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Clinical skills Yr2 > Respiratory examination: Anterior and posterior > Flashcards

Respiratory examination: Anterior and posterior Flashcards

1
Q

What is the general order of the respiratory exam?

A

Look

Feel: Tracheal deviation, cricosternal distance, apex beat, auscultation, percussion, vocal resonance

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2
Q

When looking at the patient, how should you position them?

A

Lying supine (on back) on the bed at 45 degrees raised angle

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2
Q

What 3 types of respiratory signs do you look for in the respiratory exam?

A

Chest signs

Hand signs

Face signs

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3
Q

Before you start the respiratory examination, how should you ask the patient to expose their chest with 2 points?

A
  1. Ask patient if they would be comfortable with removing their shirt:
    ‘Would you be comfortable with removing you shirt so I can examine your chest?’
  2. Ask patient if they want a chaperone with them
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4
Q

What 8 general signs should you look for at the start of the respiratory exam?

A

Cyanosis
Wheezing
Pallor
Cough
Edema
Cachexia
Dyspnea
Flail chest

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5
Q

What is peripheral cyanosis and how do you identify it when looking at the patient in the respiratory exam, and what is the clinical significance?

A

Blue skin discolouration most obvious around lips, mouth, ears, distal extremities

Occurs when oxygen saturation is below 85%, causing increased conc of deoxyhaemoglobin which has blue colour

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6
Q

What is the clinical significance of flail chest and what are the 4 main signs in a respiratory exam?

A

Life-threatening condition where segment of rib cage breaks due to trauma and detaches from chest wall

Paradoxical movement of chest wall where broken segment draws in when patient inhales and chest expands, and segment moves out when patient exhales and chest shrinks

Dyspnea

Chest pain

Bruising in affected area

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7
Q

What 5 medical paraphernalias should you look for in the respiratory exam?

A

Oxygen delivery devices and masks

Sputum pot

Inhalers, nebulisers

Cigarettes, vapes

Prescriptions

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8
Q

What 8 hand signs should you look and feel for in the respiratory exam?

A

Peripheral cyanosis of the fingertips

Clubbing

Fine tremor

Flapping tremor

Tar staining

Temperature

Thenar and hypothenar muscle wasting

Radial and ulnar pulses

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9
Q

What does tar staining look like in a respiratory exam, and what does it indicate?

A

Brownish stains near fingertips and under nail beds

Indicates cigarette smoking

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10
Q

What does finger clubbing in a respiratory exam indicate, and give 5 conditions that can cause this?

A

Indicates hypoxemia

Pleural effusion
Lung cancer
Bronchiectasis
ILD
CF

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11
Q

How should you look for a fine tremor in the respiratory exam, and what does it indicate?

A

Ask patient to hold out their hands and look from the side

Indicates long-term beta-2 antagonist use eg. salbutamol inhaler

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12
Q

How should you look and feel for fingertip clubbing in a respiratory exam?

A

Looking: Fingers will look clubbed at the end

Feeling: Palpate the nail beds and nails, nail beds will be very soft and spongy and nails will float and bounce

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13
Q

What does a flapping tremor/asterixis look like and what causes it, in a respiratory exam?

A

Jerking hand movements when trying to extend wrist, that resemble bird wing flapping

Ask patient to extend their wrist and see if flapping occurs

CO2 retention in conditions like COPD

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14
Q

Where should you palpate the hand for temperature in a respiratory exam, and what does it indicate?

A

Palpate dorsal and palmar surfaces

Cold temperature: Poor peripheral perfusion

Hot temperature and sweating: CO2 retention

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15
Q

After you have measures the radial and ulnar pulses in the respiratory exam, what should you measure?

A

Respiratory rate

16
Q

What 3 face signs should you look for in the respiratory exam?

A

Facial plethora

Conjunctival pallor

Central cyanosis of the tongue

17
Q

How do you look for facial plethora in a respiratory exam, and what 2 conditions can it indicate?

