Examination of Respiratory System

Posted: July 17, 2010 by gerardloh in Medicine

Examination of Respiratory System
by Dr Chua Sook Yin, MD, CSMU (UKRAINE) 2010
Dr. Kimberly Ho,   MD, CSMU (UKRAINE) 2010

1) 5 important things before you start examining patient:
I- Introduce
P- Permission
P- Position

2) General Inspection (PCLCPRHNGMA)
 P – Position
 C- Comfort
 L- Look
 C – Consciousness
 P – Pain
 R – Respi Distress
 H – Hydration
 N – Nutrition
 G- Gross deformity
 M – Movement
 A- Attachment

3) General Examination List

A) Upper Limbs
i. Palms
ii. Finger and nails
iii. Dorsal part of hand
iv. Wrist
v. Pulse
vi. BP
vii. Flapping tremor ( asterixis)

B) Head
i. Eyes
ii. Nose and ears
iii. Mouth and tongue
iv. Character of cough

Horner’s syndrome:
1) Ipsilateral partial ptosis
2) Ipsilateral miosis
3) Ipsilateral reduced sweating
4) Enophthalmos

C) Neck
i. Jugular venous pressure
ii. Trachea deviation
iii. Tracheal tug
iv. Distance from cricoid cartillage to suprasternal notch

Causes of tracheal deviation:
a. towards the lesion
-upper lobe collapse
-upper lobe fibrosis
b. away from the lesion
-massive pleural effusion
-tension pneumothorax
-upper large mediastinal masses

D) Lower Limbs –Pitting edema

4) Specific Examination of chest

A) Inspection
i. Move symmetrically with each respiration?
ii. Chest wall deformity?
iii. Scars?
iv. Dilated Veins?
v. Skin Discoloration?
vi. Visible pulsation?
vii. Radiotherapy marking?

B) Palpation
i. Chest expansion
ii. Apex beat
iii. Vocal Fremitus
C) Percussion
i. Resonant
ii. Hyperesonant
iii. Dull
iv. Stony dull

D) Auscultation
i. Breath sound
a. Intensity ( normal, reduced, absent)
b. Nature ( vesicular, bronchial)

ii. Added sounds
a. Rhonchi
b. Crackles
c. Pleural Rub

iii. Vocal Resonance
Ask the patient to sit up, repeat the examination on the back
 While percussing, ask the patient to move the elbows forward across the front of the chest to move the scapular away from the lung field.
 While the patient is sitting, palpate for cervical lymph nodes.
 Look for vertebrae tenderness.
 Examine the heart for signs of cor pulmonale.
 Examine the sputum.

Example of conclusion: There’s pleural effusion over the left lower zone evidenced by reduced chest expansion, decreased vocal resonance and fremitus, stony dull notes and reduced breath sounds over the left lower zone.


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