Respiratory Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Washes hands	0	1
Exposes patient from waist up and positions at 45 degrees	0	1
Asks if patient is in pain	0	1
General inspection around bed & patient (comfortable, respiratory distress, pursed lips, added breath sounds, scars, chest deformities, sputum pot, oxygen, medication	0	1
Asks patient to take deep breath in and out to inspect symmetry of chest expansion.	0	1
Assesses hands for temperature, peripheral cyanosis, tar stains, clubbing, wasting and tremor	0	1
Checks for CO2 flap	0	1
Pulse (rate, rhythm, bounding pulse), respiratory rate and offers to assess blood pressure	0	1
Inspects JVP	0	1
Warns before assessing tracheal deviation	0	1
Inspects face for conjunctival pallor, horner's syndrome and tongue for central cyanosis	0	1
Palpates for apex beat	0	1
Assesses chest expansion of front	0	1
Percusses over front of chest comparing both sides	0	1
Checks tactile vocal fremitus or whisper perilolquy on front of chest	0	1
Auscultates over front of chest comparing both sides	0	1
Inspects back and assesses expansion	0	1
Percusses over back avoiding scapulae	0	1
TVF or WP on back	0	1
Auscultates back	0	1
Examines lymph nodes of neck	0	1
Checks for sacral & ankle oedema	0	1
Thanks patient and offers help to redress	0	1
Washes hands	0	1
Requests oxygen saturations, temperature, chest xray, peakflow, sputum (microbiology, culture, cytology) and observations chart	0	1
Summarise appropriately with only key findings.	0	1
Offer appropriate differential diagnoses.	0	1
Patient global score	0	1	2

Potential differentials

• COPD
• Look for sputum pot, inhalers, nebulisers, dyspnoea, pursed lipped breathing, use of accessory muscles
• CO2 retention flap, bounding pulse, tar stained fingers
• Hyperexpanded (cannot palpate apex beat)
• Resonant percussion note
• Expiratory wheeze
• Look for signs of cor pulmonale (raised JVP, right ventricular heave, ankle oedema)
• Pulmonary fibrosis
• Clubbing, possible central cyanosis, tachypnoea
• Fine end-inspiratory crackles (like velcro)
• Lack of sputum
• Look for signs of autoimmune conditions in face and hands (e.g. SLE, rheumatoid arthritis) or cushingoid appearance from steroid treatment
• Pneumonectomy
• Scar on side or posteriorly
• Trachea deviated towards 
• Reduced expansion, dullness to percussion and absent breath sounds (may hear from other side)
• Lobectomy

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