Respiratory Examination

Question 1

What do you do as approaching the patient?
Resp

Answer 1

Wash hands, introduce yourself, gain consent, confirm the name and DOB, explain the examination, position patient at 45 degrees, expose full chest, ask the patient if they are in any pain

Question 2

What do you look for from the end of the bed?
Resp

Answer 2

Body habitus, respiratory effort, general colour (pallor, cyanosis, pink), hunched/tripod position, pursed lip breathing, equipment around the bed (oxygen mask, inhalers, any cigarettes, sputum pot), shortness of breath, stridor, hoarseness, cough

Question 3

What do you look for in the hands?
Resp

Answer 3

Tar staining, compare the temperature on either, peripheral cyanosis, CRT, koilinichyia, clubbing. Assess for fine tremor, CO2 retention flap (asterixis)

Question 4

What do you look for in the wrists?
Resp

Answer 4

Radial pulse, respiratory rate

Question 5

What do you look for in the face?
Resp

Answer 5

Central cyanosis, angular stomatitis, glossitis, conjunctival pallor, oral Candida, signs of Horner syndrome (miosis, ptosis), exophthalmos (sign of hyperthyroidism)

Question 6

What do you look for in the neck?
Resp

Answer 6

Raised JVP (hepatojugular reflex if needed), carotid pulse (palpate), tracheal position (palpate this too), cricosternal distance

Question 7

What do you look for in the anterior chest?
Resp

Answer 7

Any scars, obvious chest wall deformities, obvious spinal abnormalities

Question 8

What do you palpate for in the anterior chest?
Resp

Answer 8

Chest expansion and apex beat

Question 9

What else do you do for the anterior chest?
Resp

Answer 9

Percuss several areas, including the supraclavicular fossa and auscultate for breath sounds, comparing the sides the moving down for both. Assess vocal resonance (99)

Question 10

What else do you do in the neck?
Resp

Answer 10

Get the patient to sit forward and palpate the cervical lymph nodes

Question 11

What do you look for in the posterior chest?
Resp

Answer 11

Get patient to have their arms folded over the chest. Scars, any obvious deformities including spinal deformities

Question 12

What else do you do in the posterior chest?
Resp

Answer 12

Chest expansion in several places, percuss and auscultate from side to side (breath sounds and vocal resonance). Palpate for sacral oedema

Question 13

What else in the examination?
Resp

Answer 13

Pitting oedema in the ankles, assess calves for DVT

Question 14

To finish the exam
Resp

Answer 14

Thank patient, tell them exam is finished, tell them to cover up and wash hands. Summarise the findings and suggest further examination (cardio) and investigations (FBC, CXR, oxygen sats, peak flow, sputum sample, ABG, temperature)