Respiratory Examination

Question 1

Briefly outline the steps of this examination

Answer 1

• Wash hands
• Introduce self, identify patient
• Explain procedure, consent
• Any questions, pain or discomfort
• End of bed assessment
• Hand examination & capillary refill & diamond test
• CO2 retention flap
• Pulse & respiratory rate
• Face examination - eyes & mouth
• JVP
• Inspection of chest
• Trachea palpation
• Chest expansion
• Lung percussion (anterior & lateral)
• Lung auscultate (anterior & lateral)
• Lymph node examination
• Chest expansion
• Lung percussion (posterior)
• Lung auscultate (anterior)
• Leg examination
• Special tests - Vocal resonance, tactile vocal fremitus
• Thank patient, discuss findings, wash hands

Question 2

Which lymph node regions should you palpate?

Answer 2

submental, submandibular, anterior triangle, posterior triangle, pre-auricular, post-auricular, occipital, supraclavicular

Question 3

Describe how to assess JVP

Answer 3

45 degrees, facing left, measure vertical height from sternal angle to internal jugular vein pulsation

Hepatojugular reflex

Question 4

What are you looking for when examining the leg

Answer 4

pitting oedema, rash, and signs of DVT

Question 5

What are you looking for when examining the hands

Answer 5

• General - thin skin, bruising, cyanosis
• Palm - Palmar erythema
• Dorsal surface - tar staining, koilonychia
• Index finger diamond window - finger clubbing

Question 6

When inspecting the anterior chest where else should you look

Answer 6

• Anterior, lateral, posterior, axillae

Question 7

What should you do if you find an area of dullness on percussion

Answer 7

• vocal resonance (99)
• tactile focal fremitus

Question 8

Describe how you would percuss the lungs

Answer 8

• Percuss both lung fields, starting at apices, then moving inferiorly
• Compare sides by percussing the left side of the chest and the right side of the chest at the same levels
• Percuss all areas - anterior, posterior, lateral
• Note any dullness or hyper-resonance of lung fields
• Be aware of cardiac dullness and hepatic dullness
• 5 anterior, 5 posterior, 3 lateral

Question 9

Describe how you would auscultate the lungs

Answer 9

• Auscultate both lungs, starting at apices, then moving inferiorly
• Compare sides by auscultating the left side of the chest and the right side of the chest at the same levels
• Listen to the full inspiration-expiration cycle at each level, noting air entry, breath sounds, character, and any added sounds
• Auscultate all areas - anterior, posterior, lateral
• 5 anterior, 5 posterior, 3 lateral