The Respiratory Exam

Surroundings

• Is the patient on a respirator?• Is he/she on oxygen?– Delivery system? (nasal prongs, mask etc)– How many litres a minute?

General Appearance

• Is the pt dyspnoeic?• Are they using their accessory breathing

muscles?• Are they blue and bloated or pink and puffing?– DISCUSS PHYSIOLOGY

Hands• Clubbing• Nicotine staining• Peripheral cyanosis• Pallor of the palmar creases• Wasting of intrinsic hand muscles- finger abduction

(apical lung tumour pressing on the brachial plexus)• Tenderness just below the wrist (pulmonary osteoarthropathy-

associated with lung carcinoma an mesothelioma)• Asterixis (CO2 retention)• Pulse (tachycardia with beta blockers)• Resp rate (16-25)- 8>bradypnoea, 25<tachypnoea• BP (paradox- decrease of 10mmHg or more during inspiration-indicates

obstructive lung disease like asthma or COPD)

Face

• Eyes– Ptosis and pupil constriction (horners syndrome)– Conjunctival palour

• Sinuses (tenderness)• Nose- polyps• Mouth- tongue; central cyanosis

Neck

• Trachea– Deviation: thoracic mass, pnoemothorax etc– Tracheal tug (downward movements)-aortic

aneurism• JVP- elevated in heart failure, cor pulmonale• Lymph nodes

Chest

• Inspect- scars, barrel chest, kyphosis & deformity

• Palpate– Chest expansion– Percussion (compare sides)

• Auscultate – Vocal resonance– Breath sounds

• Check for bony tenderness & sacral oedema

Abdomen

• Pulsatile liver