Respiratory Examination

It is important to ensure adequate exposure for inspection- 45 degrees lying on bed, ask for consent for a male to be topless and female to be down to bra

End of the bed inspection

Work of breathing, comfortable at rest,
Oxygen, nebulisers, inhalers, sputum pot
Ask to Cough- ?wet
Watch speech when giving name + DoB
Breathe to calm own nerves + steady self

Peripheral Examination

Lower limbs

Peripheral oedema

Hands

Finger clubbing
Tobacco staining
Peripheral hypoxia
Fine tremor
CO2 retention tremor
Atrial Fibrillation

Arms

Lines or fistulas

Neck

JVP
Cervical lymphadenopathy
Trachea- central or deviated

Face

Conjunctival pallor
Central cyanosis (tongue)

Chest

Easiest done posteriorly first, then should be attempted anteriorly.

Posteriorly

Inspection

Scars: lateral thoracotomy, clamshell or VATs scars
Work of breathing, equal expansion
Cachexia, hyperinflated rib cage

Palpation

Expansion

Percussion

Findings: resonant, hyper-resonant or dull

Auscultation

Breath sounds: vesicular (normal), bronchial (thicker)
Added:
- Wheeze (insp/ exp),
- Crackles- fine/ coarse + location + change with coughing

Anteriorly

Chest expansion

Percussion

Auscultation

Right middle lobe can only be auscultated from the front

Heart

Palpate apex beat
Listen to heart sounds ? TR as a sign of pulmonary hypertension

See Respiratory Examination for full breakdown.

Signs

End of bed Sputum Pot Bronchiectasis

Inhalers COPD, asthma

Young CF

Cough Wet, productive Bronchiectasis, pneumonia

Dry ILD, lung cancer, COPD

Peripheral Oedema Heart, liver, kidney failure; consider pulmonary htn

Finger Clubbing ILD, Lung Cancer, Bronchiectasis, TB, pulmonary abscess,

Tobacco staining COPD, lung cancer

PICC/ Hickmann lines Bronchiectasis CF

JVP Raised Pulmonary Hypertension

Large v waves Tricuspid Regurgitation

Trachea Deviated Pull- pneumonectomy

Push- pleural effusion, empyema, lung cancer

Reduced COPD

Central cyanosis COPD, ILD

Lymphadenopathy Malignancy, infection

Scars Thorocotomy, clamshell, VATS

Expansion Unilateral reduced Pneumonectomy, effusion, collapse

Apex beat Lateral Mediastinal shift- collapse, effusion, tension pneumothorax

RV Heave Cor pulmonale

Percussion Dull Consolidation, collapse, pleural effusion, ILD @ bases

Hyperresonant Pneumothorax

Auscultation Bronchial breathing Pneumonia

Polyphonic wheeze COPD

Bibasal coarse crackles CHF

Bibasal fine crackles ILD

Vocal resonance Reduced Pleural effusion

Increased Consolidation, collapse, malignancy

Examiner Discussion

4 minutes.

Presentation of Signs

Rough script:

Introduction -> signs -> differentials -> negatives / severity -> complete my assessent -> investigations -> management.

I have performed a respiratory examination on Ms Jones [optional statement]
[If confident, start with diagnosis] My diagnosis is interstitial lung disease, this is because my positive signs were..
[If less confident, start with signs] My positive signs are: fine bibasal inspiratory crackles and finger clubbing; optional go into negative findings; my differentials are..
Severity comment: there was / wasn't signs of respiratory distress/ core pulmonale / lung transplant deconditioning
To complete my assessment I would perform a history, set of obs (RR, sats), investigations- CXR, baseline bloods, ABG/ VBG,

Key points

Easy to forget signs
Finishing early can give you 30s to prep your presentation
Practice presenting (!)
Skillful presentation can mask their inadequacies and dictate the examiner discussion favourably

Examiner Questions

Ultimately station specific and the least predictable part of any station. Learning the background, investigations and management for the core respiratory conditions is key. I believe the key part of this is to test your logic between signs and diagnosis. There simply isn't time for a deep dive into your knowledge base.

Written in 2026