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