Respiratory Exam

Question 1

Respiratory examination:

Introduction

Answer 1

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

Question 2

Respiratory examination:

General inspection

Answer 2

End of the bed:

• treatments around bed
• cyanosis
• SoB
• cough (dry/productive)
• wheeze
• stridor
• cachexia

Question 3

Respiratory examination:

Hands

Answer 3

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

Question 4

Respiratory examination:

Head and neck

Answer 4

Eyes:

• Conjunctival pallor
• Ptosis/miosis

Mouth:

• Central cyanosis
• Angular stomatitis

Neck:

• JVP
• Lymphadenopathy

Question 5

Respiratory examination:

Chest

Answer 5

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

Question 6

Respiratory examination:

End pieces

Answer 6

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

Question 7

How might patient age inform your findings in a respiratory examination?

Answer 7

Younger patient: more likely asthma or cystic fibrosis

Older patient: more likely COPD, interstitial lung disease, malignancy

Question 8

What condition is associated with barrel chest?

Answer 8

COPD

Question 9

What conditions are commonly associated with cachexia?

Answer 9

Malignancy, cystic fibrosis, COPD

Question 10

What is stridor indicative of?

Answer 10

Upper airway obstruction

Question 11

What respiratory conditions are linked with clubbing?

Answer 11

Lung cancer, interstitial lung disease, bronchiectasis

Question 12

Why should you check the joints of the hands during a respiratory examination?

Answer 12

Rheumatological disease can be associated with pleural effusions and pulmonary fibrosis

Question 13

Why might a patient with COPD or asthma have thinning or bruising of the skin?

Answer 13

Associated with long-term steroid use

Question 14

What is a normal adult respiratory rate?

Answer 14

12-20 breaths per minute

Question 15

Why might a fine tremor be indicative of a respiratory condition?

Answer 15

Side effect of beta 2 agonist (e.g. salbutamol)

Question 16

What respiratory condition is indicated by a flapping tremor (i.e. asterixis)?

Answer 16

CO2 retention - type 2 respiratory failure, e.g. COPD

Question 17

Why do you look for ptosis and miosis during a respiratory examination?

Answer 17

Symptoms of Horner’s syndrome. Along with anhidrosis on affected side and enophthalmos

Question 18

What specific scars might you expect to see during a respiratory examination?

Answer 18

Central chest:

• sternotomy
• thoracotomy

Clavicular:
- pacemaker

Mid-axillary:
- Chest drain

Question 19

Why should you feel for the apex beat in a respiratory examination?

Answer 19

Right ventricular heave is noted in cor pulmonale (right-sided heart failure secondary to lung disease)

Question 20

What might tracheal deviation indicate?

Answer 20

Deviates AWAY FROM:

• pneumothorax
• large pleural effusion

Deviates TOWARDS:

• lobar collapse
• pneumonectomy

Question 21

What can the different types of percussion note indicate in respiratory examination?

Answer 21

Resonant: normal for lungs

Dullness: increased tissue density (consolidation/fluid/tumour/collapse)

Stony dullness: Pleural effusion

Hyper-resonance: decreased tissue density (pneumothorax)

Question 22

What are fine crackles suggestive of in a respiratory examination?

Answer 22

Pulmonary fibrosis

Question 23

What are coarse crackles suggestive of in a respiratory examination?

Answer 23

Fluid, pneumonia, bronchiectasis

Question 24

What is a wheeze suggestive of in a respiratory examination?

Answer 24

Asthma/COPD