12 Steps Respiratory Examination Checklist

(1) Well-being, (2) posture [no. of pillows] – sitting up at 45°, (3) respiratory status, (4) height and (5) built.
No. Steps Tick
1. (a) Check Palm for Palmar erythema & hypothenar wasting
(b) Fingers for Clubbing & Tobacco staining
(c) Nail for Peripheral cyanosis.
(d) Tremors: Fine (S/E of beta agonist & theophyllines) Flapping (Severe CO2 retention)
2. (a) Radial Pulse (rate, rhythm, character - collapsing, volume)
3. (a) Symmetry at the Shoulder (Pancoast Tumour)
4. (a) Subconjunctival Pallor & Scleral Jaundice
(b) Horner’s syndrome (miosis, ptosis, anhydrosis) – Pancoast Tumour
5. Mouth for Oral hygiene (nicotinic staining) and Central Cyanosis [& hydration status]
Leukoplakia & Candidiasis
6. (a) Neck for JVP
(b) Palpate Lymph Nodes!!!!!!
7. (a) Lower extremities Pitting edema
8. Start from anterior aspect:
Inspect Chest deformity, scars [Anything obvious]
- Shape [Barrel-shaped] & AP diameter
- Symmetrical expansion
9. (a) Palpate: Tracheal deviation
(b) Assess expansion symmetry
 hand – apical, upper, middle & lower zone
 measuring tape – middle zone
(c) Assess tactile fremitus
(d) Palpate apex beat (Displaced?)
10. Percussion (Compare each side – supraclavicular, directly on clavicle, infraclavicular,
supramammary, inframammary, lung base at lateral chest)
10. Auscultation:
(a) Breath sounds
 Air entry
 Bronchial vs Vesicular
 Added sounds (wheezing, stridor, fine vs coarse crepitations)
(b) Vocal resonance (by saying ninety-nine)
11. From the Posterior: Repeat the same as anterior
 Inspection
 Palpation (Expansion & tactile fremitus)
 Percussion (Ask patient to hug a pillow) – Suprascapular, interscapular,
infrascapular, lung bases.
 Auscultation (Breath sounds and Vocal resonance)
12. Proceed with Cardiovascular Examination