respiratory exam

Question 1

what are resp causes of clubbing?

Answer 1

• lung malignancy
• TB
• Empyema
• bronchiectasis
• cyctic fibrosis
• lung disease

Question 2

why do you look for wasting of the thenar eminence and dorsal interossi?

Answer 2

can be a sign of pancaost tumour in the apex of the lung that is compressing the lower nerve roots of the brachial plexus?

Question 3

what do you look for in the hands on a resp exam?

Answer 3

warm peripheries- with co2 retention 
peripheral cyanosis
tar staining 
muscle wasting 
cap refil 
radial pulse- check if bounding, a sign of co2 retention or thready if hypovolaemic

Question 4

what to do in resp exam when you move up to the arms

Answer 4

2. measure rr whilst pretending to measure hr
3. request BP and pulsus paradox- abnormal drop in blood pressure on inspiration
4. raise arms and check for salbutamol fine tremor
5. cock wrists back and check for CO2 retention flap

Question 5

what to check on the face?

Answer 5

eyes- conjunctival pallor

face- malor flush (sle) , horners syndrome (pancoast tumour)-> will see ptosis and ipsilateral anhydrosis

tongue- blue tinge, suggestive of central cyanosis

Question 6

what to check on neck?

Answer 6

• JVP, (>3cm above the sternal angle) if raised it could be cor pulmonale or right HF
• check for bounding carotid pulse
• check for central trachea and the cricosternal distance, this will be decreased <3 finger breadths if the lung is hyperexpanded due to copd
• check for lymph nodes

Question 7

what to inspect when you reach the chest?

Answer 7

• look for chest wall deformities
• scars in chest or axilla
• radiotherapy tattoos
• skin changes such as telangectasia
• look at breathing pattern-> seesaw (obstrction) , kusmal (dka), and flail chest (blunt injury)

Question 8

how should you palpate the chest?

Answer 8

• check for equal lateral expansion- thumbs should move apart by >5cm
• check for anterior posterior expansion- lay hands flat on chest by the clavicle
• feel for the apex beat in the 5th intercostal space in the midclavicular line line
• feel for right ventricular heave present in cor pulmonale
• percuss in the upper middle and lower zones and also in the axilla

Question 9

what does a hyperresonant lung suggest?

Answer 9

pneumothorax

Question 10

what does a dull chest suggest?

Answer 10

pneumonectomy
collapsed lung
consolidation

Question 11

what does stony dull resonance suggest?

Answer 11

pleural effusion

Question 12

how should you listen to the lungs?

Answer 12

with the bell auscultate at the apex of the lungs

auscultate in the upper middle and lower zones with diaphragm

also auscultate in the axilla

assess vocal resonance by getting patient to say 99 as you auscultate all zone and use the bell for the apicies-> sound increased in areas of consolidation but reduced in areas of pleural effusion

Question 13

what does monophonic and polyphonic wheeze differentiate between?

Answer 13

monophonic= tumour

polyphonic= asthma/ copd

Question 14

what to look for on the back?

Answer 14

spinal deformities

equal expansion

peripheral odema at the sacrum

percuss in all the zones

auscultate in all zones

check for vocal resonance in all zones

Question 15

what to check for in the legs?

Answer 15

• erythema nodosum
• pitting odema
• press on calves to compare for tenderness or swelling suggestive of dvt

Question 16

how to close a resp exam?

Answer 16

observations:

• o2 sats
• blood pressure
• temperature

bedside tests:

• sputum sample
• peak flow

further investigations:

• blood tests
• cxr