Respiratory Examination

Question 1

Components?

Answer 1

Introduction
Inspection
Palpation
Percussion
Auscultation

Question 2

Introduction?

Answer 2

1. Ensure adequate hygiene of hands and stethoscope
2. Introduce self and confirm patient’s name
3. Ask if patient is in any discomfort
4. Explain the procedure
5. Seek permission to examine the respiratory system
6. Position patient appropriately with chest adequately
   exposed (45 degrees, shirt off)

Question 3

General inspection?

Answer 3

1. Inhalers / nebulisers / oxygen / sputum pot
2. Signs of respiratory distress:
   – Nasal flaring
   – Tracheal tug
   – Sternal recession
   – Intercostal recession
   – Subcostal recession
3. Weight loss

Question 4

Inspection of hands?

Answer 4

1. peripheral cyanosis
2. tar staining
3. finger clubbing
4. flapping tremor
5. Palpate radial pulse: rate and rhythm and volume

Question 5

Respiratory causes of clubbing?

Answer 5

1. Chronic suppurative lung disease (abscess, bronchiectasis)
2. Ca Bronchus / mesothelioma
3. Pulmonary fibrosis

Question 6

Inspection of face, eyes and mouth?

Answer 6

1. Cyanosis
2. Plethora
3. Lip-pursing

Question 7

Inspection of chest?

Answer 7

chest shape, scars and deformities, pattern of breathing
Count respiratory rate

Question 8

Inspection of chest?

Answer 8

chest shape, scars and deformities, pattern of breathing
Count respiratory rate

Question 9

Types of chest deformities?

Answer 9

1. pectus carinatum
2. pectus excavatum
3. rickets
4. barrel chest

Question 10

Palpation of neck and chest?

Answer 10

1. Cervical lymphadenopathy (done when patient sitting
   forward)
2. Check position of trachea
   - normally in midline
3. Locate the apex beat
   - normally in 5th ics, mid-clavicular line
4. Assess chest expansion anteriorly (and posteriorly when patient sitting forward)
   - placing hands around the rib cage

Question 11

Describe the percussion of the chest?

Answer 11

Percuss front of chest, laterally (and posteriorly)
Note: If areas of dullness on percussion, test for vocal fremitus or
test for vocal resonance after auscultation

Question 12

What is Tactile / Auditory Vocal Fremitus?

Question 13

What does each percussion note mean?

Answer 13

1.normal resonance - normal
2. hyper resonant - pneumothorax, emphysema, bulla
3. dull - consolidation
4. stony dull - effusion

Question 14

What can Tactile / Auditory Vocal Fremitus be used for?

Answer 14

Use TVF or AVF to distinguish consolidation from effusion:
* Consolidation: INCREASED VF
* Effusion: DECREASED VF

Question 15

Auscultation of chest?

Answer 15

Auscultate front of chest.
* (If areas of dullness on percussion and vocal
fremitus not performed, test for vocal
resonance.)
* Sit patient forwards. Neck lymph node exam,
inspection, expansion, percussion and
auscultation posterior chest

Question 16

Types of breath sounds?

Answer 16

Vesicular (normal) breath sounds are:
* Soft / quiet
* No inspiratory / expiratory gap
– Bronchial breath sounds (= consolidation) are:
* Louder / harsher
* Gap between inspiration and expiration
* Sounds like listening over trachea

Question 17

Name and describe any potential added sounds?

Answer 17

Wheeze (small airway narrowing):
* High pitched, musical
* Often prolonged expiration
– Crackles (opening of fibrosed alveoli or alveoli full of fluid /
pus / mucus)
* Do they clear with coughing?
* Common in the lung bases with heart failure or bronchiectasis
– Stridor (upper airway narrowing):
* Harsh noise heard in inspiration