This document provides information on inspecting and palpating the respiratory system during a physical examination. Key points include: - Inspection involves observing symmetry, shape, size of chest wall, tracheal position, and respiration. Abnormal chest shapes include barrel-shaped, pectus carinatum, and pectus excavatum. - Palpation is used to confirm inspection findings and check for tracheal deviation, tenderness, crepitus, chest expansion, apex beat, cricosternal distance, and vocal fremitus. - Signs found on inspection and palpation can provide clues about underlying respiratory conditions such as COPD, pneumonia, pleural effusion, and lung

1. RESPIRATORY
EXAMINATION
INSPECTION AND PALPATION
PRESENTOR -DR.RASHI VOHRA
MODERATOR -DR.RITISHA BHATT

2. Approaching a Patient
PROPER HISTORY TAKING GENERAL PHYSICAL
EXAMINATION
SYSYEMIC EXAMINATION

3. RESPIRATORY SYSTEM EXAMINATION
INSPECTION
PALPATION
PERCUSSION
AUSCULTATION

4. INSPECTION
• Explain the procedure to the patient and
ask permission.
• Ensure proper lighting.
• Adequate Exposure and Position of the
patient.

5. SEQUENCE
• SYMMETRY OF CHEST
• SHAPE AND SIZE OF THE CHEST WALL
• SUBCOSTAL ANGLE
• APICAL IMPULSE
• CONDITION OF THE VERTEBRAL COLUMN
• TRACHEAL POSITION
• RESPIRATION
• VISIBLE VEINS, SCARS, SINUSES OVER CHEST

7. •Intercostal spaces are equal in
both hemithorax.
•Ribs lie obliquely.
•Shoulders and bony prominences
are at the same level.

8. BARREL SHAPED CHEST
• Chronically overinflated
lungs.
• Transverse : AP diameter is
equal.
• Ribs are more horizontal in
position.
• Supraclavicular fossae are
full.
• Sternum is bulged forward.
• Distance between cricoid
cartilage and suprasternal
notch is reduced.
ABNORMALITIES OF SHAPE

9. BARREL SHAPED CHEST

10. ABNORMALITIES OF SHAPE
PECTUS CARINATUM
(pigeon shaped)
PECTUS EXCAVATUM
(cobbler’s chest)

11. ABNORMALITIES OF SHAPE
PECTUS CARINATUM
(CAUSES)
• RICKETS
• CHRONIC NASAL OBSTRUCTION
• SEVERE ASTHMA
• EDWARDS SYNDROME
• DOWN’S SYNDROME
• MARFAN’S SYNDROME
• HOMOCYSTINURIA
• MORQUIO SYNDROME
• OSTEOGENESIS IMPERFECTA

12. ABNORMALITIES OF SHAPE
PECTUS EXCAVATUM
(CAUSES)
• RICKETS
• MARFAN’S SYNDROME
• SCOLIOSIS
• EHLERS-DANLOS SYNDROME

13. PECTUS EXCAVATUM

14. INSPECTION FROM THE BACK
• DROOPING OF THE SHOULDER
• UNDUE PROMINENCE OF MEDIAL
BORDER OF SCAPULA
• LEVEL OF INFERIOR ANGLE OF
SCAPULA
• VERTEBRAL COLOUMN
• INTERCOASTAL SPACES FROM
BOTH SIDES

15. THE VERTEBRAL COLOUMN
Cervical and lumbar spine
have lordosis.
Thoracic and sacral have
kyphosis.

16. LORDOSIS
INWARD CURVE OF THE
LUMBAR SPINE.
KYPHOSIS
EXAGGERATED,
FORWARD ROUNDING OF
THE BACK
SCOLIOSIS
SIDEWAYS CURVATURE
OF THE SPINE

17. SCOLIOSIS
KYPHOSIS
HYPER LORDOSIS

18. TRACHEAL POSITION
TRAIL SIGN
The undue prominence of the clavicular head of sternocleidomastoid on
the side to which trachea is deviated.

