Respiratory examination

(Redirected from Chest expansion)
Jump to navigation Jump to search

WikiDoc Resources for Respiratory examination


Most recent articles on Respiratory examination

Most cited articles on Respiratory examination

Review articles on Respiratory examination

Articles on Respiratory examination in N Eng J Med, Lancet, BMJ


Powerpoint slides on Respiratory examination

Images of Respiratory examination

Photos of Respiratory examination

Podcasts & MP3s on Respiratory examination

Videos on Respiratory examination

Evidence Based Medicine

Cochrane Collaboration on Respiratory examination

Bandolier on Respiratory examination

TRIP on Respiratory examination

Clinical Trials

Ongoing Trials on Respiratory examination at Clinical

Trial results on Respiratory examination

Clinical Trials on Respiratory examination at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Respiratory examination

NICE Guidance on Respiratory examination


FDA on Respiratory examination

CDC on Respiratory examination


Books on Respiratory examination


Respiratory examination in the news

Be alerted to news on Respiratory examination

News trends on Respiratory examination


Blogs on Respiratory examination


Definitions of Respiratory examination

Patient Resources / Community

Patient resources on Respiratory examination

Discussion groups on Respiratory examination

Patient Handouts on Respiratory examination

Directions to Hospitals Treating Respiratory examination

Risk calculators and risk factors for Respiratory examination

Healthcare Provider Resources

Symptoms of Respiratory examination

Causes & Risk Factors for Respiratory examination

Diagnostic studies for Respiratory examination

Treatment of Respiratory examination

Continuing Medical Education (CME)

CME Programs on Respiratory examination


Respiratory examination en Espanol

Respiratory examination en Francais


Respiratory examination in the Marketplace

Patents on Respiratory examination

Experimental / Informatics

List of terms related to Respiratory examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]


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 - 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.

Video: Respiratory Examination


Respiratory examination

The basic steps of the examination can be remembered with the mnemonic IPPA:

  • Inspection
  • Palpation
  • Percussion
  • Auscultation

General physical examination

  • Check whether the patient is well oriented with time, place, and person. The mnemonic 'PICKLE' is used sometimes for general physical examination. PICKLE stands for Pallor, Icterus, Cyanosis, Clubbing, Koilonychia, Lymphadenopathy, and Edema


  • General inspection
    • Patient's body mass (look for wasting, cachexia, puffiness)
    • Check for any instruments present like inhalers, peak flow meter, or oxygen cylinder
  • Hands
    • Flapping tremor, CO2 narcosis tremor, nicotine stain
    • Palpate the pulse and simultaneously check for the respiratory rates. This prevents the patient from getting conscious.
    • Check for pulsus paradoxus (COPD)
    • Rhythm AF can be seen in pneumonia
  • Nasal cavity - Flaring alae nasi suggest labored breathing
  • Oral cavity - Nicotine staining on the inner surface of oral cavity or teeth
  • Neck - Tracheal deviation (can suggest of tension pneumothorax), dilated vessels, and abnormal pulsations. No supraclavicular or infraclavicular fullness in neck. No visible swelling on neck
  • Chest - Ideally the observer should stand at the foot end of the patient and
    • Identify the apex
    • Abnormal movement of chest
    • Abnormal pulsations of the chest
    • Accessory muscles of respiration, scalene, sternocleidomastoid
    • Any chest deformity, swelling or scar
  • 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


  • Check for local rise of temperature
  • Check for tenderness
  • Check for any subcutaneous emphysema
  • Check for supraclavicular fullness
  • 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


Middle finger strikes the middle phalanx of the other middle finger. The sides of the chest are compared.


Other systems evaluation

  • Ideally cardiovascular and, abdominal examination should also be done

Respiratory System at a Glance

Main lobes are outlined in black. The following abbreviations are used: RUL = Right Upper Lobe; LUL = Left Upper Lobe; RML = Right Middle Lobe; RLL = Right Lower Lobe; LLL = Left Lower Lobe.

(Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

Anterior View

Posterior View

Right Lateral View

Left Lateral View


Possible Examination Findings

Pectus Excavatum

Barrel Chest



External links

Template:WH Template:WS