Respiratory examination

Question 1

End of bed observation

Answer 1

Well/ ill

Comfortable/ distressed

Shortness of breath

Signs of respiratory distress: pursed lip breathing, intercostal recession, use of accessory muscles, braced/ splinting posture

Question 2

Consent and examination

Answer 2

Patient sitting upright on examination couch and comfortably

Expose the chest

Question 3

Peripheral examination starting in hands

Answer 3

Finger clubbing

Cigarette tar staining

Peripheral cyanosis

Question 4

Arms

Answer 4

Radial pulse: rate and rhythm

Radial pulse character: bounding which may represent CO2 retention

Respiratory rate

CO2 retention flap

Question 5

Eyes

Answer 5

Pale conjunctiva of the eyes

Question 6

Mouth

Answer 6

Central cyanosis

Ask patient to lift up tongue

Question 7

Neck

Answer 7

Lymph nodes

• submandibular
• cervical chain
• supraclavicular

Question 8

Trachea

Answer 8

Check for tracheal deviation

Question 9

Chest observation

Answer 9

Chest wall scars

Barrel chest

Pigeon chest

Concave chest

Question 10

Examine the front

Answer 10

Expansion

Percussion

Auscultation

Question 11

Examine the back

Answer 11

Expansion

Percussion

Auscultation

Question 12

Special investigations

Answer 12

Peak flow meter