Respiratory Physical Exam

  • WIPE, blah blah 🙂
  • “Take vital signs”
  • Position: from the front: 45°, from the back: sitting
  • Proper exposure: from the waist up
  • General inspection of the pt and surroundings “not connected to IV lines, feeding tubes, oxygen, inhalers”

 

  • Peripheral signs:
    • Nails:
      • Capillary refill
      • Clubbing
      • Cyanosis
      • Koilonychia
      • Splinter hemorrhage
    • Arms:
      • Tremor
      • Pulse
      • BP
    • Mouth:
      • Central cyanosis
      • Dry mucous membrane
      • Dental hygiene
    • Neck:
      • JVP
  • Chest inspection:
    • Symmetry
    • Scars, skin changes\discoloration, rashes
    • Chest deformities: pectus carinatum\excavatum barrel chest, kyphosis, scoliosis, Harrison sulcus in pediatric pts
    • Visible pulsations
    • Dilated veins
    • Measure RR
  • Palpation: (ask pt if they have any pain?)
    • Neck:
      • Tracheal deviation
      • Lymph nodes
    • Chest expansion
    • Tactile vocal fremitus (ask pt to say 99)
    • Apex beat
  • Percussion:
    • Over the clavicles for lungs’ apices
    • Over the chest for lung zones
  • Auscultation: (don’t forget to auscultate over the supraclavicular fossa for the lungs’ apices)
    • “Good bilateral air entry, normal vesicular breath sounds, no added sounds”
    • Vocal resonance (ask pt to say 99)
  • To complete:
    • ENT exam
    • Cardiovascular exam 

 


  • Differential diagnosis of tracheal deviation?
    • Towards: atelectasis, pleural fibrosis, pneumonectomy, lung agenesis/aplasia
    • Away: pneumothorax, pleural effusion, tumors
  • Differential diagnosis of finger clubbing?
    • Respiratory: lung ca, bronchiectasis, CF, sardoidosis, interstitial lung ds
    • Cardiac: cyanotic congenital heart ds, infective endocarditis
    • GI: cirrhosis, IBD, celiac

 


Download the PDF version: here

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