clinical skills Flashcards
respiratory exam checklist
Inspection
GENERAL ( end of the bed)
Inhalers, nebs, cigarette packs, sputum samples and oxygen supplementation.
HANDS
Tobacco, tar staining, clubbing, cyanosis , bruised or thin skin, arm tremor when arms lifted indicated salbutamol used
HEAD AND NECK
JVP, eye pallor = anaemia, mouth - check gums and tongue
THORAX
Previous scars of surgery.
RESPIRATORY RATE
Lower Limbs
Overt swelling, erythema etc.
Palpation and percussion
Lymph nodes
Position of Trachea
Central Cap Refill time- press on fingertips then time how long it takes for blood to return
Chest expansion - place hands around front and back of chest then ask patient to take deep breath
Percussion
Percussion of lungs
Resonant percussion note is normal
Dull percussion indicated consolidation, collapse or effusion
Hyperesonance = pneumothorax(sound is louder when travelling through air)
Inspiratory stridor indicates
Upper airway obstruction
Coarse crackles indicate
Pneumonia or pulmonary oedema
Wheezing indicates
asthma or COPD
Fine crackles indicate
Pulmonary fibrosis
What do increased and decreased vocal resonance indicate
Ask patient to repeat 99 and listen to the vocal resonance in the auscultation sites on the anterior chest
Increased vocal resonance = consolidation, lobar collapses, tumour due to increased tissue density
Decreased vocal resonance = pleural effusion or pneumothorax due to decreased tissue density
Causes of lymphadenopathy ( palpable lymph nodes)
Infection
Malignancy
Sarcoidosis
Distinguishing between pleural effusion and consolidation
consolidation generates bronchial breath sounds while an effusion is associated with a relative absence of sound.
<p>What is a monophonic wheeze</p>
<p>Monophonic wheeze may indicate tumour in one lung<br></br></p>
<p>what is bronchial breathing</p>
<p>it is abnormal if hear in the parts of the lung that are far from main airways</p>
<p>loud and tubular quality</p>
<p>high pitched</p>
<p>inspiration and expiration last the same amount of time (insipiration normally lasts longer)</p>
<p>definited gap between both phases</p>
