Respi PE Flashcards
(17 cards)
What are the first steps before starting the respiratory exam?
• Gather equipment (stethoscope, pen torch, ruler, spatula).
• Perform hand hygiene.
• Introduce yourself, check patient ID, explain the procedure, and obtain consent.
• Position patient at 45° with arms at the side.
• Expose chest while maintaining modesty.
What do you check in the general inspection?
• Patient’s appearance: alert, cyanosis, pallor, respiratory distress, accessory muscle use.
• Breathing pattern: shortness of breath, chest movement.
• Surroundings: oxygen devices, inhalers, sputum mug, cigarettes, mobility aids.
What do you check in the hand examination?
• Color: Cyanosis (hypoxia).
• Nails: Clubbing (lung cancer, bronchiectasis).
• Tremors: Fine tremors (salbutamol), Flapping tremor (CO2 retention).
• Temperature: Cold (poor perfusion), Warm (CO2 retention).
What do you check in the face examination?
• Face color: Red (polycythemia), Pale (anemia).
• Eyes: Conjunctival pallor, Horner’s syndrome (ptosis, miosis).
• Mouth: Central cyanosis (hypoxia), Oral candidiasis (steroid inhaler use).
How do you assess the Jugular Venous Pressure (JVP)?
• Position patient at 45°.
• Turn head slightly left.
• Look for IJV pulsation behind sternocleidomastoid.
• If raised, suggests pulmonary hypertension, cor pulmonale, heart failure.
How do you check trachea position?
• Ensure head is neutral.
• Place middle finger on suprasternal notch.
• Palpate for deviation (shifted trachea = pneumothorax, pleural effusion).
What do you inspect on the chest?
• Scars (surgery, chest drains).
• Chest wall deformities (pectus carinatum, excavatum, kyphosis).
• Accessory muscle use.
• Symmetrical expansion.
How do you check chest expansion?
• Place hands on upper anterior chest above nipples.
• Wrap fingers around chest, thumbs touching at midline.
• Ask patient to take deep breath.
• Thumbs should move 5 cm apart symmetrically.
What are the types of percussion sounds and their meanings?
• Resonant → Normal.
• Dull → Consolidation, tumor, lobar collapse.
• Stony dull → Pleural effusion.
• Hyper-resonant → Pneumothorax.
What are the different breath sounds in auscultation?
• Vesicular → Normal.
• Bronchial → Harsh, equal inspiration/expiration (consolidation).
• Quiet breath sounds → Reduced air entry (effusion, pneumothorax).
What are the added lung sounds and their meanings?
• Wheeze → Asthma, COPD.
• Stridor → Upper airway obstruction.
• Coarse crackles → Pneumonia, bronchiectasis.
• Fine end-inspiratory crackles → Pulmonary fibrosis.
What is vocal resonance and how is it assessed?
• Ask patient to say “99” repeatedly.
• Increased resonance = consolidation, tumor.
• Decreased resonance = pleural effusion, pneumothorax.
What are the steps for posterior chest examination?
• Inspection: Scars, unequal movement.
• Palpation: Chest expansion at 3 levels.
• Percussion: Compare resonance on both sides.
• Auscultation: 5 points on both sides, breath sounds, added sounds.
What does sacral and peripheral oedema indicate?
• Press sacrum and ankles for pitting oedema.
• Suggests right heart failure (cor pulmonale).
How do you palpate for lymph nodes?
• Palpate submental, submandibular, cervical, supraclavicular.
• Left supraclavicular node (Virchow’s node) = lung/GI malignancy.
What are the final steps after completing the examination?
• Explain to patient that exam is complete.
• Thank the patient.
• Perform hand hygiene.
• Summarize findings.
• Request further tests (SpO2, sputum sample, peak flow, chest X-ray, ABG).
Lymph nodes, trachea, palpate
