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Physical examination 2B > Respiratory examination > Flashcards

Respiratory examination Flashcards

1
Q

What are the introductory steps for a respiratory examination?

A
  • Wash hands
  • Put on PPE
  • Introduce yourself to the patient
  • Ask name and DOB.
  • Explain the examination.
  • Acquire consent.
  • Offer a chaperone.
  • Adjust bed head to 45.
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2
Q

What comes after the introduction?

A

General inspection.

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3
Q

What does general inspection entail?

A

Inspect around the bed for any equipment/medications.

Inspect the patient:
- Build?
- Breath rate?
- General comfort level?

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4
Q

What comes after general inspection?

A

Inspection of the hands.

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5
Q

What can be picked up on from inspection of the hands?

A
  • Clubbing? (Bronchiectasis, lung cancer, ILD, CF)
  • Colour? (Pallor - anaemia. Cyanosis - Hypoxia).
  • Tar staining? Suggestive of a heavy smoking history).
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6
Q

What comes after inspection of the hands?

A
  • Flapping tremor test.
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7
Q

How is the flapping tremor test conducted?

A
  • Extend wrists and elbows in front of patient.
  • Hold there for 10 seconds.
  • Flap suggestive of hypercapnia.
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8
Q

What comes after the flapping tremor test?

A
  • Radial pulse assessment.
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9
Q

What can be picked up on from a radial pulse assessment?

A
  • Bounding pulse suggestive of CO2 retention.
  • Pulsus paradoxus. Get patient to take a deep breath in and hold. If some beats become unpalpable in the radial pulse, but they can be auscultated using a stethescope directly on the heart, this is a +ve pulsus paradoxus.

Pulsus paradoxus is suggestive of severe respiratory disease or cardiac tamponade.

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10
Q

What comes after assessment of the radial pulse?

A

Measure the BP of the patient (probably not in OSCE).

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11
Q

What comes after BP measurement?

A
  • JVP assessment.
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12
Q

How is JVP assessed.

A
  • Ensure bed has been set at 45.
  • Get patient to look over their left shoulder.
  • Look for a dual-pulse waveform in the neck.
  • Measure the distance between this and the angle of Louis.
  • If greater than 3cm, suggestive of a raised JVP (cor pulmonale).
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13
Q

What comes after JVP assessment?

A
  • Assessment of breathing.
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14
Q

How is breathing assessed?

A

Observe the breathing of the patient for approx. 10s, noting:
- Rate
- Rhythm
- Effort
- Pursed lips?

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15
Q

What comes after assessment of breathing?

A
  • Inspection of face.
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16
Q

What can be picked up on from facial inspection?

A

Eyes:
- Conjunctival pallor (anaemia).
- Eyeball displacement (Horner’s syndrome).
- Conjunctival oedema (CO2 retention, COPD).

Mouth:
- Central cyanosis (hypoxia).

17
Q

What comes after facial inspection?

A

Palpation of the neck.

18
Q

How is the neck palpated and what are the potential findings?

A

Palpate the trachea, checking it is central:
- Deviates towards collapsed lung or pulmonary fibrosis.
- Deviates away from pneumothorax.

Palpate the cricosternal distance.
- Should be 3-4 fingertips long.

19
Q

What comes after neck palpation?

A

At this point, ask the patient to remove their top and reoffer a chaperone.

Palpation of the cervical lymph nodes.

20
Q

What comes after palpation of the cervical lymph nodes?

A

Inspection of the chest.

21
Q

What are the potential findings of inspection of the chest?

A
  • Surgical scars.
  • Asymmetrical breathing.
  • Reduced breath volume.
  • Barrel chest? (COPD).
  • Use of accessory muscles (increased resp. effort).
22
Q

What comes after inspection of the chest?

A

Palpation of the chest.

23
Q

How is the chest palpated?

A

Wrap hands around the chest wall just inferiorly to the nipple, with thumbs medial. Ask the patient to breathe in and out deeply:
- Normally, thumbs should move up and out during breath in, and down and in during a breath in.

Palpate the chest for the apex beat (usually in the fifth intercostal space at the midclavicular line).

24
Q

What comes after palpation of the chest?

A

Percussion of the chest.

25
Q

What are the different locations for percussion of the anterior chest?

A
26
Q

What can the findings from percussion of the chest tell you?

A
  • Dull = area of consolidation/lobar collapse.
  • Resonant = pneumothorax, pleural effusion.
27
Q

What comes after percussion of the chest?

A

Auscultation of the chest.

28
Q

What are the different locations for auscultation of the anterior chest?

A
29
Q

What are the different sounds that can be heard during auscultation of the chest?

A
  • Normal breath sounds.
  • Bronchial breath sounds (harsh breath sounds). Associated with consolidation.
  • Wheeze (constant whistling sound present throughout breathing). Associated with obstructive respiratory disease.
  • Quiet breath sounds. Associated with reduced air entry to an area, as seen in pneumothorax/pleural effusion.
  • Crackles (brief popping sounds). Suggestive of PF, bronchiectasis, pneumonia.
30
Q

What comes after auscultation of the chest?

A

Vocal resonance test.

31
Q

How is vocal resonance tested?

A

Auscultate each of the areas previously auscultated, but get the patient to say “ninety-nine” each time. Listen to how well this is transmitted (the volume):
- Loud is suggestive of consolidation or collapse.
- Quiet is suggestive of pleural effusion or pneumothorax.

If suspected to be loud, get patient to whisper “two-two-two” while auscultating the area - this will further pronounce any hyper-resonance.

32
Q

What comes after vocal resonance test?

A

CHECK THE PATIENT IS ABLE TO SIT FORWARDS.

Repeat inspection, palpation, percussion and auscultation on the posterior chest wall whilst the patient sits forwards.

33
Q

Where are the locations of percussion and auscultation on the posterior chest wall?

A
34
Q

What comes after posterior chest assessment?

A

Assessment of the ankles for oedema.

35
Q

What comes after ankle assessment?

A

Conclusion with the patient

36
Q

How is the examination concluded with the patient?

A
  • Thank the patient for their time.
  • Ask them to redress.
37
Q

What comes after conclusion with the patient?

A
  • Check sputum pot if available.
38
Q

How is the examination concluded in an OSCE?

A
  • Wash hands.
  • Report key findings to examiner.
  • Say you would like to assess peak flow, and assess a sputum culture (if this was not available).

Physical examination 2B (13 decks)

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