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*3. Thorax > Clinical skills: respiratory history and exam > Flashcards

Clinical skills: respiratory history and exam Flashcards

1
Q

What are the systems review questions?

A

URTIs - runny nose, sore throat, sneezing, post nasal drip, ear blockage/pain/discharge

Coughing
Wheezing
Stridor
Dyspnea

Sputum
Haemoptysis
Epistaxis

Chest pain
Face pain

Hoarseness of voice
Snoring/apnea

Fatigue
Fever
Unexplained weight loss
Night sweats

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2
Q

What are the 4 risk factors? Where do you ask?

A

Exposure to allergens/irritants (in PMHx)
Smoking (DASH)
Occupation
Recent travel

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3
Q

What are the steps to the respiratory exam?

A

Initial approach
General inspection
Vital signs
Hands and wrists
Face
Neck
Chest
Heart
Liver
Lower limb

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4
Q

INITIAL APPROACH
What three things should you do?

A

Initial 7 steps
Position patient correctly and examine with adequate exposure
Ask patient if they’re in pain/discomfort before and during exam.

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5
Q

GENERAL INSPECTION
What are you looking for?

A

Cough/breathing
- Cough
- Wheeze
- Stridor
- Dyspnea

  • Use of accessory muscles during breathing
  • Breathing pattern (rate, depth, symmetry, normal rise and fall)

Voice
- Hoarseness

Face
- Pallor
- Plethora (red cheeks)

General
- Body build
- Hydration
- Cigarette packet

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6
Q

VITAL SIGNS
What vital signs should you measure?
Is it okay to skip?

A

Blood pressure
Pulse
Respiratory rate
Pulse oximeter
Temperature

Pulsus paradoxus

Yes

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7
Q

HANDS AND WRISTS
What are you looking for?

What are you feeling for?

A

Look
- Peripheral cyanosis
- Clubbing
- Tar staining
- Muscle wasting

Feel
- Muscle weakness (grip strength)
- Wrist tenderness
- Flapping tremor

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8
Q

HANDS AND WRISTS
What might muscle wasting on one side be due to?
How to test for flapping tremor?

A

Apical lung tumour - affects the brachial plexus
Get patient to put arms out in front of them, extend wrists and abduct fingers. Ordinarily would get to hold for 1 minute. Looking for hands flapping like a bird.

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9
Q

FACE
What to inspect for?

A

General
- Plethora (red cheeks)
- Icterus (jaundice)

Eyes
- Icterus (jaundice - whites)
- Pallour (conjunctiva)
- Horner’s syndrome

Nose
- Paranasal sinuses

Mouth/throat
- Crowding of pharynx
- Central cyansosis (tongue)
- Teeth

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10
Q

What is the cause of Horner’s syndrome, and signs?

A

Apical lung tumour
Small pupil, no sweating on side of face

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11
Q

Neck: what 5 things?

A

Pemberton’s sign for one minute
Trachea position
Trachea tug
JVP
Cervical lymph nodes

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12
Q

NECK
How to perform Pemberton’s sign?

A

Get patient to hold hands above head for 1 minute

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13
Q

NECK
What are 3 key features of Pemberton’s sign?

A

Facial congestion
Cyanosis
Difficulty breathing

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14
Q

NECK
What is the cause of Pemberton’s sign?

A

Due to thoracic outlet obstruction (SVC syndrome) due to a mass in the mediastinum – eg. tumour, retrosternal goitre, mediastinal lymphadenopathy

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15
Q

NECK
What are the 9 lymph node groups you need to feel for, in order?

A

Submental, submandibular, pre-aureicular, post aureicular, posterior chain, supraclavicular, subclavicular, anterior chain, occipital

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16
Q

CHEST - BACK
What are the 4 steps?

A

Inspect
Palpate
Percuss
Auscultate

17
Q

CHEST - BACK
What are we inspecting for?

A

General shape
- Chest deformities (barrel, pigeon, funnel)
- Spinal deformities (kyphosis, lordosis, scoliosis)

Skin
- Scars or rashes
- Prominent veins
- Swelling

Lungs
- Symmetry of breath movement
- Use of accessory muscles
- Harrison’s sulcus
- Hoover’s sign

18
Q

CHEST - BACK
What are you palpating for?

A

Chest expansion
Rib pain
Subcutaneous emphysema (bubbles under skin above the scapula)
Tactile fremitus

19
Q

CHEST - BACK
Where do you percuss?
How to report normal finding?

A

2x3 + 2x lateral
Upon percussion, the chest is resonant and symmetrical

20
Q

CHEST- BACK
Describe auscultation
How to report back findings?

A

Ask them to breathe deeply
2x3 + 2x lateral
–> On auscultation, breath sounds are symmetrical and vesicular, with no added sounds.
2x vocal resonance

21
Q

CHEST - FRONT
Inspection?

A

As per chest back PLUS
- Expansion of upper lobes
- Apex beat

22
Q

CHEST - FRONT
Palpation

A
  • Chest expansion
  • Rib pain
  • Apex beat (not if breasts)
23
Q

CHEST - FRONT
Percussion

A

2x above clavicles, 2x on clavicles (2 FINGERS ONLY), 2x below clavicle, 2x below breast, 2x laterally
If the patient has breasts, don’t percuss under the breast

24
Q

CHEST - FRONT
Auscultation

A

2x above clavicles (bell), 2x below clavicle (diaphragm from now on), 2x below breast, 2x laterally
Vocal resonance: 2x2, apices with bell

25
Q

HEART
ABDOMEN
LOWER LIMBS

A

4 valves
Liver
Pitting oedema, cyanosis

26
Q

Why do we inspect the liver on a lung exam?

A

Expansion of lungs during emphysema  liver gets pushed down; may be able to feel.

*3. Thorax (33 decks)

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