Respiratory PE Flashcards
Basic Respiratory Examination
Respiratory distress signs
Cyanosis
Vitals: RR and O2 sat
Hands: clubbing, pulmonary osteoarthropathy
Face: Horner’s syndrome (myosis, ptosis, anhidrosis), central cyanosis
Neck: tracheal position, tracheal tug
Core respiratory exam: always mention we are comparing the left and right sides
Inspection: movement of the chest wall - upper lobe from behind looking down on clavicles, lower lobes - inspect posteriorly and look at back
Palpation - chest expansion
Auscultation - anterior, axillary, posterior
- absent breathing sounds, intensity of breathing sounds, added sounds - wheezing, crackles, pleural friction rub
Vocal resonance
CVS Exam - Loud P2
Legs - edema
COPD Examination
Your next patient is a 50 year old man who presents to your general practice complaining of shortness of breath. He is a chronic smoker. X-rays has been done.
(X-ray shows: hyperinflated chest)
Tasks:
1. Explain steps of examination to the patient
2. Explain physical examination with anatomical landmarks to medical student
3. PE findings will appear on the screen at 7 minutes
4. Explain your diagnosis
Barrel-shaped chest
Pursed lip breathing
Drowsiness
Flapping tremor
Reduced chest expansion
Hyperresonance on percussion
Early inspiratory crackles +/- wheeze
Signs of right sided heart failure (cor pulmonale)
Pulmonary Embolism Examination
Case 1: Your next patient is a 40 year old man who has presented to your general practice complaining of acute shortness of breath. He is also complaining of chest pain which is worse on deep inspiration (pleuritic chest pain). He had a total knee replacement last week and stopped taking aspirin. He is a chronic smoker.
Task:
1. Explain your physical examination to the medical student with anatomical landmarks
Case 2: Your next patient is a 24 year old lady who has presented to the ED complaining of SOB and chest pain which is worse on inspiration. She was started on Yasmin (OCP) 2 months ago.
Task:
I. Explain physical examination to the medical student
Tachypnea and tachycardia
Pleural friction rub if infarction because of large emboli
Massive emboli: raised JVP, right ventricular heave (heart failure features)
Loud P2 and murmur
Size difference for unilateral swelling (DVT)
Pediatric Respiratory Examination
Case 1:
Your next patient is a 10 month old child who has been brought to the emergency department with difficulty breathing and cough
Tasks:
1. Explain physical examination steps to mother
2. Explain physical examination to the medical student
3. PE findings will be given
4. Diagnosis and differentials
Case 2:
Your next patient is a 4 year old boy who has been brought the ED with cough and breathing difficulty. He has had cough and runny nose since last night. He has not been eating well. He has been tested for Covid 19 and the result is negative. Temp 39 degrees, he has mild dehydration.
Level of consciousness
Respiratory distress signs
- use of accessory muscles
- tracheal tug
- intercostal retrations
- nasal flaring
- paradoxical abdominal breathing
Cyanosis
Dehydration signs
ENT examination
Tracheal tug & position
Apnea episodes
PE findings: widespread wheeze, increased RR, tracheal tug, no fever
Diagnosis: Bronchiolitis
*never diagnose a child less than 12 months with asthma.
PE findings: stridor, tracheal tug, increased RR, bronchial breathing sounds
Diagnosis: Croup
Epiglotitis - expiratory stridor (more sore throat, drooling than difficulty breathing)
Croup - inspiratory stridor
Diagnosis: Pneumonia
Summary of findings:
I am looking for decreased expansion on the affected side, dullness on percussion. On auscultation, I expect to hear bronchial sounds, inspiratory crackles, pleural friction rub, increased vocal resonance
Fall Examination
Your next patient is a 30 year old man who presents to the ED after a fall. He is complaining of chest pain which is worse on deep inspiration. He is also complaining of shortness of breath. Saturation is 93% and patient is on oxygen.
Task:
1. Explain your physical examination to the medical student with anatomical landmarks
(Some cases have x-rays - explain to medical student; some cases - explain chest tube insertion)
Concept of the Case:
- Rule out injuries
○ Lung: pneumothorax, hemothorax, lung contusion
○ Heart: tamponande
○ Rib fracture
○ Abdominal organs
Neck: Tracheal position
Resp Inspection: Subcutaneous emphysema
Flail chest
Asymmetric chest movement
Displaced apex beat
Rib fracture
Stab Wound Examination
Your next patient is a 24 year old man who has been brought to the emergency department after a stab wound to this chest. He is feeling short of breath. He has been stabilized and primary survey has been done. Vitals are stable.
Task:
1. Explain your examination to the medical student
Radioradio delay and radiofemoral delay
Neck: tracheal position, increased JVP
Respiratory inspection: area of stab wound, chest movement
Palpation: apex beat
Percussion: hyperresonance (PT) and dullness (HT)
Auscultation: Hammon’s crunch
CVS: muffled hear sounds
Abdominal exam: Cullen and grey turner’s sign
