How To Take Respiratory History

Question 1

Respiratory examination sequence

Answer 1

1. Introduction
2. Inspection overall of pt
3. Inspection of hands
4. Assess face and eyes
5. Inspect anterior chest
6. Palpate anterior chest
7. Purcuss anterior chest
8. Ascultate anterior chest
9. Palpate lymph nodes
10. Inspect posterior chest
11. Palpate and vocal resonance posterior chest
12. Percuss posterior chest
13. Auscultate posterior chest
14. Assess sacral oedema and calves

Question 2

1. Introduction

Answer 2

• introduce yourself
• confirm name
• exam explanation
• gain consent
• check for pain
• ask if they have questions
• Wash hands and Don PPE as appropriate
• Environment- check for obstructions

Question 3

2. Inspection

Answer 3

• treatments around the bed
• Shape of chest
• Use of accessory muscle
• cyanosis
• SOB
• cough
• wheeze
• stridor
• cachexia

Question 4

3. Inspection of hands

Answer 4

• Remember 5 C’s- Cyanosis, muscle wasting (Cachexia), clubbing, Check nails, CO2 flap
• touch hands- peripheral cyanosis, feeling the warmth, muscle wasting
• ask them to turn over look for tar staining, thinned skin (pred), palmar erythema
• nails look for leuconicia (injury, kidney/respiratory disease), koilonychia (IDA), splinter haemorrhage (IE)
• finger clubbing (shamroths window)- cardiac, respiratory, GI
• hold hand out for fine tremor (B2 agonist/neuro) or asterixis (CO2 flap)
• Check pulses- radial and brachial and assess RR
• do observations

Question 5

4. Assess face and eyes

Answer 5

• ask to turn head to the right- assess JVP (raised HF/Cor pulmonea)
• central cyanosis- lips
• check for conjunctiva pallor (Lower eye lid)
• ## inspect mouth- cyanosis, angular stomatitis

Question 6

5. Inspect anterior chest (including axilla)

Answer 6

• look for wall deformities
• scars

Question 7

6. Palpate anterior chest

Answer 7

• assess tracheal position
• assess cricosternal position (3-4 fingers)
• palpate chest wall for pain
• tactile fremitus
• palpate apex beat (5th space under nipple)- DONT NEED
• assess expansion of chest (thumbs to mid sternum, hands around ribs)
• ## reduced expansion= lung collapse, pneumonia

Question 8

7. Purcuss anterior chest

Answer 8

• percuss all 5 spots
• resonance is normal
• note cardiac and liver dullness
• ## dull percussion= consolidation, collapse, effusion

Question 9

8. Ausculate the lungs (anteior)

Answer 9

• vesicular is normal
• stridor= upper airway obstruction
• wheeze- asthma, COPD, infection, HF
• coarse crackles- pulmonary oedema, pneumonia
• fine crackles- fibrosis

Question 10

9. Palpate lymph nodes

Answer 10

• ask pt to sit forward
• feel under the jaw line
• down sides of trachea
• up the clavicles
  -the back up the neck towards the back of the ear
• causes lymphadenopathy= malignancy, infection, sarcoidosis

Question 11

10. Inspect posterior chest

Question 12

11. Assess posterior chest expansion palpitation and vocal resonance

Answer 12

• same as before, put hands around the ribs (thumbs on the spine) and check for expansion (5cm)
• unilaterally reduced= lung collapse, pneumonia
• vocal resonance- put flat of hand on inside of scapula and ask pt to say 99
• start at top, move to middle, then put hands across chest
• increased resonance= consolidation, collapse, tumour
• decreased resonance= pleural effusion

Question 13

12. Percuss posterior chest wall

Answer 13

• same as before
• resonant: normal
• dullness: consolidation or collapse
• stony dullness: pleural effusion
• hyper-resonant: pneumothorax

Question 14

13. Ausculatate posterior chest wall

Answer 14

• vesicular= normal
• inspiratory stridor= upper airway obstruction
• wheeze= asthma, COPD, infection
• coarse crackles- pneumonia, pulmonary oedema
• fine crackles- fibrosis

Question 15

14. Assess for sacral oedema and calves

Answer 15

• look for oedema, note where too
• signs of DVT