Respiratory examination

Respiratory examination

In medicine, the respiratory examination is performed as part of a physical examination,[1] 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.

Positioning and environment

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.


Main article: Palpation

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.

If a patient has pneumonia, palpation may reveal increased vibration and dullness on percussion. If there is pleural effusion, palpation should reveal decreased vibration and there will be 'stony dullness' on percussion.

The examiner then tests for


Main article: Percussion (medicine)

The physician attempts to examine changes in density of the lung fields by examining its resonance.

Specifically, percussion is performed with the middle finger striking the middle phalanx of the other middle finger of the other hand. The sides of the chest are compared. This is performed symmetrically on all lung fields, on the anterior and posterior chest walls.

Examples of alterations in density may include pleural effusion and pneumothorax. The sound is described as tympanic if there is a pneumothorax because air will stretch the pleural membranes. Conversely, if there is fluid between the pleural membranes, the percussion will be dampened and sound muffled.


Main article: Auscultation

[2] The physician then auscultates the respiratory sounds over the lung fields, listening to the fields through a stethoscope. This is conducted while the patient is breathing, noting normal breath sounds and any abnormalities including:

Lastly an assessment of transmitted voice sounds is performed.


  1. Colin D. Selby (25 October 2002). Respiratory : an illustrated colour text Check |url= value (help). Elsevier Health Sciences. pp. 14–. ISBN 978-0-443-05949-0. Retrieved 7 March 2011.
  2. Palaniappan R, Sundaraj K, Ahamed NU, Arjunan A, Sundaraj S. Computer-based Respiratory Sound Analysis: A Systematic Review. IETE Tech Rev 2013;30:248-56

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