RESPIRATORY SYSTEM EXAMINATION:

This is essentially an examination of the patients lungs; however it is a complex examination

which also includes examination of other parts of the body including the hands, face and neck.
The respiratory examination aims to pick up on any respiratory (breathing) pathology that may be
causing a patients symptoms e.g. shortness of breath, cough, wheeze etc. Common conditions
include chest infections, asthma and chronic obstructive pulmonary disease (copd)
STEPS FOR RESPIRATORY EXAMINATION:

Begin by washing your hands, introduce yourself and clarify the patients identity.
Explain what you would like to do and gain the patients consent.

Tell the patient that you need to expose his chest for clinical examination.The patient
should be sitting up and exposed from the waist up -

Make a general observation of the patient from the end of patients bed. Check whether he
look comfortable at rest, does he look tachypnoeic,dyspneic .

Using accessory muscles, are there any obvious abnormalities of the chest. Also check for
any clues around the bed such as inhalers, oxygen masks, or cigarettes - Look for any
sputum mug near the bed .

Ask the patient to cough and listen.

NOW MOVE TO HANDS OF THE PATIENT,DETAILED EXAMINATION BEGINS
WITH HANDS:
o Look for:
Clubbing
Cyanosis(peripheral)
Nicotine staining
Wasting or weakness .Ask the patient to spread the fingers against
resistance:finger abduction and adduction (lung cancer involving
brachial plexus)
Check the wrist tenderness (hypertrophic pulmonary osteoarthropathy)
Check the Pulse (any tachcardia,,pulsus paradoxus)
Look for Flapping tremor (for co2 necrosis)Ask the patient to extend
their arms and cock their wrists to 90 degrees. Observe the hands in this
position for 20- 30 seconds; a coarse flap may also be a sign of carbon
dioxide retention .

NOW MOVE TO THE FACE OF PATIENT:

o Press the maxillary sinus for tenderness
o Examine the EYES to look for ptosis,pupil size in both sides (to check Horners
syndrome caused by apical lung tumor)
o Look at the Tongue and oral cavity of the patient(sign of central cyanosis)

PALPATION :
o Look for any use of accessory muscles such as the sternocleidomastoid muscle.
Also palpate for the left supraclavicular node (Virchows Node). This drains
the thoracic duct so an enlarged node (Troisiers Sign) may suggest metastatic
cancer e.g. lung or abdominal.

Now gently palpate the Trachea. Is the trachea in midline or deviated (if it is deviated, it
may suggest a tumour or pneumothorax.)

Now ask the patient to sit on the edge of the bed and examine his chest posteriorly.

EXAMINATION OF CHEST POSTERIORLY:

INSPECTION:
Look for any scars (any previous lung surgery)
o shape of the chest
o spine

PALPATION:
o Palpate cervical lymph nodes,
o chest expansion
o Tactile fermitus(place both hands on back of his chest and ask the patient to say
99 or 111)

PERCUSSION:
o Supraclavicular region
o Back
o Axillae

AUSCULTATION:
o Breath sounds
o Adventitious breath sounds
o Vocal resonance(ask the patient to say 99 and auscultate the chest)
o NOW EXAMINE THE CHEST ANTERIORLY(Ask the patient to get in the bed)

INSPECTION:
o Look for:

Any scar,radiotherapy marks

shape of chest
Chest expansion

PALPATION:
o supraclavicular lymph nodes
o chest expansion
o Tactile fermitus

PERCUSSION:
o Percuss the clavicles directly
o Percuss the chest anteriorly

AUSCULTATION:
o Now auscultate the chest anteriorly

IMPORTANT POINT TO REMEMBER:

LOOK FOR JVP,(Raised JVP could be due to right heart failure, Secondary to chronic
lung disease.)
IF you r suspecting right heart failure .ALWAYS LOOK FOR LEG
SWELLING,ASCULTATE THE HEART AND PALPATE THE LIVER.

NOW you r done with Respiratory examination .say thanks to patient and wash your hands.