Respiratory Exam Flashcards
What is the appropriate patient positioning? (2)
- Undressed to the waist
- 45°supine or seated
What do you look for on general inspection? (4)
What are the types of cough character? (5)
Sputum characteristics: (3)
- Colour and volume
- Purulent/Mucoid/Mucopurulent
- Blood
Hoarseness: (3)
- Laryngitis
- Recurrent laryngeal nerve injury
- Inhaled corticosteroids
Stridor: (3)
What is the respiratory examination of the hands?
What is HPO?
What do you look in the nose?
- Nose
– Deviated septum, inflammation, engorged turbinates, polyps
What do you look in the mouth?
- Mouth
– Cyanosis, inflammation (red, swollen pharynx and tonsils ±pus)
What does tenderness over sinuses indicate?
Sinusitis
What causes Horner’s syndrome? (3)
What is Pemberton’s sign?
Tracheal deviation?
Tracheal tug?
Cor pulmonale:
DVT:
Shape and symmetry: (3)
- Barrel-shaped chest
– Increased AP diameter
– Severe asthma or COPD - Pigeon chest (Pectus carinatum)
– Outward bowing sternum/costal cartilages
– Chronic childhood respiratory infections and rickets - Funnel chest (Pectus excavatum)
– Developmental defect - depression lower end of sternum
– Severe: decreased lung capacity
What is Harrison’s sulcus? (2)
- Linear depression lower ribs just above costal margins
– Severe asthma in childhood and rickets
Hoover’s sign:
– On inspiration chest moves in and abdomen out (COPD)
* paradoxical movement
* significant hyperinflation
Kyphosis/Scoliosis/Kyphoscoliosis:
Reduced lung capacity when significant
Scars: (2)
- previous surgery
- previous ICD
Radiotherapy:
Erythema
Prominent veins (facial plethora) indicate…
SVC obstruction
Trauma: (4)
⎻ Bruising
⎻ Swelling
⎻ Erythema
⎻ Lacerations
- Symmetry (Anterior and posterior)
- Expansion
- Upper lobes :
- Lower lobes:
- from behind looking down at the clavicles
- inspect posteriorly
Reduced movement
Unilateral:
Reduced movement
Bilateral:
Chest expansion: (3)
- Apex Beat (Will be covered in CVS)
⎼5th ICS just medial to MCL
⎼ Displaced - Towards side of lesion:
- Away from lesion:
- collapse lower lobe, localized fibrosis
- pleural effusion, tension pneumothorax
Impalpable apex beat:
COPD hyperinflation
Cardiomegaly:
Lung pathology:
- Apex beat displaced but trachea central
- Apex beat central but trachea deviated
Vocal fremitus: (5)
– Palms placed on the chest wall
– Patient says “99”
– Compare vibrations left and right – Increased in consolidation
– Same as vocal resonance
- Ribs – tenderness: (2)
– Fracture (trauma/malignancy)
– Costochondritis(joints)
- Subcutaneous emphysema:
– Air tracking from the lungs
- Symmetrical Percussion:
Stony dull - fluid: (2)
- Pleural effusion
- Haemothorax
Dull: (2)
- Consolidated Lung (fluid in the alveoli)
- Solid structure
Resonant:
Normal lung
Hyper-resonant: (2)
- Pneumothorax
- Hollow structure (bowel)
Liver dullness:
6th ICS MCL
Cardiac dullness:
Left precordium:
- resonance = hyperinflation (COPD/Asthma)
Auscultation:
- Normal breath sounds (vesicular): (3)
- Most of chest area
- Inspiration longer and louder than expiration
- No gap between inspiration and expiration
- Bronchial breathing: (5)
- Hollow, blowing quality
- Audible in expiration
- Gap between inspiration and expiration
- Sound of turbulence in the upper airway without filtering by the alveoli (bronchial breathing is heard normally over the upper
airways but not over the lung fields) - Consolidated lung (e.g. lobar pneumonia) conducts turbulent sound from the upper airway without filtering
Amphoric breathing: (3)
– Exaggerated bronchial sounds
– Hollow sound like blowing over a bottle
– Large cavity
Intensity of breath sounds
* Normal or reduced
* Reduced = (6)
Added sounds: (2)
Wheeze:
Crackles:
Pleural friction rub: (3)
Vocal resonance:
- Normal =
- Consolidation =
- Whispering pectoriloquy =
– Normal – muffled sounds
– Consolidation – Numbers become clearly audible (consolidated lung transmits higher frequencies better)
– Whispering pectoriloquy – whispered speech distinctly heard
