In these there should be a breakdown of the information in the reference guides including symptoms relevant systems information and specific examination techniques that will be utilised to make the history and physical exam notes. those notes will be skeleton outlines to use. and should contain specific examinations
Easy reference
Common conditions
- The Common Cold (Acute Coryza)
- INfluenza
- Acute bronchitis
- Sinusitis
- Pneumonia
- Lobar pneumonia
- COVID-19
- Tuberculosis
- Pneumothorax
- Asthma
- COPD
- Pleural effeustion
- Pulmonary embolism
- Bronicial carcinoma
- Idiopathic pulmonary fibrosis
- Brochiectasis
- Cystic fibrosis
- Paediactric respiratory conditions
Associated symptoms
- Dyspnoea
- cough
- sputum
- haemoptysis
- Wheeze
- Haorseness
- Systemic symptoms
Even Deeper
Examinations
Examination of the chest The patient should be sitting upright for the respiratory examination. the patient can sit on the side of the couch or lying with the head raised at maximal height.
The patient will need to lean all the way forward for best back access. this may been support to help them lead forward
Look
Look for signs of dyspnoea:
- Increased respiratory rate
- Use of accessory muscles
- Intercostal in-drawing and subcostal in-drawing due to increased work of breathing
Look for pattern of respiration:
- Is expiration prolonged (Expiratory phase should only me slightly longer than inspiratory phase)
- Is breathing regular Look at the shape and symmetry of chest:
- Pectus excavatum
- Pectus carinatum
- Hyperinflation
- Harrisons sulcus
- Kyphosis, scoliosis may also reduce lung capacity
- lesions or scars of the chest wall
Look at movement of the chest wall:
- Is movement symmetrical?
- Is movement reduced?
Reporting:
Palpation
Assessment of tracheal position:
Tracheal position can be displaced by disease of the upper lobes of the lungs.
Tracheal position can be:
- displaced towards the side of the lesion by upper lobe collapse upper lobe fibrosisor pneumoectomy
- Displaces away from by massive pleural effusion, or tension pneumothorax
- Displaced either way by an upper mediastinal mass such as retrosternal goitre, lymphoma, or lung cancer
How to perform:
W I P E R
Check for pain or discomfort Place middle finger gently on the trachea just above the suprasternal notch Place one finger either side of the trachea. gently apply pressure either side of the trachea whichever finger goes further and deeper is the side that is is deviated away from.
Reporting:
Patient with respiratory disease “I assessed the position of Mrs White’s trachea. The trachea was deviated to the left.”
Patient without respiratory disease “I assessed the position of Mr Samuel’s trachea. It was in the midline.”
Chest expansion:
The chest wall expands during inspiration, A clinician can measure this expansion and compare sides. Expansion of ~5cm is normal.
Chest expansion can be decreased on one side or both.
Symmetrical deflation due to hyperinflation:
- Asthma
- Emphysema Unilateral deflation in chest expansion can be caused by:
- Consolidation
- Pneumothorax
- Localised collapse of an area of the lung
- Pleural effusion
How to perform
W I P E R
You need the patient to be sitting on the the side on the couch and be behind them or if they are lying have them sit up. put hands on them Ask them to breathe out fully ask them to breath in fully you may ask them to breath several times
thank the patient and lat the patient know what to do next and put clothing back on
wash ur hands
Reporting
Over 5 cm is typical and noted to be normal
Percussion
Quick notes
Areas for percussion Lung apices in supraclavicular fossa clavicles in medial third anterior chest in at 3 places from below the clavicles to the diaphragm (on both sides)
Lateral chest in 3 places from the diaphragm to the axilla on either side
Posterior chest in at least 4 places from the upper chest to diaphragm on both sides (patient should be leaning forward and arms crossed in frint )
let patient release
Auscultation
Quick notes
Breath sounds can either be vesicular or bronchial vesicular sounds are produced in the large airways and transmitted through normally aerated alveolar tissue (sounds like rustling of leaves)
bronchial breath sounds Transmitted airwats to chest wall through areas of abnormal lung (fluid in pneumonia). The sounds are harsher and akin to a hollow blowing quality
Intensity Normal breath sounds Reduced or absent breath sounds occur when the intensity of vesivulra sounds are diminished Can be due to: reduced conduction of sound Reduced airflow and can be symmetrical asymmetrical
Added sounds
- crackles
- wheezes
- Pleural rubs
hotw to
just listen to a great number of sites bilaterally