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:
- Position of the patient and the environment.
- Inspection of the patient and respiratory effort.
- Palpation of the patient's anterior and posterior chest.
- Percussion of the patient's anterior and posterior chest walls.
- Auscultation of the patient's anterior and posterior chest walls.
One method to remember the steps of the examination is through the mnemonicPIPPA:
When accompanying other physicians or students, medical staff typically report as they examine a patient. Examples of a normal examination may include:
- adjustment of environment
- "on inspection, effort is normal"
- "no tenderness to palpation", "fremitus WNL (within normal limits)"
- "clear to percussion bilaterally" or "CTP B"
- "clear to auscultation bilaterally" or "CTA B"; "no R/R/W (rhonchi, rales or wheezes)"
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