Respiratory Examination

Question 1

1

Answer 1

Introduction
“Today I have been asked to examine your chest. This will involve looking from the end of the bed, feeling different parts of the chest and then listening with the stethoscope. Will that be okay?”
Adjust head of the bed to a 45 degree angle

Question 2

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Answer 2

Inspect the patient from the end of the bed looking for signs suggestive of underlying pathology (e.g. cyanosis, shortness of breath, cough, wheeze, stridor, pallor, oedema, cachexia)

Question 3

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Answer 3

Look for objects or equipment on or around the patient (e.g. oxygen delivery devices, sputum pot, walking aids, medical equipment…)

Question 4

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Answer 4

INSPECT HANDS
1) Get them to bring them up in front of them
(Looking for peripheral cyanosis)
2) Turn them over
(Bruising or thinned skin - long term steroid use
Tar Staining - smoking)
3) Look for finger clubbing (e.g. through Scamroth’s window test)
4) Arms out straight looking for fine tremor (B2 Agonist Use)
5) Cock wrists back to assess for asterixis (CO2 Retention)
6) Assess the temperature
And relax

Question 5

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Answer 5

Palpate and assess the radial pulse

Assess the respiratory rate

Question 6

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Answer 6

Turn head to the left and assess Jugular Venous Pressure

If needs be elicit hepatojugular reflux if appropriate

Question 7

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Answer 7

Inspect the face - look for central cyanosis (hypoxia) and plethoric complexion

Question 8

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Answer 8

Inspect the eyes - looking for signs such as conjunctival pallor, ptosis, miosis, enophthalmos

Pull down on the lower eye lid - look for conjunctival pallor

Question 9

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Answer 9

Open the mouth (look for angular stomatitis, central cyanosis)

Lift the tongue to the roof of the mouth

Question 10

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Answer 10

Inspect the chest - looking for scars and chest wall deformities

(Also get them to lift their arms up to look at the axilla)

Question 11

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Answer 11

Assess tracheal position

“I’m now just going to feel the position of the windpipe, let me know if it’s too uncomfortable”

Assess cricosternal distance - normal = 3-4 fingers

Question 12

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Answer 12

Palpating of the chest

Palpate the apex beat - fifth intercostal space, mid-clavicular line

Question 13

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Answer 13

Assess chest expansion

“I’m now going to assess the expansion of the chest, this will involve me placing my hands around the chest quite tightly and asking you to take a deep breath in”

Question 14

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Answer 14

Percuss the lung fields - resonant percussion is normal
(Note cardiac dullness)

Question 15

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Answer 15

Auscultate the lung fields
Ask the patient to breathe deeply in and out through their mouth
(Vesicular breathing is normal)

Auscultate with the diaphragm of the stethoscope

Question 16

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Answer 16

Assess vocal resonance
“This time every time I place my stethoscope on your chest can you say 99 for me”

(Tactile vocal fremitus is an alternative test)

Question 17

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Answer 17

Palpate lymph nodes
“Can you now sit forward for me, I’d like to examine the glands in the neck”

Question 18

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Answer 18

Position the patient with their arms folded across their chest
Inspect posterior chest
Assess Chest expansion
Percuss the posterior chest wall
Auscultate the chest
Assess Vocal Resonance

Question 19

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Answer 19

Assess for sacral oedema

Assess for pedal oedema (suggestive of right Ventricular failure)

Question 20

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Answer 20

Assess for signs of DVT

Do this by squeezing the calves “let me know if you have any pain in your calves”

Question 21

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Answer 21

Thank the patient
“In summary I performed a respiratory exam on … had no peripheral stigmata of respiratory disease, their pulse was regular and they had a normal respiratory rate. They had a normal and symmetrical percussion note on the front and back of the chest. On Auscultation they had normal vesicular breathing with no added sounds. This was a normal respiratory exam. To complete the exam I would like to measure their oxygen saturations and also send off a sputum sample.”