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%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
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% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
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% Document Info
\author{hjsdhaj}
\pdfinfo{
  /Title (respiratory-examination.pdf)
  /Creator (Cheatography)
  /Author (hjsdhaj)
  /Subject (Respiratory Examination Cheat Sheet)
}

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% Header and Footer
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\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Respiratory Examination Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{hjsdhaj} via \textcolor{DarkBackground}{\uline{cheatography.com/201639/cs/42785/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}hjsdhaj \\
  \uline{cheatography.com/hjsdhaj} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 20th March, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
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% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{p{0.88 cm} x{7.12 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Preperation and Equipment :}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{W}} & Wash Hands \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{I}} & Introduce Yourself + Patient's Identity \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{P}} & Permission \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{P}} & Patient Position ({\bf{45°}}) + Pain \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{E}} & Explaination \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{{\emph{Must wash stethoscope before and after}}}}, usually a good idea to do during general inspection\{\{ac\}\}} \tn 
% Row Count 13 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{{\emph{Let the patient know they will be required to remove their top}}}}\{\{ac\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{General Inspection:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{•Normal Body Habitus}} & Not Thin/Wasted or Obese \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{•Patient's Colour}} & Cyanosis/Pallor \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{•Breathing Difficulty}} & Posture, use of accessory muscles, Stridor/Wheeze, Dyspnea (SOB) \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{•Alertness}}} \tn 
% Row Count 9 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{•Chest Deformity}}} \tn 
% Row Count 10 (+ 1)
% Row 5
\SetRowColor{white}
{\bf{•Medical paraphernalia:\{\{nobreak\}\}}} & Inhalers/Sputum Cup/Oxygen Tubing/Peak Flow Meter/Pulse Oximeter/Walking Aid \tn 
% Row Count 14 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.584 cm} x{2.508 cm} x{2.508 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Hands:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Temperature:}}\{\{nobreak\}\} & Peripheral \seqsplit{vasoconstriction/poor} perfusion & Warm hands+ Cyanosis = Respiratory problem not circulatory \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
{\bf{Peripheral Cyanosis:}} & Bluish \seqsplit{discolouration} of nails & O2 Sat \textless{}85\% \tn 
% Row Count 8 (+ 3)
% Row 2
\SetRowColor{LightBackground}
{\bf{Clubbing:}} & Place 2 fingernails together and look for Schamroth's sign & Chronic low blood-oxygen levels \tn 
% Row Count 13 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Joint Swelling}}} \tn 
% Row Count 14 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Nicotine Staining}}} \tn 
% Row Count 15 (+ 1)
% Row 5
\SetRowColor{white}
{\bf{Pallor of the palmar creases:}} &  & Anaemia \tn 
% Row Count 18 (+ 3)
% Row 6
\SetRowColor{LightBackground}
{\bf{Wasting of the small muscles of the hand:}} &  & Possible apical lung tumour -\textgreater{} can erode into the brachial plexus \tn 
% Row Count 23 (+ 5)
% Row 7
\SetRowColor{white}
{\bf{Wrist Tenderness:}}\{\{nobreak\}\} & Palpate for tenderness &  \tn 
% Row Count 26 (+ 3)
% Row 8
\SetRowColor{LightBackground}
{\bf{Anhydrosis:}}\{\{nobreak\}\} & Does the patient notice that one side of their face is dryer then the other? & Horner's Syndrome\{\{nl\}\}\{\{nl\}\}Apical tumour has invaded the sympathetic chain \tn 
% Row Count 32 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{2.584 cm} x{2.508 cm} x{2.508 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Hands: (cont)}}  \tn
% Row 9
\SetRowColor{LightBackground}
{\bf{Tremors:}} & Stretch out hands and close eyes for 15 seconds & •Coarse flapping tremor ({\bf{Asterixis}}) - CO2 retention/hypercapnia\{\{nl\}\}\{\{nl\}\}•Fine Tremor β2 agonist use - Salbutamol \tn 
