MRCP PACES Respiratory Exam
  • Inspect (end of the bed)
    • Scars (pneumonectomy / lobectomy, VATS, chest drain)
    • Chest expansion
    • Respiratory distress
    • Cough – character, wet / dry
    • Pectus excavatum / carinatum
  • Hands
    • Peripheral cyanosis
    • Clubbing – malignancy, bronchiectasis or pulmonary fibrosis
    • Tar stains
    • Wasting of dorsal interossei
  • Wrist
    • Pulse – bounding in CO2 retention
    • CO2 retention flap
  • Face
    • Conjunctival pallor
    • Horner’s syndrome (Pancoast tumour)
    • Central cyanosis
  • Neck
    • JVP
    • Trachea – central / deviated (deviates towards collapse / pneumonectomy / PTX, away from effusion)
    • Cervical lymph nodes
  • Anterior chest
    • Inspect: scars
    • Palpate
      • Apex beat
      • Parasternal heave
      • Palpable S2
      • Chest expansion (AP, 2x lateral)
    • Percuss – apices, 3x anterior, 2x axillary
    • Auscultate: breath sounds, wheeze, crepitations (fine / coarse)
    • Vocal resonance
  • Posterior (sit up and fold hands across chest)
    • Inspect: thoracotomy
    • Palpate: chest expansion x3
    • Percuss x8
    • Auscultate and vocal resonance x8
    • Sacral oedema
  • Legs: pedal oedema
  • Complete examination:
    • Vitals, especially temperature and SpO2
    • Inspect sputum pot
    • Chest radiograph
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