Respiratory Exam

Question 1

What should be asked about cough in a respiratory history?

Answer 1

Frequency, character, does it cause pain?

Question 2

What should be asked about sputum in a respiratory history?

Answer 2

Frequency, colour, type, amount

Question 3

What should be asked about haemoptysis in a respiratory history?

Answer 3

Colour and amount of blood

Question 4

What should be asked about chest pain in a respiratory history?

Answer 4

Location, character, relationship to breathing

Question 5

What should be asked about breathlessness in a respiratory history?

Answer 5

Does it happen on rest or exercise, precipitating factors, is there a wheeze present

Question 6

What should be asked about upper respiratory tract in a respiratory history?

Answer 6

Nasal obstruction, discharge, bleeding

Question 7

What should be asked in a more general inquiry during a respiratory history?

Answer 7

Weight, sweats, smoking (number smoked/ for how long), if ex-smoker- when stopped?

Question 8

What should be looked for in a general inspection during a respiratory exam?

Answer 8

Oxygen tanks, signs of breathing, obvious cyanosis, distress

Question 9

What should be looked for in the inspection of the hands during a respiratory exam?

Answer 9

Temperature, peripheral cyanosis, tar staining, finger clubbing (lung cancer), palor, palmar erythema

Question 10

What should the radial pulse be assessed for in the inspection of the hands?

Answer 10

Rate, rhythm, volume and character

Question 11

What should be checked for in inspection of the hands, and what does it indicate?

Answer 11

Flapping tremor- CO2 retention (asterixis)

Question 12

What should be looked for in the inspection of the face during a respiratory exam?

Answer 12

Central cyanosis (lips and tongue, eyes) and anaemia (eye)

Question 13

During an inspection of the chest, what should be looked for?

Answer 13

Shape, symmetry, scars (remember the axilla)

Question 14

What is the 1st step in palpation?

Answer 14

Palpation of the trachea- check for deviation at sternal notch (pneumothorax)

Question 15

What is the 2nd step of palpation?

Answer 15

Apex beat of the heart found at the 5th intercostal space in the mid-clavicular line (using hand)

Question 16

What is the 3rd step of palpation?

Answer 16

Chest expansion:

• place your hands on the patient’s chest, inferior to the nipples
• wrap your fingers around either side of the chest
• bring thumbs together in the midline, so that they touch
• ask patient to take a deep breath
• observe movement of your thumbs, they should move apart equally
• if one of your thumbs moves less, this suggests reduced expansion on that side
• reduced expansion can be caused by lung collapse/pneumonia

Question 17

What is the 4th step of palpation?

Answer 17

Vocal fremitus (use hand to compare sides)

Question 18

What areas is it important to percuss?

Answer 18

Supraclavicular (lung apices), infraclavicular, chest wall (3-4 locations bilaterally) and axilla

Question 19

How is percussion performed?

Answer 19

1. Place your non-dominant hand on the chest wall
2. Your middle finger should overlie the areas you want to percuss (between ribs)
3. With your dominant hand’s middle finger, strike the middle phalanx of your non-dominant hand’s middle finger
4. The striking finger should be removed quickly, otherwise you may muffle resulting percussion note

Question 20

What are the qualities of breath sounds heard in auscultation?

Answer 20

Vesicular (normal) and bronchial (harsh sounding- similar to auscultating over the trachea)

Question 21

Where should auscultation be done?

Answer 21

Apex, chest and axilla, comparing on both sides

Question 22

How is vocal resonance performed?

Answer 22

• Ask patient to say “111” repeatedly and auscultate the chest again
• Increased volume over an area suggests increases tissue density (especially if there is a dull percussion note over the same area)- consolidation/tumour/lobar collapse
• Decreased volume over an area (especially if there is an associated dull percussion note) suggests fluid outside of the lung (pleural effusion)

Question 23

What should be done after auscultation?

Answer 23

Palpation of the lymph nodes:

• anterior and posterior triangles of the neck
• supraclavicular region
• axillary region

Question 24

How is the examination completed?

Answer 24

Assessment of the posterior chest, assessment of sacral and ankle oedema, and maybe peak flow? thank the patient, wash hands and summarise

Question 25

How is a normal respiratory exam summarised?

Answer 25

• Normal pulse and respiratory rate
• No peripheral stigmata of respiratory disease
• Normal and symmetrical chest expansion
• Normal, vesicular breath sounds