Respiratory examination
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In medicine, the respiratory examination is performed as part of a physical examination, or when a patient presents with a respiratory problem (dyspnea (shortness of breath), cough, chest pain) or a history that suggests a pathology of the lungs.
Position/Lighting/Draping
Position - patient should sit upright on the examination table. The patient's hands should remain at their sides. When the back is examined the patient is usually asked to move their arms forward (hug themself position) so that the scapulae are not in the way of examining the upper lung fields.
Lighting - adjusted so that it is ideal. Draping - the chest should be fully exposed. Exposure time should be minimized.
The basic steps of the examination can be remembered with the mnemonic IPPA:
- Inspection
- Palpation
- Percussion
- Auscultation
Inspection
- Tracheal deviation (can suggest of tension pneumothorax)
Chest wall deformities
- Kyphosis - curvature of the spine - anterior-posterior
- Scoliosis - curvature of the spine - lateral
- Barrel chest - chest wall increased anterior-posterior; normal in children; typical of hyperinflation seen in COPD
- Pectus excavatum
- Pectus carinatum
Signs of respiratory distress
- Cyanosis - person turns blue
- Pursed-lip breathing - seen in COPD (used to increase end expiratory pressure)
- Accessory muscle use (scalene muscles)
- Diaphragmatic paradox - the diaphragm moves opposite of the normal direction on inspiration; suspect flail segment in trauma
- Intercostal indrawing
Palpation
- Tracheal deviation - check whether trachea is in centre line.
- Tactile fremitus - the patient says boy-O-boy or ninety-nine, whilst physician sense with ulnar aspect of hand for changes in sound conduction.
- Respiratory expansion - check whether expansion is equal
- Location of apex beat - check if there has been deviation of heart
Percussion
Middle finger strikes the middle phalanx of the other middle finger. The sides of the chest are compared.
- dullness indicates consolidation
- hyper-resonance (as can be simulated by percussing the inflated cheek) suggests a pneumothorax
- diaphragmatic excursion - normal is 3 to 6 cm.
Ausculation
- Inspiratory crackles (decompensated congestive heart failure)
- Expiratory wheezes (asthma, emphysema)
- Stridor and other upper airway sounds
- Bronchial vs. vesicular breath sounds
- Appropriate ratio of inspiration to expiration time (expiration time increased in COPD)
Vocal fremitus (not usually done)
External links
- Respiratory exam - University of Florida
- Exam of the chest - University of Florida
- Respiratory exam - Respiratory Exam
- Lung sounds online - Emory University School of Medicine
Physical examination |
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Neurology | Mental state | Eyes | Jugular venous pressure | Respiratory system | Precordium | Abdomen | Peripheral vascular | Hip | Knee | Intimate |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
