Respiratory Examination

Munsif Mufalil

Introduction
Wash

your hands

Introduce
Confirm Get

yourself

their details

consent Observation (Eg inhalers, BiPAP etc) Examination (Eg Obesity, colour, breathing

General General

etc)

Inspection

Hand - Clubbing, tar staining and wasting of intrinsic muscle (T1 invasion apical lung tumour)

Tremor - for? Pulse, rate and rhythm Pulsus Paradox - able to auscultate heart sounds on inspiration but unable to feel radial pulse due to low blood volume - Severe COPD and Cardiac Tamponade

Check BP Check JVP - raised pulsatile suggestive of cor pulmonale, non pulsatile suggestive of SVC obstruction but then facial odema can be noted.

Inspection Contd

Respiratory rate and rhythm Eyes - Horners Syndrome - Pancoast Tumor Eyes - Chemosis (Conjuctival odema seen with hypercapnia secondary to COPD)

Facial Swelling - SVC Obstruction

Dental Caries - Can cause lung abscess due to debris inhalation

Central Cyanosis

Inspection Contd

Chest

Shape - Barrel Chest - Hyperinflation in Emphysema Shape - Severe kyphoscoliosis, severe pectus excavatum, pectus carinatum Symmetry Scars Muscle Wasting Chest vs Abdominus Breathing Accessory Muscle Use

Palpation

Trachea - Central or deviated Chest expansion - Normal 3-5cm

Tactile vocal fremitus - Increased in consolidation and decreased in effusion/pneumathorax

Percussion

Start from apices and do it side to side anteriorly.

Dull? Resonant? Hyper-resonant?

Auscultation

Start at apices, side to side anteriorly (Clavicle to 6th rib mid-clavicular line, axilla to 8th rib mid-axillary line)

Note for - Vesicular, Bronchial, Rhonchi, Crackles/Creps, pleural rub.

Vocal Resonance (99 whilst auscultating - loud or well transmitted in consolidation and reduced in effusion or pneumothorax) Whispering Pectoriloquy (222 - consolidation)

Repeat

Do the same on the back - patient sitting forward Generally signs better elicited in the back

Other Stuff

Palpate cervical lymph nodes

Check Sputum pot

Peak flow? Thank Wash hands

Random Tips

Practice on your mates to look slick on the day

Look confident Never fret/show anxiety/fear Be honest with positive findings and negative findings - Do not make up stuff

Questions