A

Reddened, flushed skin

Indicates secondary polycythemia or CO2 retention conditions eg. COPD

18
Q

How do you look for conjunctival pallor in a respiratory exam, and what condition can it indicate?

A

Ask patient to pull down lower eyelid and look for paleness

Indicates anaemia

19
Q

How do you look for central cyanosis of the tongue?

A

Ask patient to stick out tongue and look for purple/blue colour

20
Q

When palpating the patient’s neck, what 2 things do you feel for in the respiratory examination?

A

Tracheal deviation

Cricosternal distance

21
Q

How do you feel for tracheal deviation in the respiratory exam?

A
  1. Ask patient to position chin slightly downwards to relax neck muscles
  2. Warn patient that this can feel slightly uncomfortable and that you’ll gently palpate neck
  3. Start palpating at suprasternal notch then move up and place a finger on each side of trachea
  4. Feel if distance between each side of trachea and SCM muscle is symmetrical, asymmetry indicates deviation
22
Q

Give 4 causes of tracheal deviation?

A

Trachea deviated towards areas with lower pressure and away from areas with higher pressure

Deviation away: Pneumothorax, pleural effusion

Deviation towards: Lobar collapse, pneumonectomy

23
Q

What is the cricosternal distance?

A

Distance between suprasternal notch and inferior border of cricoid cartilage

In men, the cricoid cartilage is the adam’s apple

24
Q

How do you measure the cricosternal distance in a respiratory examination, and what is the normal distance?

A
  1. Warn patient that this might be slightly uncomfortable
  2. Use fingertips to measure distance between suprasternal notch and inferior border of cricoid cartilage
  3. Normal distance is 3-4 fingertips, less indicates hyperinflation
25
Q

In the respiratory examination, what should you palpate first on the chest, and what abnormality are you checking for?

A

Apex beat

Displaced apex beat indicates cardiomegaly

26
Q

Where is the apex beat located, and how do you check for a displaced apex beat?

A

Located on 5th intercostal space/mid-clavicular line, under nipple

  1. Place fingers horizontally and feel for beat
27
Q

What are the 3 main respiratory causes of a displaced apex beat?

A

Cardiomegaly due to COPD, ILD

Pneumothorax

Large pleural effusion

28
Q

How do you palpate chest expansion in the anterior respiratory exam?

A

Upper chest: Place hands on shoulders and ask patient to take deep breaths in and out, see if hands move symmetrically

Lower chest: Place hands on chest under mid-clavicular line with thumbs lightly fixed and pinky fingers firmly fixed at costal margins. Ask patient to take deep breaths in and out and see if hands move symmetrically

29
Q

How do you palpate chest expansion in the posterior respiratory exam?

A

Place hands flat on back with thumbs under inferior border of scapula and pinky fingers firmly fixed on lateral thorax

Ask patient to take deep breaths in and out and see if hands move symmetrically

30
Q

Give 3 causes of asymmetrical/unilateral chest expansion in the respiratory exam?

A

Pneumonia

Pneumothorax

Pleural effusion

Reduced chest expansion on affected side

31
Q

Give 2 respiratory causes of bilateral reduced chest expansion?

A

Asthma

COPD

32
Q

Which 6 landmarks do you percuss in the respiratory exam?

A

Supraclavicular
Infraclavicular
Supramammary
Inframammary
Upper axillary
Lower axillary

33
Q

Which 6 landmarks do you auscultate in the respiratory exam?

A

Supraclavicular
Infraclavicular
Supramammary
Inframammary
Upper axillary
Lower axillary

34
Q

Which 6 landmarks do you check for vocal resonance in the respiratory exam?

A

Supraclavicular
Infraclavicular
Supramammary
Inframammary
Upper axillary
Lower axillary

35
Q

When looking at the patient, what should you look for in their general posture?

A

Kyphoscoliosis

Clinical skills Yr2 (9 decks)

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