Thorax Examination Questions (Complete) [Respiratory Station] Flashcards
Please assess the temperature of the patient’s upper limbs
“Could you please put your arms out in front of you like this im just going to assess the temperature”
Using the dorsal part of your hands, assess for temperature on both sides of the ARM (just below the elbow). Move down towards the hands.
N.B. Cool hands may suggest poor peripheral perfusion, excessively warm and sweaty hands can be associated with CO2 retention.
Please assess for the patient’s heart rate.
“I would like to feel for the pulse in your wrist of thats okay with you?”
Feel for the radial pulse.
Ideally palpate for at least 30 seconds and x2 (60 seconds is a more accurate measurement).
Please assess the patient’s respiratory rate.
“Im just going to feel for your pulse on your wrist if thats okay?”
Count the number of inspirations for 60 seconds
Should be between 12-20 breaths per minute
Please assess the jugular venous pressure.
“Could you lay down for me and turn your head to the left?”
A raised jugular venous pressure can be visibly seen between the two heads of the sternocleomastoid muscle
Please assess the tracheal position
“Im now going to feel the position of your windpipe. Id like you to position your chin slightly downwards. Please let me know if you feel any discomfort okay?”
Use your index finger and apply gentle pressure to locate the border of the trachea and do the same on the opposite side
Please assess the cricosternal distance
“Im now going to feel the position of your windpipe. Id like you to position your chin slightly downwards. Please let me know if you feel any discomfort okay?”
Cricosternal distance is the distance between the inferior border of the cricoid cartilage and the suprasternal notch:
- Measure the distance between the suprasternal notch and cricoid cartilage using your fingers.
- In healthy individuals, the distance should be 3-4 fingers.
Please palpate the apex beat of the heart
“Im just going to feel your chest for the apex beat of the heart. Could you please lie down for me?”
Locate the midclavicular line and then the 5th intercostal space at the line visually for your examiner to see.
Feel for the apex beat alonge the 5th intercostal space
Please assess for chest expansion of the anterior chest wall.
“Im now going to assess the expansion of the chest. This will involve me placing my hands on your chest and asking you to take a deep breath in and out”
Place your hands on the chest inferior to the nipple and wrap hands around either sides of the chest. Bring thumbs together at the midline so that they touch.
Ask patient to take a deep breath in.
Check for symmetry
Please percuss the anterior lung fields
“Im just going to tap on your chest, please let me know if you feel any discomfort”
Middle finger on place you want to percuss and middle phalanx of other hand should tap on it.
Percuss supraclavicularly (for apex)
Percuss infraclavicularly
Percuss 3-4 regions bilaterally on the anterior chest wall [ideally 2nd and 6th ICS]
Percuss the axilla (Sides of chest)
Please auscultate the anterior lung fields
“Im just going to have a listen to your chest, id like you to take deep breaths in and out for me”
Auscultate the supraclavicular regions (Use the small bell here and large bell for rest)
Auscultate the infraclavicular regions
Auscultate 3-4 locations bilaterally
Ausculatate the axilla
Please assess for anterior vocal tactile fremitus
“Im going to place my hand on different areas of your chest. Everytime you feel my hands placed on your chest id like for you to say “ninety nine”.
Place the lateral (pinky side) side of hand on areas where you usually asucultate and compare difference in vibration between the two sides.
Please palpate the lymph nodes and name them as you go along
“Id like to ask you to sit up for me, id like to examine for any glands in your neck, please let me know if you feel any discomfort”
Submental
Submandibular
Pre-auricular
Post-auricular
Superficial cervical
Deep cervical
Posterior cervical
Supraclavicular
N.B. Look at the geekymedics video
Please assess the posterior chest wall expansion
“Could you please sit up for me? Im just going to wrap my hand around your back and ask you to take deep breaths in and out for me”
Ask to take a deep breath in and out and look for symmetry in expansion
Please percuss the posterior chest wall
“Im just going to tap your back. Could you fold your arms in front of you for me?”
Areas of percussion
Please auscultate the posterior chest wall .
“Im just going to have a listen to your chest. Could you please sit up for me and fold your arms and just take deep breaths in and out for me”.
Please assess for posterior tactile vocal fremitus
“Im going to place my hands on your back like this and each time you feel my hands and like you to say 99 for me”
Use lateral side of hands (pinky)
