Respiratory exam is performed as part of a physical exam.

AE is shorthand for Air entry, referring to the intensity of breath sounds.

A drawing of lungs with arrows through them, indicates there is nothing abnormal to find on auscultation of the chest.

Pediatric source: OSCE stop

• Respiratory Sx, including:
  • SOB/dyspnea
  • Cough
  • Chest pain
• Hx that suggests pathology of the lung
• Very rarely performed in it's entirity
• Usually merged w/ the cardiac exam to cover DDx's, thus rarely performed in isolation

Patient information

When do you want to assess the breathing system?
So when there's some sort of breathing symptom, like finding it difficult to breathe, coughing, or chest pain. If we find some previous problem with the lung. We rarely do the whole exam, because it takes so long And we usually merge it with the heart exam, to exclude certain alternatives we may be thinking.

• Fingers:
  • Clubbing via Schamroth's window test, of interstitial lung disease
  • Tar staining, of smoking
  • Resistance test, of weakness and wasting. This involves asking the patient to move their fingers against your fingers, or towards your fingers
• Palms
  • Peripheral cyanosis, of hypoxia
• Hands
  • Flapping tremor, of carbon dioxide narcosis, asking patient to "put hands up, like a policeman doing a stop sign"
• Wrist
  • Pulse, including for the regularly irregular pulse of pulsus paradoxus
  • Subliminally counting for extreme respiratory rate, for of bradypnea and tachypnea
• Head
  • Ptosis eyelids of Horner's syndrome, of apical lung cancer
  • Central cyanosis, of hypoxia, asking patient to raise tongue to roof of mouth
• Neck
  • Tracheal deviation, of deviation towards fibrosis, or deviation away from pleural effusion or pneumothorax. Note to patient this might feel a bit uncomfortable
  • Lymphadenopathy, starting to palpate at the top of the jaw line, moving towards and down the neck, to the supraclavicular area. Comment on having felt for postauricular nodes, submandibular nodes, cervivical nodes, and supraclavicular nodes, and that no lymphadenopathy could be felt

Chest, starting from anterior, then posterior (remember "IPPA":

• Inspection, asking patient to breathe out and in:
  • No evidence of breathlessness of COPD
  • No obvious wheeze of asthma, or stridor of inhaled objects
  • No obvious chest deformities or scars
  • Not evidently using his accessory muscles to breathe
• Palpation:
  • Displaced apex beat, of moving towards the area of lung collapse (only on front)
  • Chest expansion, such as hyperexpansion of chest in COPD, by placing the thumbs together, and asking the patient to breathe out and in, and ensuring the fingers sufficiently move away from each other
  • Vocal fremitus, of pleural effusion, which is a palpable vibration on the body, found by asking the patient to repeat "999" (a low frequency vocalization), and feeling the patient's chest. It is indicative of friction
• Percussion:
  • Percussion for the hyperresonance of pneumothorax, or the hyporesonance of consolidation, from top to bottom, on one side, then the other side, starting supraclavicular and going downwards (3x sets) (When doing the back, you must remember to ask patient to hug themselves, so you don't percuss their clavicle)
  • Ask patient to lift arm up, then percuss the two sides of the body (once on either side)
• Auscultation:
  • Listening for asymmetric and abnormal breath sounds of wheeze of asthma, stridor of inhaled objects, or crackles of pulmonary edema, asking patient to breathe normally, again starting supraclavicular, on either side, then going downwards (3x sets). Also doing the sides
  • Vocal resonance, of pleural effusion. It is again starting supraclavicular, on either side, 3 sets, but asking the patient to repeat "999" each time the stethescope is on the chest (only on back)
• For completion:
  • Sputum pot
  • Bed side peak flow
  • Obs chart, paying particular attention to the temperature and oxygen sats

• Labored breathing