Respiratory Examination Flashcards
What is generally observed from the patient when they walk in?
- Dyspnoeic
- Cough
- Wheeze
- Cyanosis
Hands in general observation
-Introduce yourself
-Shake hand= start hand examination (perfusion, temperature, tar staining, occupational= mining with coal tattooing)
=Cyanosed (peripheral= purple)
=Veins dilated abnormally
=Finger clubbing (abnormal curvature of fingernail, nail fold swollen and red)
=Nail bed fluctuation (rock back and forwards, marked fluctuation)
Arms in general observation
- Pulse rate and rhythm of radial artery
- Time respiratory rate at the same for half a minute
- Flapping tremor (cock hands upwards)
Head in general observation
- Jugular venous pressure (elevation)
- Central cyanosis (tongue out and up, look around edge of tongue for purple discolouration)
Inspection of thorax
- Shape of chest (barrel chest in COPD)
- Symmetry
- Deformity (pectus excavatum)
- Scars (thoracic or cardiac operations)
- Look for expansion of chest (deep breaths, comparing sides under clavicles)
Palpation of chest
-Position of mediastinum/ trachea
=Head straight, use one finger in sternal notch, posterior if central
-Cricosternal distance (bottom of cricoid cartilage to sternum, normally 2 fingers but usually reduced in COPD)
-Tracheal tug, feel cricoid cartilage pressing against finger and trachea goes down
-Apex beat, position of lower part of mediastinum
-Obvious signs of RV heave
Percussion of chest
-Start at clavicles downwards (middle finger in between ribs, wrist only movement)
-Down mid-clavicular line sides
=Liver dullness of right side
-Then axillary line both sides
Auscultation of chest
-Same position as percussion
=Bell, low-pitched noises
-Deep breaths in each position
=Background breaths should be vesicular, added sounds= external wheeze? Usually bronchi/wheezes or crepitations/crackling, rub sounds
Voice
-Spoken voice 1-1-1= tactile vocal fremitus
-Whispered voice (in dullness/ fluid)= whispered pectoriloquy
=Check if all the same in all parts of lung
Nodes at back
-Bring arms in to bring scapula out symmetrically
=Cervical nodes (anterior triangle, scalene nodules behind head of sternomastoid (in notch), palpate posterior triangle)
Expansion at back
-Hands spread across thorax equidistant and raise fold of skin so in breaths they move apart and equal
Percussion of back
- Lung closest to surface of body= supraclavicular fossa
- 2cm each side of vertebrae
- Down the line
Auscultation of back
-Supraclavicular fossa start
=Same as percussion and use bell
-Repeat with vocals
What else can be tested at the end of the consultation?
- Test for pitting oedema/ peripheral
- Cardiac complications
