Respiratory examination

Question 1

General inspection

Answer 1

Look for:
– breathlessness
– weight loss within the pt
– cyanosis
– chest deformity (pectus carinatum or pectus excavatum)
– look for any equipment they may use to help them breath like asthma inhalers
– look for any general confusion (severe pneumonia) or distress

Question 2

Breathing rate

Answer 2

Assess breathing, listening out for any stridor while the pt is breathing

Listen if there’s any reduction in breath sounds as that may suggest a pneumothorax

Question 3

Hands

Answer 3

Look for:
– tobacco ‘tar’ staining
– peripheral cyanosis (circulation problems or cold)
– finger clubbing (lung malignancy, fibrosis, chronic infection)
—- most often associated with the brackets
— most cases have thoracic disease but it can also be due to GI disease like ulcerative colitis

– hypertrophic pulmonary osteoarthropathy
—- can squeeze wrist as painful swelling in the wrists and ankles

– look for tremor
—- flapping is seen with ventilatory failure

Question 4

Neck and face

Answer 4

Look for JVP

Look for accessory muscle use when breathing:
– these muscles being used is associated with people with COPD and severe acute asthma

Lateral shift of trachea:
– place finger into suprasternal notch (warn pt it can be uncomfortable)
– distance between sternum and cricoid cartilage, usually 3-4 finger pads

Central cyanosis:
– look in mouth and around mouth for central cyanosis

Question 5

Chest

Answer 5

Use hands to detect if there’s symmetrical chest expansion (normal)

Percussion notes:
– resonant percussion note should be heard if its over normal lung
– dull noise over solid structures like the liver etc
—- also pulmonary consolidation, pulmonary collapse, severe pulmonary fibrosis
– hypersonnant over pneumothorax
- stony dull- pleural effusion, haemothorax
(do either side staring with just above clavicle and go down a little bit each time and tap)
(do each side as well around the serratus anterior area)

Question 6

Ausculatation

Answer 6

Get pt to breath in and out deeply with the mouth
– dont get pt to do this for a prolonged period of time as it can cause dizziness for the pt

Either side start above clavicle (on the neck), can get pt to say Scooby doo when your in this position down to the 6th rib

Dont get too close to the centre as you might get sounds from the trachea etc

Get pt to say 1,1,1

Pt can also whisper- whisper won’t be heard with normal lung, but is transmitted with consolidated lung in pneumonia for an example

Abnormal sounds you may here:
- diminished breathing:
– causes:
—- obesity/thick chest wall
—- pneumothorax
—- pleural effusion
—- COPD (reduced airflow)

• bronchial breathing:
  – causes:
  —- lung consolidation (pneumonia) (most common)
  —- localised pulmonary fibrosis (less common)

There may also be:
– wheeze (implies airway narrowing)
– crackles
– stridor
– pleural rub

Question 7

Posterior

Answer 7

Chest wall expansion (look at the movement of the thumbs)

When percussing:
– get pt to cross their arms for the superior part of the chest wall as it abducts the scapula