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Respiratory Exam Cheat Sheet (DRAFT) by

Respiratory Exam : palpation, obs, ascultation, normal and abnormal breathing sounds

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Observ­ation

General obs: Shortness of breath, colour, dentition, wheeze, stridor, repiratory rate
Face: Horner's syndrome (pancoast tumour), cynanosis of the lips/t­ongue (central cyanosis), pursed lips (COPD), signs of anaemia (Glossitis of the tongue, pale conjun­ctiva, angular stomatitis at the corners of the mouth
Hands: Cyanosis, clubbing, signs of anaemia (spooning of the nails, pale palmar creases), nicotine stains
Chest: Scarring , barrel chest, caving chest, pigeon chest
Respir­atory rate (RR) : measures severity of breath­les­sness
- Measure movements of the chest
- Normal = 12-18 breaths per minute
- Can be raised due to breath­les­sness, COPD, infection, anxiety

Palpation

- Tracheal deviat­ion­/apex beat deviation for medias­tinal shift
- Chest expansion
- Lymph node & Thyroid exam
- Percussion of the lungs along rib inters­paces and clavicles
- Pneumo­thorax = hyperr­esonant sound,
- Pneumonia = solid areas
- Fluid = dull sound
- Auscul­tation

Horner's syndrome

- Disruption of the sympat­hetic nerves supplying the eye
- Ipsila­teral Miosis (small pupil), Ptosis (drooping eyelid), Anhydrosis (No sweating), Enopth­almos (Sunken eyes)
- Apical lung tumour­/in­fection

Anaemia

- Signs of anaemia
- Left to right: Spooning of the nails, Glossitis, Angular stomatitis

Cyanosis

- Cyanosis of the tongue and fingers

Clubbing

Clubbing of the fingers and test for clubbing
- The finger would not be able to do the test or have no diamond sign(S­cha­mnr­oth's window)
Causes:
- Bronchial Cancer
- Chronic Suppur­ative lung disease such as:
Bronch­iec­tasis
Empyema (abscess of the lung)
TB
Cystic Fibrosis
-

Chest Shapes

1 = Barrel chest - COPD
2 = Pidgeon Chest/­Pectus carinatum - poorly controlled severe childhood asthma
3 = Accessory muscles of respir­ation - COPD
4 = Pectus Excavatum = depression of the sternum

Percus­sio­n/A­scu­ltation

- Where to tap or listen to the chest

Breath Sounds

- Vesicular Breathing: Normal breathing
- Inspir­ation longer than expiration
- No pause between inspir­ati­on/­exp­iration
- Bronchial Breathing: Consol­ida­tio­n/c­oll­aps­ed/­com­pressed lung (effusion)
- Inspir­ation equally long as expiration
- Pause between inspir­ati­on/­exp­iration - much harsher sounds
- Wheezes: - Arises from the bronchi (usually expira­tory)
- Long and uninte­rrupted
- Can be low/high pitched
- Caused by partial obstru­ction (Asthma, COPD, Tumour)
- Crackles: - Arises from the alveol­i/b­ronchi
- Discon­tin­uous, bubbling
- Best heard at the start of inspir­ation (harsh­/fine)
- Due to fluid/­sec­retions (Pulmonary oedema­/pn­eumonia (like a crisp packet being rustled)
- Stridor: - Arise from the Larynx­/tr­achea (usually inspir­atory)
- Partia­l/large airway obstru­ction (tumour, swelling of mucosa)
- Friction Rub: - Arise from the pleura
- Creaki­ng/­rubbing
- Unchanged by coughing
- Pleurisy (pneum­oni­a/p­ulm­onary embolism)