Thoracic examination for respiratory disorder

Question 1

What is the order of examination for respiratory disorder?

Answer 1

Inspection, palpation (general, symmetrical expansion, tactile fremitus), percussion, ausculation

Question 2

what are 6 features you should comment on during inspection of the thoracic region?

Answer 2

• facial expressions (colour, difficulty breathing)
• respiratory rate
• use of accessory muscles of respiration
• shape of the chest e.g. barrel shaped
• position of the spine (medially aligned)
• location of the scapula (should be even

Question 3

What is included in the general palpation of the thoracic region?

Answer 3

Palpates beginning at apex, using gentle circular motion of the fingers, downwards and sides. Uses back of hands to check temp. Palpates the lower angles of scapula at T8 (comment on symmetry). Comments on any pain or tenderness, lumps or bumps, and temperature.

Question 4

What is symmetrical expansion checking for?

Answer 4

Pneumothorax (collapsed lung) or scoliosis

Question 5

What is involved in tactile fremitus?

Answer 5

Get the patient to say “blue moon” over and over again as you palpate the posterior thorax

Question 6

What should the outcome of tactile fremitus look like?

Answer 6

Symmetrical vibration, that decayed as you descended

Question 7

What are some common causes of tactile fremitus differing?

Answer 7

COPD, mucus, tumour, mass

Question 8

What are the different sounds you hear during percussion?

Answer 8

Hollow = good
Dull = mass

Question 9

Where are the bronchovesicular sounds heard?

Answer 9

Along the sides of the spine

Question 10

Where are the vesicular sounds heard?

Answer 10

Along the sides of the spine lower down

Question 11

If there are abnormal sounds on auscultation, what could this be indicative of?

Answer 11

Asthma, COPD