3. Resp examination Flashcards
general inspection respiratory exam
patient (colour, breathing, comfort, position, purse-lipped
breathing in COPD, nutritional state (obesity may suggest obstructive sleep apnoea,
Pickwickianism))
hand signs resp exam
Clubbing
Tar staining
Wasting of the intrinsic muscles (T1 nerve invasion by an apical lung cancer)
Tremor (flapping asterixis in respiratory failure, fine with beta-agonists e.g.
salbutamol)
pulse CO2 retention
bounding pulse
what does a raised JVP indicate resp exam
cor pulmonale
A raised non-pulsatile JVP may be
seen in superior vena cava (SVC) obstruction due to a lung cancer, in which case there
will be oedema of the face and neck.
face respiratory signs
Horner’s syndrome
● Chemosis (conjunctival oedema may be seen with hypercapnia 2° to COPD)
● Look for respiratory disease in the face and mouth:
● Facial swelling is seen in SVC obstruction
● Dental caries (may cause lung abscess by inhalation of debris)
● Central cyanosis
inspection of the chest resp exam
Shape
● Barrel chest (hyper inflated in emphysema)
● Severe kyphoscoliosis
● Severe pectus excavatum (funnel chest)
● Pectus carinatum (pigeon chest) +/- Harrison’s sulci
Symmetry
● Scars
● Muscle wasting
● Chest versus abdominal (diaphragmatic) breathing
● Use of accessory muscles
● Recession (more common in children, but can be seen in adults with partial
laryngeal/tracheal obstruction)
what does tactile vocal fremitus test for
Transmission of vibrations is
increased in consolidation as sound travels quicker through solid than air.
Transmission is decreased with an effusion or pneumothorax as the lung tissue becomes separated from the chest wall
tracheal deviation causes? which way would it go?
The trachea deviates away from tension pneumothorax and large pleural effusions.
The trachea deviates towards lobar collapse and pneumonectomy.
cause of symmetrical reduction in chest expansion
pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion.
causes of asymmetrical reduction in chest expansion
pneumothorax, pneumonia and pleural effusion can all cause ipsilateral reduced chest expansion.
cause stony dullness
typically caused by an underlying pleural effusion.
cause dullness to percussion
suggests increased tissue density (e.g. cardiac dullness, consolidation, tumour, lobar collapse).
Stony dullness: typically caused by an underlying pleural effusion.
what is bronchial breathing
harsh-sounding (similar to auscultating over the trachea), inspiration and expiration are equal and there is a pause between. This type of breath sound is associated with consolidation.
what is wheeze? causes?
a high-pitched, musical, adventitious lung sound produced by airflow through an abnormally narrowed or compressed airway(s)
Wheezing can be either expiratory, inspiratory, or both. Expiratory wheezing is more common and may mean that a person has a mild blockage causing the wheezing.
asthma, COPD and bronchiectasis.
what are coarse crackles?
discontinuous, brief, popping lung sounds typically associated with fluid/secretions
pneumonia, bronchiectasis and pulmonary oedema.