Good

1. RESPIRATORY EXAMINATION
Ass. Pro. Dr. Zahraa M. AlRufaie

2. 1. Greet the parent
2. Take permission
3. Wash your hand

3. Chest
Respiratory examination
Precordium

4. General examination
•Gender, age, body build,
nutrition state, syndromic,
position, pale, cyanosis,
jaundice, clubbing and
lymphadenopathy

5. •Examine the signs of
respiratory distress : nasal
flaring, granting, air hanger
position, use of accessory
muscle and retraction of
respiratory muscle
( dyspnea)
•Accessories ( O2 supply,
nebulizer, CPAP and
ventilator)

7. Inspection
• 1. Shape of chest / diameter, congenital or acquired deformities (e.g.
pectus excavatum, pectus carinatum, kyphoscoliosis).

8. Inspection
•Surgical scars /thoracotomy and chest tube scar
•Abnormal mass
•Abnormal pigmentation /hypo or hyper pigmented lesion
•Respiratory movement ( symmetrical or not like in
pneumothorax and cardiomegaly) and pattern of
breathing tachypnoea, retractions, use of accessory
respiratory muscles and paradoxical respiration

10. Palpation
•Chest expansion and symmetry /Chest expansion should be about
3–5 cm in school age children
•Trachea position central or deviated
•Apex beat
•Abnormal pulsation, veins and masses
•Tactile vocal fremitus/ Low-pitch, high-amplitude sounds, such as
repeating ‘‘ninety-nine’’ or ‘‘one-one-one’’ (equivalent
vocalizations should be used in other languages), rather loudly will
result in increased tactile fremitus in the case of parenchymal
consolidation (e.g. pneumonia) and attenuation of the tactile
fremitus in the case of pneumothorax and pulmonary distension
(air trapping). Pleural friction rubs may also be noted

11. Percussion
• Resonance /normal, hyperresonance in
pneumothorax or hyperinflation, or dullness in
consolidation, pleural effusion or collapse
• Most pediatricians use the indirect method of
percussion, whereby they tap lightly, vertical to
the surface, with the long finger of one hand
(plexor), two or three times in each position,
on the terminal phalanx of the middle finger of
their other hand (pleximeter), which is placed
over an intercostal space. The chest is
percussed symmetrically.

12. Auscultation

13. • Symmetry of breath sound/ should be equal , decrease in pneumothorax and
foreign body inhalation and pleural effusion, increase in pneumonia
• Quality of breath sound: bronchial or vesicular
• Inspiratory / expiratory phase
• Added sound (rhonchi, crepitation, stridor plural rub
• Vocal resonance

15. What is the mean of global rating during life
and OSCE
Excellent 4 Good 3 Satisfactory 2 Borderline 1 Poor 0 Global rating
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