Respiratory Exam

Question 1

Introduction

Answer 1

INTRODUCTION:
• Greet the examiner.
• Greet the patient.
• Introduce yourself and establish rapport.
• Confirm patient’s identity.
• Briefly explain what the examination is about.
• Obtain consent.
• Ask for a chaperone.
To the examiner:
I would like to:
• screen my patient for privacy.
• adequately expose my patient (tell patient to take off shirt or singlet).
• place my patient in an anatomical position (e.g. with the body su-
pine, the arms at the sides and the palms facing upwards).
• sanitize or wash my hands with running water and soap.
• Ask to perform a quick general examination
• Points to note: Sclera jaundice, conjunctival pallor, peripheral cyano-
sis, finger clubbing, cervical lymphadenopathy, etc

Question 2

Anterior chest what should we inspect for

Answer 2

INSPECTION:
Inspect from the side to the foot of the bed or from head to toe. Points to note:
• Symmetry of the chest wall
• Any deformity (pectus excavatum, pectus carinatum, etc.)
• Chest wall movements (use of accessory muscles)
• Chet tube in-situ, endotracheal tube, etc.

Question 3

In Palpation what should we do

Answer 3

Respiratory rate (hold the patient’s hand as a distraction while you count the respiratory rate)
• Check for trachea deviation
• Check for chest expansion (three lung zones: upper, middle and
lower)
• Check for tactile fremitus
− Tell patient to say 99
− Must be done bilaterally and comparatively

Question 4

Percussion of the anterior wall

Answer 4

Must be done bilaterally and comparatively
• Start by tapping the clavicle with a finger (lung apex)
• Percuss the three lung zones (upper, lower and middle zones)
• Percuss the axilla (two zones: upper and lower

Question 5

AUSCULTATION of the anterior chest include

Answer 5

AUSCULTATION:
• Must be done bilaterally and comparatively
• Auscultate the three lung zones (upper, lower and middle zones)
• Tell the patient to breath in and out
• Auscultate the axilla (two zones: upper and lower)
• Check for vocal fremitus (tell the patient to say 99)

Question 6

Posterior chest what should we begin with

Answer 6

INSPECTION:
• Inspect the back of the patient.
• Points to note:
• Curvature of the vertebrae (scoliosis, kyphosis, etc.)
• Any other deformity
• Scarification marks

Question 7

Palpation of posterior back

Answer 7

Check for chest expansion (three lung zones: upper, middle and lower)
• Check for tactile fremitus
• Tell patient to say 99
• Must be done bilaterally and comparatively

Question 8

Percussion of posterior chest

Answer 8

PERCUSSION:
Must be done bilaterally and comparatively
Percuss the three lung zones (upper, lower and middle zones)

Question 9

AUSCULTATION of the posterior chest

Answer 9

AUSCULTATION:
• Must be done bilaterally and comparatively
• Auscultate the three lung zones (upper, lower and middle zones)
• Tell the patient to breath in and out
• Check for vocal fremitus (tell the patient to say 99)

Question 10

What should we do last

Answer 10

Thank the examiner and request do a general physical examination