Skill certification checklist: Clinical Examination of Respiratory System
Give proper instructions to the subject and upper region of the body is to be exposed
for examination.
Stand on the right side of the subject
Examination to be carried out by inspection, palpation, percussion & auscultation.
Inspection
Examine the position of trachea.
Ask the subject to keep his/her head and neck straight and look for the position of
trachea. (Normally it is in the midline or slightly deviated to right.)
Look for any prominence of clavicular head of sternocleidomastoid.
Inspect the chest and give your observations.
Give proper instructions to the subject and make him/her sit comfortably on a stool.
(the upper region of the body is to be exposed for examination).
Look for apical impulse.
Note the shape and symmetry of the chest.
Examine for the presence of any abnormalities of chest.
Look if all areas move equally and symmetrically with respiration.
Note the rate of breathing.
Note the rhythm of breathing.
Look for the depth of breathing.
Observe for the type of respiration.
Look for any dilated/engorged veins or visible pulsations/scars.
Observe if there is muscle wasting and
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drooping of shoulders.
Look for deformities of vertebral column.
Note if there is any use of accessory muscles of respiration when at rest.
Report the findings.
Palpation
Palpation of trachea
Fix the head of the subject so that the head and neck in in the midline position.
Place tips of examiner’s index and ring fingers on the sternoclavicular joints on both
sides and middle finger over the suprasternal notch.
Feel the tracheal rings in suprasternal notch gently by the middle finger for nay
deviation.
Report the findings.
Palpate for the apex beat
Expose the precordium
Put the palm on the precordium over the
mitral area to feel apical impulse
Use the ulnar border of the hand to
further confirm the pulsation
Use the tip of the finger to finally locate
the apex and mark the position
Examine for the movements of chest.
Note the anteroposterior and transverse diameters of the chest.
Ask the subject to exhale fully and take measurement.
Ask the subject to take in a deep, full breath and repeat the measurement.
Calculate difference between above two values to determine expansion of the
chest.
Place your palms firmly on both sides of subject’s chest, tips of your fingers at the sides
and tips of thumbs just meeting in mid-line on front of the chest.
Ask the subject to take a deep inspiration and note your thumbs moving equally away
from the mid-line.
Place the examiner’s hand on the upper part of the chest on both the sides and note
the movement of chest with respiration.
Stand behind the subject and place the examiner’s hands on the subject’s shoulders
on both the sides and note their movement with respiration.
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Elicit vocal fremitus in the anterior chest wall of the given subject and report your findings.
Give proper instructions to the subject and make him/her sit comfortably on a stool.
(the upper region of the body is to be exposed for examination)
Place the ulnar border of the hand in the intercostal spaces on one region of one
side of the chest.
Ask the subject to say ‘9’ or ‘99’.
Feel for the vibration on the chest wall.
Repeat the same on the opposite side and compare.
Repeat the same in all regions of the anterior chest wall with comparison to other
side.
Report the findings.
Tenderness -Palpate all regions of chest wall to elicit tenderness if present
Percussion of the lung fields.
Mark and percuss the anterior, posterior and axillary areas bilaterally.
Change the hand position accordingly to expose the lung fields.
Report the observations.
Auscultation
Ask the subject to take slow and deep breaths.
Auscultate anterior, posterior and axillary areas bilaterally using the diaphragm of the
stethoscope.
Comments on the intensity, type, symmetry of the breath sounds.
Comment on any added sounds.
Report the observations.
Elicit vocal resonance over all the lung fields of the given subject.
Place the diaphragm of the stethoscope on region one side of the chest.
Ask the subject to say ‘9’ or ‘99’.
Hear the sounds on the chest wall.
Repeat the same on the opposite side and compare.