Respiratory Examination Flashcards
What exposure is required for a respiratory examination?
From the pubic symphisis upwards
What position is required for a respiratory examination?
Supine position with the upper body elevated 45 degrees + Sitting position
What are the potential signs of respiratory distress on general inspection from the end of the bed (8)?
- Tachypnoea
- Cough
- Cyanosis
- Use of accessory muscles
- Audible wheeze
- Nasal flaring
- Sweating
- Tripod
How is the trachea assessed?
- The trachea should be located equidistant between the clavicular heads as it is a midline structure
- Tracheal deviation arises due to unequal intrathoracic pressure
What is the clinical significance tracheal deviation away from the side of a lesion (3)?
- Extensive pleural effusion
- Tension pneumothorax
- Chest expansion
What is the clinical significance tracheal deviation towards the side of a lesion (3)?
- Upper lobe collapse
- Upper lobe fibrosis
- Pneumonectomy
How is chest expansion assessed?
- Normal chest expansion should be 4-5 cm and symmetrical
- Expansion should take off at the same time bilaterally
What is the clinical significance of unilateral decrease in chest expansion (4)?
- Pneumothorax
- Pleural effusion
- Collapsed lung
- Consolidation
What is the clinical significance of symmetrical decrease in chest expansion (4)?
- Asthma
- COPD
- Fibrosis
- Rib Fracture
How are the lungs percussed?
What is the clinical significance of hyper-resonant percussion (4)?
- Pneumothorax
- Hollow bowels
- COPD
- Acute Asthma
What is the clinical significance of hypo-resonant percussion (5)?
- Bone
- Tumour
- Consolidation
- Collapse
- Normal liver
What is the clinical significance of stoney dull percussion (2)?
- Pleural effusion
- Haemothorax
How are the lungs auscultated?
What is the clinical significance of bronchial breath sounds (4)?
- Consolidation
- Pleural effusion
- Pulmonary fibrosis
- Collapsed lung
What is the clinical significance of polyphonic sounds (4)?
- Asthma
- COPD
- Heart failure
- Bronchiectasis
What is the clinical significance of monophonic sounds (2)?
- Carcinoma
- Foreign body
What is the clinical significance of wheeze sounds (1)?
- High pitched sound due to airway narrowing, loudest on expiration
What is the clinical significance of stridor sounds (1)?
- High pitched sound due to upper airway obstruction
What is the clinical significance of crackles sounds (1)?
- High pitched, discontinuous popping sounds from air being forced through a collapsed or fluid, pus or mucus filled airway
What is the clinical significance of fine crackles sounds (1)?
- Velcro like sound during late inspiration originating from small airways. Caused by fluid or fibrosis.
What is the clinical significance of coarse crackles sounds (1)?
- Heard in early inspiration originating from large airways
How is tactile vocal fremitus performed?
- Palpable vibrations as a result of sound transmitting through lung tissue
What is the clinical significance of increased tactile vocal fremitus (3)?
- Consolidation pneumonia
- Tumour
- Lobe collapse
What is the clinical significance of decreased tactile vocal fremitus (3)?
- COPD
- Pleural effusion
- Pneumothorax
Which lymph nodes are assessed in a respiratory examination (11)?
How are lymph nodes assessed?
- Using the pads of the fingers in a circular motion palpate across all the cervical lymph node groups. Note:
- Size
- Mobility
- Tenderness
- Consistency
What is the clinical significance of lymphadenopathy?
- Infection
- Inflammation
- Malignancy
- Medication
- Benign idiopathic
How does COPD present (6)?
- Bilaterally decreased chest expansion
- Hyper-resonant percussion
- Polyphonic wheeze
- Prolonged expiratory phase
- Decreased tactile vocal fremitus
- Hyperinflated chest
How does pneumothorax present (5)?
- Decreased chest expansion ipsilaterally
- Tracheal deviation away from lesion if tension pneumothorax
- Hyper-resonant percussion over pneumothorax
- Decreased intensity of breath sounds on affected side
- Decreased tactile vocal fremitus on affected side
How does lobar collapse present (5)?
- Tracheal deviation towards lesion
- Decreased chest expansion ipsilaterally
- Dullness percussion
- Reduced breath sounds over affected area
- Increased tactile vocal fremitus
How does consolidation present (4)?
- Decreased chest expansion ipsilaterally
- Dullness to percussion
- Bronchial breath sounds over consolidation
- Increased tactile vocal fremitus
How does pleural effusion present (6)?
- Decreased chest expansion ipsilaterally
- Tracheal deviation away from lesion if extensive effusion
- Stoney dull percussion
- Reduced intensity breath sounds
- Bronchial breath sounds
- Reduced tactile vocal fremitus
How does fibrosis present (2)?
- Bilateral decrease in chest expansion
- Fine end inspiratory crackles
How does acute asthma present (4)?
- Bilateral decrease in chest expansion
- Hyper-resonant percussion
- Expiratory wheeze
- Prolonged expiratory phase
How are X-Rays in a Systematic Approach (ABCDE)?
-
Airway:
- Is the trachea central?
- Carina
- Trace the bronchi and hilar structures
-
Breathing:
- Lung borders
- Pleural borders - vasculature is not seen peripheral to this
-
Cardiac:
- The heart should be no more than half the width of chest cavity
- Right border: right atrium
- Left border: left Atrium and left ventricle
-
Diaphragm:
- Shape
- Assess costophrenic and cardiophrenic angles, note any blunting
-
Everything else:
- Mediastinal contours, bones, soft tissues and devices
