Respiratory Examination

Presentations

Core Respiratory Presentations

1. Interstitial Lung Disease

2. Pneumonectomy

3. Lobectomy

4. Pleural Effusion

5. Bronchiectasis

6. COPD

7. Lung Transplant

8. Normal examination

Respiratory Examination

6 minutes

Introduction + End of bed

WINDEC:

• Wash hands

• Introduce yourself

• Ask for name & date of birth

• Explain the examination and ask for consent

Exposure

• It is important to ensure adequate exposure for inspection. 

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- expansion, percussion and auscultation

• Right middle lobe can only be auscultated from the front

• Palpate apex beat

• Listen to heart sounds ? TR as a sign of pulmonary hypertension

See Respiratory Examination for full breakdown.