After this course, you should seek to:

• List and describe key structures involved in ventilation
• Outline the principal properties, relations and functional interactions of these structures
• Assess their status via case history, observation and appropriate testing
• Demonstrate key psychomotor skills relevant to your examination of the above
• Apply yourself to a novel theoretical clinical situation, demonstrating a synthesis of pulmonary knowledge and skills, testing any hypotheses you generate
• Explicitly analyse your diagnostic process, reflecting on its strengths and weaknesses
• Evaluate the bearing of these processes on your subsequent physiotherapeutic care

NB the above may be the subject of formative or summative assessment, in line with prevailing MACP guidelines


References

Visit as many of the references shown below as possible prior to your course. These are drawn from a variety of texts and take a range of forms (pictorial, textual and tabular). Our intention is to provide you with an assortment of information sources that you can choose from - and that you can match to your own learning style.

Detail on history and practical procedure: Ref 1 pp 106-113

The previous medical history: Ref 7 p519; Ref 4 pp 267-268; Ref 1 pp 113-124

Example of clinical manifestation of cyanosis: Ref 4 p 134,

Clinical examples of finger clubbing: Ref 4 pp 238-242

Example of clinical manifestation of smoker: Ref 4 pp 269

Examples of chest deformity: Ref 4 pp 269-273

Details of overall clinical examination procedure: Ref 1 p 207

Bring your own:

Stethoscope (preferably Littmann type)
Pen torch
Tongue depressors

Indications: Thoracic pain (with or without traumatic history)
Dyspnoea, wheeze, cough
Sore throat or fever
Haemoptysis
Abnormal sputum production
Pain on respiration

• Structures involved
Nasopharynx, larynx, major airways, lungs, pleura and lymphatic structures

• General observation: Examples
Distress: e.g. associated with exertion and with breathing
Facies: Smoker’s face, cyanosis, nicotine staining
Voice: Hoarse or 'gravelly', smokers’ type
Habitus: Posture, scholiasts, overuse of accessory muscles
Smell: Nicotine, foetid breath

• The History: Examples
The presenting history such as cough, sputum, haemoptysis, chest pain
The previous medical history e.g. chronic obstructive airways disease and TB
The family history e.g. serious allergenic disorders, smoking and malignancy
The occupational history: industrial dust - asbestos, micro-particulate dust
The recreational history: pets, ‘bird fancying’, smoking

• The ‘hands on’ procedures
Hands and Periphery for colour, temperature, nail deformity and clubbing
Face for the membranes and respiratory behaviour. Neck: What might alter the position of the trachea or produce an apical swelling? Skin: Eczematous lesions or scars might reveal an underlying respiratory connection.
Specific examination of the chest comprises close inspection, palpation, percussion, and auscultation. What features of function and structure are particularly revealed by these procedures?

© Crawford & Cook 2005