Respiratory System Examination PDF

+-----------------------------------+-----------------------------------+ | WIPE | Wash hands, Introduce yourself | | | and gain consent, Position | | | patient, expose | +===...

+-----------------------------------+-----------------------------------+ | WIPE | Wash hands, Introduce yourself | | | and gain consent, Position | | | patient, expose | +===================================+===================================+ | General Impression | - Productive cough = pneumonia, | | | bronchiectasis, COPD | | | | | | - Dry cough = asthma, | | | interstitial lung | | | | | | - Wheeze = asthma, COPD, | | | bronchiectasis | | | | | | - Stridor = high-pitched breath | | | sound = narrowed upper | | | airways | | | | | | - Shortness of breath = | | | including nasal flaring, | | | pursed lips, accessory muscle | | | use, tripod | | | | | | - Cyanosis = poor circulation = | | | peripheral vasoconstriction | | | secondary to hypovolaemia OR | | | inadequate oxygenation = | | | right-to-left cardiac | | | shunting | | | | | | - Cachexia = extreme muscle | | | loss = underlying malignancy | | | | | | - Oedema = swelling = right | | | ventricular failure | +-----------------------------------+-----------------------------------+ | Hands | - Tar staining = smoking | | | behaviours = risk if IHD and | | | respiratory pathology risk | | | | | | - Finger clubbing = knuckles | | | and nails together = | | | respiratory disease accounts | | | for 80% | | | | | | - Asterixis (flapping tremor) = | | | hands falling forward when | | | outstretched = severe CO2 | | | retention due to severe COPD. | +-----------------------------------+-----------------------------------+ | Face | - Plethoric complexion = red | | | rash on face = COPD & CO2 | | | retention | | | | | | - Ptosis = drooping eyelids = | | | Horner's syndrome = apical | | | lung carcinoma | | | | | | - Miosis = constricting pupils | | | = Horner's syndrome = apical | | | lung carcinoma | | | | | | - Conjunctival pallor = white | | | in lower lid = underlying | | | anaemia | | | | | | - Oral candidiasis = thrush = | | | immunosuppression | | | | | | - Central cyanosis = bluish | | | colouration of lips/tongue = | | | severe hypoxaemia, pneumonia, | | | COPD and pulmonary embolism. | +-----------------------------------+-----------------------------------+ | Neck | - Trachea positioning = should | | | be central | | | | | | - Lymph nodes = periauricular | | | (front of ear), parotid | | | (under earlobe), | | | submandibular (under bend of | | | jaw), submental (under jaw), | | | anterior chain (in line with | | | ear on neck), posterior chain | | | (in line with hair) | +-----------------------------------+-----------------------------------+ | Arms | - Pulse rate = if they are | | | tachycardiac = severe sign of | | | asthma and accompanies | | | dyspnoea or hypoxia | +-----------------------------------+-----------------------------------+ | Chest | - Pectus carinatum = proud | | | chest = pigeon chest | | | | | | - Pectus excavatum = sunken in | | | chest = can interfere with | | | the function of the | | | heart/lungs | | | | | | - Chest palpation | | | | | | - Apex beat = fifth | | | intercostal space (is | | | base of the heart) = | | | displacement can occur | | | due to ventricular | | | hypertrophy from COPD, | | | pulmonary hypertension, | | | large pleural effusion, | | | tension pneumothorax | | | | | | - Chest expansion = | | | observing movement of | | | thumbs on chest = reduced | | | movement indicates | | | reduced expansion | | | | | | - Percussion/auscultation = 12 | | | points from clavicle to under | | | chest | +-----------------------------------+-----------------------------------+ | Abdomen | - Liver = | | | hepatomegaly/tricuspid | | | regurgitation/ptosis | | | | | | - Motion of abdomen = inward | | | motion during inspiration = | | | diaphragmatic paralysis | +-----------------------------------+-----------------------------------+ | Back | - Scars and deformities | | | | | | - Sacral oedema | | | | | | - Posterior expansion = | | | observing movement of thumbs | | | while breathing | | | | | | - Percussion/auscultation = 5 | | | points around scapula | +-----------------------------------+-----------------------------------+ | Legs | - Oedema = legs swelling = cor | | | pulmonale = enlarged right | | | ventricle due to a lung | | | condition | | | | | | - Cyanosis = bluish | | | discolouration = hypothermia | | | or hypoxia | +-----------------------------------+-----------------------------------+