Respiratory Examination

Question 1

What position is right for the respiratory examination?

Answer 1

The head of the bed should be at 45 degrees

Question 2

What do we inspect in a resp exam?

Answer 2

Shortness of breath - cough, wheeze, stridor
Cyanosis - other colour too, plethoric complexion
Pallor
Oedema
Pursed lip breathing
Accessory muscles
Cachexia

Look also for walking aids, medical aids, equipment, inhalers and oxygen devices

Question 3

What are the ways to provide oxygen therapy?

Answer 3

1. Nasal cannulae 24-32% 1-6Lmin flow rate
2. Simple face mask 35-50% 6-10 fr
3. Partial rebreather - face mask with reservoir bag with no one-way valve, 50-80% 6-15 fr
4. Non-rebreather facemask and reservoir bag with one way valve 90% 15 fr
5. Controlled oxygen therapy, venturi mask. Facemask with interchangeable adaptors that can deliver 24-60% 2-15fr

Question 4

What does green or yellow sputum show?

Answer 4

Infection

Question 5

What does pink/red sputum show?

Answer 5

Infection or cancer

Question 6

What does white sputum show?

Answer 6

Allergies, asthma or viral infections

Question 7

What does grey sputum show?

Answer 7

Environmental, common in miners, factory workers or smokers

Question 8

What does brown sputum show?

Answer 8

Chronic lung disease, cystic fibrosis or bronchiectasis

Question 9

What may you inspect from a patient’s hands?

Answer 9

Clubbing, tar staining, different colours, temperature, temors

Clubbing is a spongieness of the nailbed, wider at base of nailbed than at the bone or joint

Question 10

THIS

What can cause clubbing

Answer 10

Cyanotic heart or cystic fibro

Question 11

What do you assess about a person’s pulse?

Answer 11

Pulse rate
Bounding - associated with CO2 retention e.g. TII resp failure
Assess at the wrist and the carotid pulse

Question 12

After pulse rate, what else do you measure?

Answer 12

Respiratory rate, 12-20 in healthy adults. Measure over 10-15 seconds. Tachypnoea is fast, bradypnoea is slow.
ALWAYS sign post

Question 13

THIS

How can you tell the difference between JVP and carotid pulse?

Answer 13

POLICE JVP IS
non-Palpable
readily Occludable
Location - between heads of SCM
Inspiration - drops with inspir
Contour - biphasic waveform
Erection - drops when sitting erect

Raised is a sign of increased…

Question 14

What is the hepatojugular reflex?

Answer 14

Press gente pressure to the liver and observe for a rise in JVP, useful in diagnosing ventricular dysfunctions.

Question 15

What is horner’s syndrome?

Answer 15

Panko’s tumour and lung tumours. Stroke, lesion in brainstem, injury to nerve or carotid artery. (top 4 are main ones)

1. Reduced sweating (anhydrosis)
2. Ptosis
3. Miosis (constricted pupil)
4. Enophthalmos (sunken eyeball)
5. Vasodilation
6. Conjunctival something (reddened eye on affected side)

Question 16

Why do you check in someone’s mouth?

Answer 16

Candida if they’re using inhaled corticosteroids incorrectly, so may be getting systemic adverse affects.

Question 17

THIS

Label these scars or chest wall deformities.

Answer 17

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Question 18

THIS

After inspection, what do we assess next?

Answer 18

Tracheal position, two fingers either side of the trachea and then use middle finger to assess position.
Cricosternal distance. Three fingers between cricoid cartilage and sternum.

Question 19

How do we assess chest expansion?

Answer 19

Both hands on either side of back or chest. Use thumbs together if possible. Should move

Question 20

What would affect chest wall expansion?

Answer 20

1. Consolidation and pneumothorax and pleural effusion normal or decrease on affected
2. Lobar collapse or pleural thickening decreased.

Question 21

What would affect percussion notes?

Answer 21

Resonant - normal
Dullness - consolidation, pleural thickening or collapse
Stony dullness - pleural effusion
Hyper-resonant - pneumothorax

Question 22

THIS PICTURE

How do we auscultate the lungs?

Answer 22

Ask patient to breath in gently, in and out through their mouth.
These are the areas to check.

Question 23

THIS

What diagnoses may affect lung auscultation?

Answer 23

Vesicular - normal
Quiet - consolidation, collapse, effusion
Polyphonic wheeze - asthma, COPD
Bronchial - consolidation, fibrosis
Fine crackles - pulmonary fibrosis
S - crackles ???

Question 24

How do you assess tactile vocal fremitus?

Answer 24

Ninety nine three times and feel it
Increased in consolidation
Decreased in pneumothorax, pleural effusion, pleural thickening, consolidation.

Question 25

THIS IMAGE

Where do you palpate the lymph nodes?

Answer 25

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Question 26

What may you assess in the legs?

Answer 26

Signs of deep vein thrombosis or you may see oedema

Question 27

What are some respiratory causes of clubbing?

Answer 27

Lung cancer, pulmonary fibrosis, bronchiectasis.

COPD does not!

Question 28

What might a tremor be a sign of?

Answer 28

Asterixis, tremor on raising hands to signal stop shows CO2 retention.
Fine tremor can be a sign of salbutamol use.