1. The Respiratory Exam

2. Surroundings Is the patient on a respirator? Is he/she on oxygen? – Delivery system? (nasal prongs, mask etc) – How many litres a minute?

3. General Appearance Is the pt dyspnoeic? Are they using their accessory breathing muscles? Are they blue and bloated or pink and puffing? – DISCUSS PHYSIOLOGY

4. Hands Clubbing Nicotine staining Peripheral cyanosis Pallor of the palmar creases Wasting of intrinsic hand muscles- finger abduction (apical lung tumour pressing on the brachial plexus) Tenderness just below the wrist (pulmonary osteoarthropathy- associated with lung carcinoma an mesothelioma) Asterixis (CO 2 retention) Pulse (tachycardia with beta blockers) Resp rate (16-25)- 8>bradypnoea, 25<tachypnoea BP (paradox- decrease of 10mmHg or more during inspiration- indicates obstructive lung disease like asthma or COPD)

5. Face Eyes – Ptosis and pupil constriction (horners syndrome) – Conjunctival palour Sinuses (tenderness) Nose- polyps Mouth- tongue; central cyanosis

6. Neck Trachea – Deviation: thoracic mass, pnoemothorax etc – Tracheal tug (downward movements)-aortic aneurism JVP- elevated in heart failure, cor pulmonale Lymph nodes

7. Chest Inspect- scars, barrel chest, kyphosis & deformity Palpate – Chest expansion – Percussion (compare sides) Auscultate – Vocal resonance – Breath sounds Check for bony tenderness & sacral oedema

8. Abdomen Pulsatile liver