridor- upper airway obstruction
-Wheezing- asthma and COPD
-Coarse crackles- neumonia and pulmonary oedema
-Fine crackles-pulmonary fibrosis

Question 6

posterior chest

Answer 6

same as anterior. inspect, palpate, percuss, auscultate
across and down the spine and sides of ribs

Question 7

explanations

Answer 7

observation of chest movement= lung dysfunction, intercostal tightness, muscles dysfunction
percussion= see if resonant. may be fluid filled or solid
ausculate= to distinguish normal respiratory sounds from abnormal ones e.g. crackles, wheezes