% Row Count 10 (+ 10)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{CO2 retention signs:}} {\bf{{\emph{(Mention at least 2)}}}} \newline •SOB \newline •Daytime Sluggishness \newline •Headache \newline •Asterixis \newline •Bounding pulse}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.596 cm} x{3.42 cm} x{2.584 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Vitals:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Pulse:}} & Take pulse rate and rhythm during examinaiton of the hands. & Bounding Pulse =\textgreater{}CO2 retention \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
{\bf{Breathing Rate:}} & After taking pulse continue straight to breathing rate without informing the patient &  \tn 
% Row Count 9 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.356 cm} x{2.66 cm} x{2.584 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Face/Neck:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Face:}} &  & \seqsplit{Pallor/Plethoric} facies (Facial Swelling and Redness) \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
{\bf{Eyes:}} &  & \seqsplit{Ptosis/Miosis} (Horner's Syndrome)\{\{nl\}\}\{\{nl\}\}Anaemia \seqsplit{(Conjunctival} \seqsplit{Pallor)/Jaundice} \tn 
% Row Count 12 (+ 7)
% Row 2
\SetRowColor{LightBackground}
{\bf{Mouth:}} &  & Postnasal Drip/Pursed Lips \tn 
% Row Count 14 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Tongue:}} & Bluish \seqsplit{discolouration} of lips/inferior aspect of tongue & Central Cyanosis \tn 
% Row Count 18 (+ 4)
% Row 4
\SetRowColor{LightBackground}
{\bf{Voice:}} &  & Hoarseness \tn 
% Row Count 19 (+ 1)
% Row 5
\SetRowColor{white}
{\bf{Cervical Lymph Nodes:}}\{\{nobreak\}\} & Palpate under jaw, base of neck &  \tn 
% Row Count 22 (+ 3)
% Row 6
\SetRowColor{LightBackground}
{\bf{Neck:}} & {\bf{Offer to check JVP}}\{\{nl\}\}\{\{nl\}\}Look for distended veins\{\{nl\}\}\{\{nl\}\}Palpate trachea - Tracheal tug\{\{nl\}\}Inform patient that this may be uncomfortable, palpate either side of the trachea 3 finger breths below Adam's apple, place finger in midline of the trachea, ask patient to take a deep breath & JVP elevated in pulmonary hypertention\{\{nl\}\}\{\{nl\}\}Abnormal downward movement of the trachea - Can indicate a dilation or aneurysm of the aortic arch \tn 
% Row Count 44 (+ 22)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.584 cm} x{2.508 cm} x{2.508 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Chest Wall:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Inspection:}}\{\{nobreak\}\} & •Pectus Excavatum \seqsplit{(indent)/Carinatum} (outward dent)\{\{nl\}\}•Barrel Chest\{\{nl\}\}•Incisions\{\{nl\}\}•Spinal Curvature\{\{nl\}\}•Asymmetry of Movement\{\{nl\}\}•Scars &  \tn 
% Row Count 13 (+ 13)
% Row 1
\SetRowColor{white}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Palpate for chest expansion}}} \tn 
% Row Count 14 (+ 1)
% Row 2
\SetRowColor{LightBackground}
{\bf{Palpate for tactile fremitus:}} & Use ulnar boarder of the hand\{\{nl\}\}\{\{nl\}\}Anterior chest\{\{nl\}\}+\{\{nl\}\}Posterior chest - Ask patient to bear hug to move scapulas out of the way & Air = less vibration\{\{nl\}\}\{\{nl\}\}Solid = more vibration \tn 
% Row Count 25 (+ 11)
% Row 3
\SetRowColor{white}
{\bf{Percussion of chest wall:}} & Including {\bf{apexes}} and {\bf{lateral}} chest wall\{\{nl\}\}\{\{nl\}\}{\bf{Compare both sides}}\{\{nl\{\{nl\}\}Both front and back of chest & Lungs = Resonant\{\{nl\}\}Heart = Dull\{\{nl\}\} \tn 
% Row Count 35 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{2.584 cm} x{2.508 cm} x{2.508 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Chest Wall: (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
{\bf{Auscultation of chest: (using diaphragm)}} & Ask patient to take a deep breath in and out through their mouth. \{\{nl\}\}\{\{nl\}\}Including {\bf{apexes}} and {\bf{lateral}} chest wall\{\{nl\}\}\{\{nl\}\}{\bf{Compare both sides}}\{\{nl\{\{nl\}\}Both front and back of chest & May hear:\{\{nl\}\}•Fine crackle\{\{nl\}\}•Coarse crackle\{\{nl\}\}•High-pitched wheeze\{\{nl\}\}•Pleural friction rub \tn 
% Row Count 16 (+ 16)
% Row 5
\SetRowColor{white}
{\bf{Auscultate for vocal resonance:}} & Will be on the same side as tactile fremitis if present &  \tn 
% Row Count 21 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.32 cm} x{5.68 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Peripheral Oedema:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Sacrum:}} & 2 Thumbs on the sacrum while patient is sitting up \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Tibia/ankle:}} & Two thumbs on the tibia/ankle bony portion \tn 
% Row Count 4 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{While looking at legs: Bruising of varying ages on the shins = {\bf{Sarcoidosis}}\{\{nobreak\}\} \newline -Immune disease}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Conclusion:}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{\{\{ac\}\}{\bf{Thank patient and explain that the examination is finished}} \newline % Row Count 2 (+ 2)
{\bf{{\emph{Sanitise Hands and Stethoscope}}}}\{\{ac\}\}% Row Count 3 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}