The Respiratory Exam
Through inspecting, palpating, percussing and auscultating the chest, it is possible to comprehensively assess for respiratory pathology.
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Positioning: patient sitting upright
Signs of common respiratory diseases
Chronic Obstructive Pulmonary Disease
Bronchiectasis
Interstitial Lung Disease
Lung Cancer
Pleural Effusion
Look Around the Room
Cigarettes, O2 devices, puffers, other meds
Inspect the Patient
Age, gender, body habitus
Respiratory Effort
Nasal flaring, accessory muscles, recession
Breathing
Respiratory rate, Cheyne-Stokes, Kussmaul
Ask the Patient to Cough
Barking, brassy, whooping, bovine, postprandial
Listen and characterise
Sputum Sample
If available - colour, volume, blood, pus
Asterixis
Arms out, wrists extended (15 sec), look for tremor
Pemberton's Sign
Ask the patient to hold their arms above their head
Assess for Proximal Myopathy
Inspect the shoulder muscles, ask the patient to raise their arms against resistance
Radial Pulse
Rate, rhythm, character, postural change
Respiratory Rate
Taken surreptitiously whilst measuring pulse
Oxygen Saturation
Anteriorly and posteriorly
Scars
From trauma or past surgery
Deformities
Pigeon chest, funnel chest, barrel chest, scoliosis
Anteriorly and posteriorly
Percuss
Resonance (normal), hyper-resonance, dullness
Deep breaths in and out through the mouth. Auscultate, alternating from left to right.
Auscultate anteriorly and posteriorly, including the axillae and supraclavicular fossae.
Breath Sounds
Vesicular (normal sounds), bronchial sounds
Adventitious Sounds
Stridor, wheeze, crackles / crepitations, pleural rub
Vocal Resonance
Auscultate while patient says “blue balloons”