Respiratory examination Flashcards
What is the first part of any introduction to an examination?
Wash hands
Introduce yourself
Patient details (Name, DOB + age)
Explain a resp exam to a patient
I’ve been asked to examine your chest today, it’s going to involve me having a general inspection of your arms, face and chest before having a feel of your chest and back and having a listen with my stethoscope.
What else would you include in an intro?
Expose pt
Chaperone
Pain or discomfort
In a respiratory exam what do you inspect?
Bedside
General inspection of patient
Hands
Temperature
Radial pulse
Jugular venous pressure (JVP)
Face
Eyes
Mouth
Chest
When inspecting a bedside in a respiratory exam what might you see?
Inhalers
Nebs
O2 mask
sputum pot
When inspecting a patient generally in a respiratory exam what are you looking for?
Colour
Breathing
Comfort
Position
Purse-lipped breathing
SOB
Nutritional state
In what condition do you see pursed lip breathing?
COPD
In terms of a respiratory exam what might obesity suggest?
obstructive sleep apnoea
What does cachexic mean?
What does it indicate in a resp exam?
Wasting of muscle and fat
Malignancy
Cystic fibrosis
COPD
How might age impact your diagnosis in a resp exam?
Younger is more likely asthma or cystic fibrosis.
Older more likely COPD / interstitial lung disease / malignancy.
What might a dry cough indicate in a resp exam?
Asthma
ILD
What might a productive cough indicate in a resp exam?
Bronchiectasis
COPD
CF
What might additional breathing sounds indicate in a resp exam?
a) Wheeze
b) Stridor
c) Difference between the two
a) Asthma / COPD / bronchiectasis
b) Upper airway obstruction
c)Wheeze = expiratory whereas stridor = inspiratory
When inspecting the hands what are you looking for?
Finger clubbing;
Tar staining;
Wasting of the intrinsic muscles;
Features of rheumatological disease (joint swelling / tenderness);
Fine tremor;
Flapping tremor;
Skin changes;
Colour;
In a resp exam what can the following indicate?
a) Finger clubbing
b) Tar staining
c)Wasting of intrinsic muscles
d) features of rheum diseases
e) fine tremor
f) flapping tremor
a) Lung cancer / ILD / Bronchiectasis.
b) Increased risk of COPD/lung cancer.
c) T1 nerve invasion by an apical lung cancer.
d) Rheumatological diseases, such as rheumatoid arthritis
can be associated with pleural effusions + pulmonary
fibrosis.
e) Beta-2 agonist use (salbutamol).
f) Coarse flapping tremor suggests CO2 retention.
In a resp exam what can the following indicate?
a) Skin changes in the hands
b) Colour of the hands
c) Cool peripheries (temp of hands)
a) Bruising/thinning of skin are associated with long-term
steroid use (ILD/asthma/COPD).
b) Peripheral cyanosis suggest hypoxia.
c) Poor perfusion/peripheral vasoconstriction.
How do you asses for a flapping tremor?
How long in do you assess for it in the OSCE?
Ask patient to bend wrists + maintain for 15 seconds
5 seconds in OSCE
When palpating the radial pulse in a respiratory exam what are you assessing for?
How long do you assess them for?
BPM (rate)
Rhythm
RESP RATE
pulsus paradoxus
15 secs for HR and RR
What does a bounding pulse indicate?
CO2 retention
What is a normal RR?
Normal = 12–20 breaths/min