1. Introduction
The respiratory examination assesses the lungs, pleura and chest wall and often appears in OSCEs. A systematic approach helps identify common patterns such as consolidation, pleural effusion, pneumothorax, chronic airway disease and interstitial lung disease.
2. Preparation and general inspection
Wash your hands, introduce yourself, confirm the patient''s identity and explain the examination. Position the patient at 45 degrees if tolerated and expose the chest appropriately while maintaining dignity. Inspect from the end of the bed for breathlessness, audible wheeze or stridor, cough, sputum pot, inhalers, oxygen therapy, nebulisers and cachexia.
3. Hands, arms, face and neck
Inspect the hands for clubbing, peripheral cyanosis, tar staining and asterixis if carbon dioxide retention is suspected. Assess the pulse. Check for a tremor if the patient is using beta agonists. Examine the face for central cyanosis and features of Horner syndrome. Assess the trachea and identify any deviation. Consider the cricosternal distance and palpate cervical lymph nodes if relevant.
4. Chest inspection and palpation
Inspect the chest for symmetry, scars, deformity, increased work of breathing and use of accessory muscles. Assess chest expansion by placing your hands on the chest wall and comparing movement side to side. Tactile vocal fremitus is less commonly used in routine undergraduate stations but may help differentiate pleural effusion from consolidation.
5. Percussion and auscultation
Percuss the chest in a ladder pattern, comparing side with side over the anterior, lateral and posterior chest. Auscultate the same areas with the diaphragm of the stethoscope while the patient breathes through an open mouth. Note breath sound intensity and character, added sounds and vocal resonance when indicated.
6. Completion
To complete the examination, assess the posterior chest fully if not already done, check for peripheral oedema or signs of deep vein thrombosis when clinically relevant, and measure observations such as respiratory rate, oxygen saturation and temperature. Summarise the findings and suggest appropriate investigations.
Preparation
General inspection
Hands
Face
Neck
Inspection
Palpation
Percussion
Auscultation
Completion