Respiratory Exam Flashcards
Respiratory examination:
Introduction
Wash hands
Introduce yourself
Confirm patient name/DOB
Explain exam and gain consent
Expose patient chest
Position patient at 45 degrees
Ask if patient has any pain
Respiratory examination:
General inspection
End of the bed:
- treatments around bed
- cyanosis
- SoB
- cough (dry/productive)
- wheeze
- stridor
- cachexia
Respiratory examination:
Hands
Inspection:
- Tar stains
- Clubbing
- Peripheral cyanosis
- Signs of rheumatological disease
- Skin changes (e.g. bruising, thinning)
Assess temperature
Palpate pulse rate and rhythm
Respiratory rate
Fine tremor
Asterixis
Respiratory examination:
Head and neck
Eyes:
- Conjunctival pallor
- Ptosis/miosis
Mouth:
- Central cyanosis
- Angular stomatitis
Neck:
- JVP
- Lymphadenopathy
Respiratory examination:
Chest
Look:
- Scars
- Skin changes
- Asymmetry and deformities
Feel:
- Tracheal position
- Apex beat
- Chest expansion
- Tactile vocal resonance
- Percussion
Listen:
- Anterior, posterior and lateral
- Vocal resonance
Respiratory examination:
End pieces
Examine sacrum and legs for oedema
Obs: Temperature, BP, O2 sats
If indicated: Sputum, CXR, ABG, cardiovascular examination
Thank patient and explain findings to the examiner
How might patient age inform your findings in a respiratory examination?
Younger patient: more likely asthma or cystic fibrosis
Older patient: more likely COPD, interstitial lung disease, malignancy
What condition is associated with barrel chest?
COPD
What conditions are commonly associated with cachexia?
Malignancy, cystic fibrosis, COPD
What is stridor indicative of?
Upper airway obstruction
What respiratory conditions are linked with clubbing?
Lung cancer, interstitial lung disease, bronchiectasis
Why should you check the joints of the hands during a respiratory examination?
Rheumatological disease can be associated with pleural effusions and pulmonary fibrosis
Why might a patient with COPD or asthma have thinning or bruising of the skin?
Associated with long-term steroid use
What is a normal adult respiratory rate?
12-20 breaths per minute
Why might a fine tremor be indicative of a respiratory condition?
Side effect of beta 2 agonist (e.g. salbutamol)
What respiratory condition is indicated by a flapping tremor (i.e. asterixis)?
CO2 retention - type 2 respiratory failure, e.g. COPD
Why do you look for ptosis and miosis during a respiratory examination?
Symptoms of Horner’s syndrome. Along with anhidrosis on affected side and enophthalmos
What specific scars might you expect to see during a respiratory examination?
Central chest:
- sternotomy
- thoracotomy
Clavicular:
- pacemaker
Mid-axillary:
- Chest drain
Why should you feel for the apex beat in a respiratory examination?
Right ventricular heave is noted in cor pulmonale (right-sided heart failure secondary to lung disease)
What might tracheal deviation indicate?
Deviates AWAY FROM:
- pneumothorax
- large pleural effusion
Deviates TOWARDS:
- lobar collapse
- pneumonectomy
What can the different types of percussion note indicate in respiratory examination?
Resonant: normal for lungs
Dullness: increased tissue density (consolidation/fluid/tumour/collapse)
Stony dullness: Pleural effusion
Hyper-resonance: decreased tissue density (pneumothorax)
What are fine crackles suggestive of in a respiratory examination?
Pulmonary fibrosis
What are coarse crackles suggestive of in a respiratory examination?
Fluid, pneumonia, bronchiectasis
What is a wheeze suggestive of in a respiratory examination?
Asthma/COPD
