Respiratory examination

Question 1

Key questions from the history

Answer 1

Breathlessness->severity with activity, poor weight gain
Cough->chronology, nature
Feeding in infancy->choking, symptoms with induction of formula
Fever
Noisy breathing->wheeze, stridor

Cough, wheeze or stridor->if sudden onset, was there a foreign body

ENT:
Pulling at ears
Difficulty swallowing
Offensive odour breath
Nasal secretions, bleeding

Family history:
Asthma, CF
Atopy
Smokers, pets
Travel to area of high TB prevalence

Question 2

Observation

Answer 2

Respiratory distress
Respiratory rate
Wheeze, stridor, grunting
Restless or drowsy
Cyanosis or pallor
Finger clubbing->CF, bronchiectasis

Question 3

Chest wall palpation

Answer 3

Assess expansion
Check trachea
Feel apex beat
Chest deformity
Crackles

Question 4

Types of chest wall deformity

Answer 4

Harrison’s sulcus
Barrel chest
Pectus excavatum->MVP, marfan’s
Pectus carinatum->idiopathic or severe asthma

Question 5

Percussion

Answer 5

Resonant
Hyper-resonant
Dull
Stony dull

Question 6

Auscultation: absent, bronchial + crackles, wheeze

Answer 6

Absent breath sounds->pleural effusion, pneumothorax, consolidation
Bronchial breathing + crackles->consolidation
Expiratory wheeze in asthma and bronchiolitis
In young children, sounds transmitted across whole chest

Question 7

Ear nose and throat: red and buldging, dull and retracted

Answer 7

Examine ear drums
Red and buldging->OM
Dull and retracted->CSOM
Nostrils->swollen, polyps, obstruction
Pharynx
Cervical lymphadenopathy

Question 8

Age and RR at rest: 12

Answer 8

12= 15-20