Ask the patient to hold out their arms and bend their wrists so that their palms are vertical pointing away from them. Respiratory causes of clubbing include: Empyema, Bronchiectesis, Non-small cell carcinoma, Lung fibrosis, CF, Abscesses, suppurative diseases – diseases that produce a lots of pus!.

Also look for a drip, any medications, sputum pots, nasal specs or masks.Ĭheck for signs of clubbing. as these are clues to possible respiratory disorders. is there oxygen, inhalers or a nebulizer etc. listen if there are any audible breathing sounds (normally there aren’t.).Normally expiratory time is shorter than inspiratory time, however, in lung diseases, often there is very short inspiration followed by prolonged expiration. look at the patient’s expiratory time.see if the patient is pursing their lips on breathing.This may be present if the patient suffers from COPD) see if there is any wasting of the accessory muscle of breathing.see if there is any ‘’breathlessness’’ – see if they are already propped up on many cushions (heart failure).see if there are any obvious signs of weight loss.Patient comfort is the most important factor. If the patient is very breathless in this position, then allow them to sit up straight. patient should be sat at 45’ for this examination.You may get very suspicious if they also have a hoarse voice and/or weight loss.Look for signs of blood – could be infection, could be malignancy.Massive amounts of sputum – most likely bronchiectasis.Yellow/green sputum – sign of infection.About 90% of diagnostic information will be gained from patient history – therefore examination should only ever be used as a subsidiary! Never just dive in and examine someone without knowing the proper history first.The middle lobe of the lung can only be auscultated from the axilla and back of the patient.Always ask the patient to strip to the waist, even women! Check they feel comfortable, women may want to keep a bra on, and always explain what you are doing, so that they don’t think you are just having a grope!.You may also be asked to palpate the apex beat to see if it has been displaced.Practice lots so you know what normal is. Remember you are always comparing the two lungs.Make sure you get consent at the start of the examination, but then you don’t need to keep asking the patient again as you do the rest of the examination! You should still explain what you are going to do, but don’t keep asking them if its ok.Always examine the patient from their right.For a quick overview of the respiratory system exam, please see the Introduction to Respiratory Exam article General Instructions

Rhonchi lung sounds upper or lower