Respiratory Examination

2

General Observation

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Observe for wheezing, stridor, cough, pallor, cachexia, character of voice (e.g., hoarseness)

3

Hands

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- Sign of tobacco smoking, not necessarily indicative of amount smoked
- May indicate Pancoast's tumour affecting T1 nerve root
Common in chronic respiratory conditions
May indicate beta-agonist use (e.g., salbutamol)
Ask patient to extend arms outwards and extend the wrists
Check for tachycardia (may indicate severe asthma, pneumonia, PE) and rhythm (e.g., AF)

4

Face inspection

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Check for pallor indicating anaemia
Check for ptosis, miosis and enophthalmos
Check nose, lips, tongue
Ask patient to sniff in through nose, gently occlude each nostril. May indicate polyps (asthma), sinusitis (asthma, bronchiectasis)

5

Neck

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Place forefinger on sternal notch. Trachea deviation may indicate lung collapse, pneumonectomy, or large pleural effusion

6

Chest wall

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- Check for pectus excavatum, asymmetry, kyphoscoliosis
- Look for thoracotomy scars, chest drain scars in axillae, VATS scars (2-3cm)
- Look for tattoos (2-3mm dots), skin erythema with well-defined edges
- Ask patient to take slow deep breath, look for symmetry, depth, and prolonged expiratory phase (COPD)

7

Surface Anatomy

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Identify suprasternal notch, sternal angle (Angle of Louis), 2nd intercostal space
Identify oblique and horizontal fissures
Identify liver and heart boundaries

8

Chest Examination

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Upper: 4th ICS, axillary line, and 5th thoracic vertebrae. Lower: xiphoid process and 10th thoracic vertebrae
Percuss supraclavicular region, infraclavicular region, 3-4 locations bilaterally and axilla. Compare sides, work superior to inferior, anterior and posterior, include axillae
Place medial border of hand/5th digit in intercostal spaces, ask patient to say '99'. Compare sides and lung fields
Auscultate all lung fields. Listen for vesicular (normal) and bronchial breath sounds. Compare sides, work superior to inferior, anterior and posterior, include axillae