Respiratory examination

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. It is very rarely performed in its entirety or in isolation; most commonly, it is merged with the cardiac examination.

In the respiratory examination, the patient is asked to sit upright on an examination table, with arms at the side. Adequate lighting is ensured and the patient is asked to expose his or her chest.

Later in the examination, when the back is examined, the patient is usually asked to move the arms forward so that the scapulae are not in the way of examining the upper lung fields. These fields are intended to correlate with the lung lobes and are thus tested on the anterior and posterior chest walls (the front and back of the patient's thorax).

The respiratory exam has conventionally been split into different stages:

One method to remember the steps of the examination is through the mnemonic PIPPA:

When accompanying other physicians or students, medical staff typically report as they examine a patient. Examples of a normal examination may include:

The examiner then observes the patient's respiratory rate, which is typically conducted under the pretext of some other exam, so that patient does not subconsciously increase their baseline respiratory rate. Signs of respiratory distress may include:

Chest wall abnormalities are also examined, and may include:

As well as the patient's respiratory rate, the pattern of breathing is also noted:

The physician then typically inspects the fingers for cyanosis and clubbing.

Tracheal deviation is also examined.

The physician then places both palms on the posterior lung fields, asking the patient to count 1 to 10. The physician aims to feel for vibrations and compare the right/left lung fields. If the patient has a consolidation, (for example caused by pneumonia), the vibration will be louder at that part of the lung. This is because sound travels faster through denser material than air.

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