Flashcards in Respiratory Exam Deck (25):
What should be asked about cough in a respiratory history?
Frequency, character, does it cause pain?
What should be asked about sputum in a respiratory history?
Frequency, colour, type, amount
What should be asked about haemoptysis in a respiratory history?
Colour and amount of blood
What should be asked about chest pain in a respiratory history?
Location, character, relationship to breathing
What should be asked about breathlessness in a respiratory history?
Does it happen on rest or exercise, precipitating factors, is there a wheeze present
What should be asked about upper respiratory tract in a respiratory history?
Nasal obstruction, discharge, bleeding
What should be asked in a more general inquiry during a respiratory history?
Weight, sweats, smoking (number smoked/ for how long), if ex-smoker- when stopped?
What should be looked for in a general inspection during a respiratory exam?
Oxygen tanks, signs of breathing, obvious cyanosis, distress
What should be looked for in the inspection of the hands during a respiratory exam?
Temperature, peripheral cyanosis, tar staining, finger clubbing (lung cancer), palor, palmar erythema
What should the radial pulse be assessed for in the inspection of the hands?
Rate, rhythm, volume and character
What should be checked for in inspection of the hands, and what does it indicate?
Flapping tremor- CO2 retention (asterixis)
What should be looked for in the inspection of the face during a respiratory exam?
Central cyanosis (lips and tongue, eyes) and anaemia (eye)
During an inspection of the chest, what should be looked for?
Shape, symmetry, scars (remember the axilla)
What is the 1st step in palpation?
Palpation of the trachea- check for deviation at sternal notch (pneumothorax)
What is the 2nd step of palpation?
Apex beat of the heart found at the 5th intercostal space in the mid-clavicular line (using hand)
What is the 3rd step of palpation?
- 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
What is the 4th step of palpation?
Vocal fremitus (use hand to compare sides)
What areas is it important to percuss?
Supraclavicular (lung apices), infraclavicular, chest wall (3-4 locations bilaterally) and axilla
How is percussion performed?
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
What are the qualities of breath sounds heard in auscultation?
Vesicular (normal) and bronchial (harsh sounding- similar to auscultating over the trachea)
Where should auscultation be done?
Apex, chest and axilla, comparing on both sides
How is vocal resonance performed?
- 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)
What should be done after auscultation?
Palpation of the lymph nodes:
- anterior and posterior triangles of the neck
- supraclavicular region
- axillary region
How is the examination completed?
Assessment of the posterior chest, assessment of sacral and ankle oedema, and maybe peak flow? thank the patient, wash hands and summarise