Week 1

Question 1

What is a normal respiratory rate?

Answer 1

12-16 breaths/minute

bradypnoea= <10
tachypnoea= >20

Question 2

What is a normal blood pressure?

Answer 2

120/80

hypotension= <90/60
hypertension= >140/90

Question 3

What is a normal heart rate?

Answer 3

60-100 beats/minute

bradycardia= <60
tachycardia= >100

Question 4

What is a normal SPO2 reading?

Answer 4

> 96%

Question 5

What are the 5 key respiratory questions?

Answer 5

breathlessness
cough
sputum (+ haemoptysis)
wheeze
chest pain

Question 6

How do you calculate pack years for smokers?

Answer 6

number of packs per day x years smoking

i.e. 1 pack per day for 30 years= 30 pack years

OR number of cigarettes smoked per day x years smoked / 20

Question 7

Describe the 4 chest shapes.

Answer 7

normal
pectus carinatum (pigeon chest)
pectus excarvatum (concave)
barrel chest

Question 8

What different types of breathing patterns might we come across?

Question 9

Where do we place our hands and what are we feeling for during palpation of breathing?

Answer 9

Ribs 7-10 with knuckles in the mid-axillary line.

Feeling for temperature, bibasal expansion, fremitus (retained secretions) & subcutaneous emphysema (air trapped under the skin)

Question 10

Landmarks for auscultation for upper lobe segments.

Answer 10

Apical (only if UL involved)= above clavicle anteriorly

Anterior= ribs 2-4 just below mid clavicle

Posterior= opposite spine of scap at T3

Question 11

Landmarks for auscultation for middle lobe segments.

Answer 11

R= ribs 4-6 mid axillary line level of nipple

L (lingular segment of UL)= same as above

Question 12

Landmarks for auscultation for lower lobes.

Answer 12

lateral= ribs 6-8 lateral mid axillary line

anterior= ribs 6-8 anterior 45 degrees down from the nipple

apical= at T7 medial to the inferior angle of the scapula

posterior= at T10 same line as previous

Question 13

Describe the different types of breath sounds we might hear during auscultation.

Answer 13

normal/vesicular breath sounds

bronchial breath sounds (louder due to consolidation/reduced attenuation)

reduced breath sounds overall or locally (pleural effusion or local obstruction)

Question 14

What are added sounds that may be heard during auscultation?

Answer 14

wheeze (more marked on expiration, airway reduced due to spasm, oedema, mucus, tumour, foreign body)

stridor (more marked on inhalation, it is an extrathoracic wheeze and occurs in croup, laryngeal oedema and tracheal stenosis)

crackles (course= retained secretions, fine end inspiratory= atelectasis, fine= could be interstitial pulmonary fibrosis or heart failure)

Question 15

Describe a circulation check.

Answer 15

DVT= colour, temperature, palpation/tenderness, Homan’s sign (passive DF)

Pulses= dorsal pedal & posterior tibial

capillary refill

Question 16

Describe an epidural check.

Answer 16

check the site of the epidural for any abnormal colouring/swelling etc

ask about:
pins & needles
numbness
weakness
heaviness
headaches
nausea/vomiting

neurological check= all dermatome & myotome points below level of epidural