Respiratory Exam
Respiratory Exam
Please assess the student performing a complete respiratory exam.
Student's Email:

GENERAL - Observe the student doing the following:

Washes hands
       
Introduces self and exam to patient
           
Appropriate draping of patient

Expose from the waist up. Intermittent exposure should be considered for female patients.

               

INSPECTION - The student should comment on the following:

Patient's general appearance

Ex: respiratory distress, generally well/unwell etc.

               
Level of consciousness
               
Signs of increased respiratory effort

Ex: tripoding, pursed lip breathing, accessory muscle use

               
Signs of cyanosis

Central cyanosis: Bluish mucous membranes, Peripheral cyanosis: Cool/bluish extremities

               
Audible breath sounds

Ex: Stridor, wheezing

               
Clubbing

Schamroth's sign

               
Barrel chest

Increased AP diameter

               
Chest wall abnormalities

Pectus excavatum (funnel chested); Pectus carinatum (pigeon chested)

               
Spinal abnormalities

Kyphosis (abnormal AP curvature of spine), Scoliosis (Abnormal lateral/torsional curvature of spine)

               
Masses, scars, lesions
               

PALPATION - Observe the student performing the following manoeuvers:

Position of the trachea
               
General palpation - anterior & posterior

Palpating for tenderness, chest wall abnormalities

               
Chest expansion
               
Tactile fremitus - anterior & posterior

Ask patient to say "toy boat" and palpate for transmission of vibration across the chest wall

               

PERCUSSION - Observe the student performing the following manoeuvers:

Percussion of lung fields - anterior & posterior

Percuss all lung fields and comment on quality of percussion note

               
Diaphragmatic excursion - posterior

Comments on findings and compares to expected

               

AUSCULTATION - Observe the student performing the following manoeuvers:

Auscultation for breath sounds - anterior & posterior

Auscultate in all lung fields (bilaterally) for air entry, adventitious breath sounds (wheezes, crackles etc)

               
Egophany

Ask patient to say "EEEEEE" and auscultate for transmission of "AAAAA" sound

               
Whispered pectoriloquy

Ask patient to whisper "1,2,3" and auscultate over suspected area for sound transmission

               

GLOBAL RATING SCALES - Please rate the student on their overall performance:

Understands rational of manoeuvers and findings
                   
Organized approach
                   
Sensitivity toward patient concerns and comfort during the examination