Respiratory Examination

Question 1

General Inspection

Answer 1

Comfort/pain
SOB
Wheeze/Stridor - asthma, COPD, CF, ILD
Oxygen - ILD, COPD
Inhalers - asthma, COPD
Sputum Pots - COPD, bronchiectasis
Medication
Walking aids
Pale/Cyanosis - <85% O2
Cachexia - malignancy, CF, COPD
Speaking in full sentences

Question 2

Hands Inspection

Answer 2

Tar staining - smoker
Clubbing - lung cancer, ILD, bronchiectasis
Peripheral cyanosis - O2 <85%
Skin changes - steroid use (ILD, asthma, COPD)
Fine tremor - B2 agonist use (salbutamol)
Flapping tremor - CO2 retention (COPD)

Question 3

Hands Palpation

Answer 3

Temperature - low, poor perfusion
Pulse
Respiratory Rate
Pulsus Paradoxus - asthma, COPD

Question 4

Head and Neck Inspection

Answer 4

Conjunctival Pallor - anaemia
Horner’s syndrome - pan coast tumour
Central Cyanosis - hypoxia
JVP raised - pulmonary hypertension, fluid overload

Question 5

Chest Inspection

Answer 5

Scars
Skin changes - erythema, thickened skin
Asymmetry - pneumonectomy, reduced air entry, thoracotomy

Question 6

Chest Palpation

Answer 6

Tracheal Position - pleural effusions, collapse, pneumothorax
Apex beat - cor pulmonale in COPD, ILD
Chest expansion - fibrosis, pneumothorax

Question 7

Chest Percussion

Answer 7

Resonant - normal
Dull - consolidation, fluid, tumour, collapse
Stony dull - pleural effusion
Hyper-resonance - pneumothorax

Question 8

Auscultation

Answer 8

Vesicular - normal
Bronchial - consolidation
Vocal resonance

Question 9

End

Answer 9

Posterior chest
Lymph nodes
Sacral oedema - cor pulmonale fluid overload
Pitting oedema in the skins
Signs of DVT in the calves

Question 10

Further Investigations

Answer 10

Oxygen saturations
Peak flow
Request CXR
ABG
Full cardiovascular examination
Provide supplementary oxygen