19. RESPIRATION
Inspiration - Active process
- By External Intercostal and Diaphragm
Expiration - Passive Process
Accessory Muscles Used
Inspiration - SCM, Scalene muscles.
Expiration - Internal and Innermost Intercostal
muscles.
Intercostal Retraction

20. • Type
Thoraco abdominal
Abdomino thoracic
• Rate and depth
Tachypnea
Bradyapnea
Hyperapnea
Apnea

21. RESPIRATION

22. MOVEMENT OF THE CHEST WALL

23. • HOOVER'S SIGN - refers to the inspiratory retraction of the lower
intercostal spaces. It results from alteration in dynamics of diaphragmatic
contraction due to hyperinflation, resulting in traction on the rib margins
by the flattened diaphragm. Seen in patients with severe obstruction, this
sign is associated with body mass index, dyspnea and frequency of
exacerbations. Excellent marker for severe airway obstruction.
• PARDOXICAL INWARD MOVEMENT – Diaphragmatic paralysis and flail
chest.

24. DISTENDED NECK VEINS

25. SCARS

26. CUTANEOUS MANIFESTATIONS IN RESPIRATORY
DISEASES
Erythema nodosum Atopic Dermatitis Lupus Perinio
Heliotrope rash and Gottron’s Papules Lupus Vulgaris

27. NEGLECTED PYORRHEAL TEETH RAISE - NECROTISING PNEUMONIA
PURSING OF LIPS DURING EXPIRATION – COPD
TREMORS - CO2 NARCOSIS
PUFFY FACE, NECK AND EYELIDS WITH DILATED VEINS- SVC OBSTRUCTION
SYNDROME
UNILATERSAL PTOSIS, ANIHYDROSIS - HORNER’S SYNDROME
PETECHIEA, PURPURA, ULCERATION/NECROSIS - SYSTEMIC VASULITIUS

28. PALPATION
• To confirm the findings of Inspection.
• Wash and Warm Hands.
• Compare both sides.
• Adequate Exposure and Position of the
patient.
• Markers, rulers, measuring tapes.

29. SEQUENCE
• Tracheal deviation
• Tenderness
• Crepitus
• Chest expansion
• Apex Beat
• Cricosternal distance
• Vocal Fremitus

30. TRACHEAL DEVIATION
• In Supine or sitting position
• Neck slightly extended
• Either keep the index finger in
the suprasternal notch and
compare distance on either side
• Or place the middle finger in
the notch and check whether
the index and ring fingers
(placed on SCM) are equidistant
to it or not

32. TENDERNESS
• TENDERNESS OF CHEST WALL
• FRACTURE OF RIBS
• SPINAL INJURY
• TUMORS INVOLVING CHEST WALL
• COSTOCHONDRITIS
• TEITZE SYNDROME
• INTERCOSTAL TENDERNESS
• INTERCOSTAL MUSCLE INJURY
• EMPYEMA
• SUBPHRENIC ABSCESS
• LIVER ABSCESS

33. CREPITUS
SUBCUTANEOUS EMPHYSEMA
GINGKO LEAF
SIGN

34. CHEST EXPANSION
• SHOULD BE BILATERALLY SYMMETRICAL
• NORMALLY AROUND 5-8 cm

35. CHEST EXPANSION
GENERALISED RESTRICTION ON ONE SIDE
• EMPHYSEMA PLEURAL EFFUSION
• BILATERAL FIBROSIS LUNG OR LOBAR COLLAPSE
• BILATERAL PLEURAL EFFUSION PNEUMOTHORAX
• ANKYLOSING SPONDYLITIS UNILATERAL FIBROSIS
• BILATERAL PLEURISY
• NEOMUSCULAR DISORDERS

36. APEX BEAT
LOCALISED IN LEFT 5TH
INTERCOASTAL SPACE , 1.5 CM
MEDIAL TO THE MID
CLAVICULAR LINE.

37. APEX BEAT

39. CRICOSTERNAL DISTANCE
• DECREASED IN
COPD

40. VOCAL FREMITUS
• TACTILE VOCAL FREMITUS IS LOW FREQUENCY PORTION OF VOCAL
SPECTRUM THAT RADIATES TO THE CHEST.
• PALPATED BY ULNAR BORDER OF THE HAND

41. INCREASED IN
• CONSOLIDATION
DECREASED IN
• PLEURAL EFFUSION
• HYDROPNEUMOTHORAX
• BRONCHIAL OBSTRUCTION
• EMPHYSEMA
• PULMONARY FIBROSIS
• LUNG COLLAPSE
• ABSENT IN
• PNEUMOTHORAX

42. THANK YOU !!