FFinalistSouthampton · 2027
Examinations

CPSA · Clinical examination · Respiratory

Respiratory examination

Inspect → palpate → percuss → auscultate the chest front and back, comparing sides. The pattern of findings localises the pathology (consolidation vs effusion vs pneumothorax vs fibrosis).

Practise it out loud

Position: Patient reclined at 45°, chest exposed.

The routine

General inspection
  1. 1At rest: respiratory rate, work of breathing, accessory muscles, pursed lips, audible wheeze/stridor
  2. 2Around the bed: oxygen, inhalers, nebuliser, sputum pot, cigarettes
Hands
  1. 1Clubbing (fibrosis, bronchiectasis, cancer), tar staining, peripheral cyanosis
  2. 2Fine tremor (β-agonist), CO₂ retention flap (asterixis), bounding pulse (CO₂ retention)
  3. 3Respiratory rate (count discreetly)
Face & neck
  1. 1Eyes: conjunctival pallor, Horner’s (apical/Pancoast tumour)
  2. 2Mouth: central cyanosis
  3. 3Trachea — central or deviated (towards collapse/fibrosis, away from large effusion/tension pneumothorax)
  4. 4Cricosternal distance (hyperexpansion in COPD); lymphadenopathy
Chest — inspect & palpate
  1. 1Scars, deformity (barrel chest, kyphoscoliosis), asymmetry
  2. 2Chest expansion — reduced on the side of pathology
  3. 3Tactile vocal fremitus — increased over consolidation, decreased over effusion/pneumothorax
Chest — percuss & auscultate
  1. 1Percussion: dull = consolidation/collapse; stony dull = effusion; hyper-resonant = pneumothorax/COPD
  2. 2Auscultate breath sounds + added sounds; compare sides, front and back
  3. 3Vocal resonance to confirm the percussion pattern

Signs & what they mean

Bronchial breathing, increased fremitus, dull percussion, coarse cracklesConsolidation (pneumonia)
Stony-dull percussion, absent breath sounds, reduced fremitus, trachea deviated awayPleural effusion
Hyper-resonant, absent breath sounds, trachea deviated away (if tension)Pneumothorax
Fine end-inspiratory “velcro” crackles, clubbingPulmonary fibrosis
Polyphonic expiratory wheeze, hyperexpansion, prolonged expirationCOPD / asthma
Coarse crackles + copious sputum + clubbingBronchiectasis

To complete, I would…

  • Check observations incl. SpO₂, peak flow, and a sputum sample
  • Request a chest X-ray
  • Examine for lymphadenopathy and peripheral oedema (cor pulmonale)

OSCE tips

  • Trachea deviates towards collapse/fibrosis but away from a big effusion or tension pneumothorax.
  • Stony-dull = effusion; just dull = consolidation.
  • Examine the back — most signs are best heard there.
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