Respiratory exam

Question 1

Resp exam: General inspection

Answer 1

• Well/unwell
  
  • Running/playing
  • Restless/drowsy
• Distressed?
  
  • Can’t complete sentences
  • Tachypnoea
  • Nasal flaring
  • Grunting
  • Use of accessory muscles
  • Recessions
    
    • Inter/subcostal
• Quality of voice
  
  • Hoarse (croup)
  • Stridor
  • Wheeze
• Oxygen
• Sats
• Medication
• Sputum pot/vomit bowl

Question 2

Resp exam: Hands

Answer 2

• Inspection
  
  • Clubbing
    
    • CF
    • Bronchiectasis
  • Peripheral cyanosis
  • Tremor/Flap
• Palpation
  
  • Capillary refill
  • Radial pulse (+ respiratory rate)
    
    • Pulsus paradoxus (acute severe asthma)
      
      • ↓ pulse amplitute on inspiration

Question 3

Resp exam: Face & neck

Answer 3

• Eyes
  
  • Conjuctival pallor
  • Petechiae (prolonged bouts of coughing)
• Mouth
  
  • Central cyanosis
  • Inflammation
• Neck
  
  • Trachea
  • Lymph nodes

Question 4

Resp exam: Chest - Inspection

Answer 4

• Symmetrical chest movement
  
  • Splinting (pneumonia)
    
    • Fail to move one side of chest due to pain
    • May be slight spinal scoliosis
• Shape
  
  • Barrel chest (air trapping in asthma)
  • Pectus carinatum (chronic asthma)
  • Pectus excavatum (normal variant)
• Recessions
  
  • Inter/subcostal
  • Harrison’s sulcus
    
    • Permanent groove at the insertion of the diaphragm (chronic asthma)
• Scars

Question 5

Resp exam: Chest - Palpation & percussion

Answer 5

• Palpation
  
  • Apex beat
    
    • Displace in effusion, collapse, or tension pneumothorax
  • Expansion
    
    • May feel crackles in young children/surgical emphysema
  • Tactile vocal fremitus
• Percussion (rarely done in infants/toddlers)
  
  • Dull = consolidation
  • Hyperresonant = air-trapping/pneumothorax
  • Stony dull = pleural effusion

Question 6

Resp exam: Ausculatation

Answer 6

• Remember to listen under the axillae
• Upper airway noises may be transmitted (especially in young children) - ask to cough
• Breath sounds
  
  • Vesicular
  • Absent
    
    • Pleural effusion
    • Pneumothorax
    • Dense consolidation
  • Bronchial (consolidation)

Question 7

Resp exam: Completion

Answer 7

• Plot height and weight on growth chart
• Peak flow
• Spirometry
• Sputum culture and sensitivity
• Sp02

Question 8

Signs of asthma

Answer 8

• Inhalers
• Pulsus paradoxus
• Hyperinflation
  
  • Hyper-resonant percussion note
• Pectus carinatum
• Harrison’s sulcus
• Wheeze