Synopsis
Perform a respectful, systematic respiratory examination, interpret combinations of physical signs with appropriate uncertainty, and turn findings into a defensible differential diagnosis and immediate plan.
- Introduce yourself, confirm identity and purpose, obtain consent, offer a chaperone when appropriate, expose only what is necessary, and monitor comfort throughout.
- Before following a routine, look for distress, altered consciousness, central cyanosis, inability to speak normally, marked work of breathing or dangerous oxygenation; pause and escalate when the patient is unstable.
- Examine from the end of the bed through hands, pulse, face, neck, chest inspection, palpation, percussion and auscultation, comparing corresponding areas on both sides.
Reasoning priorities
Establish current severity before relying on detailed physical signs.
Respiratory rate, oxygen saturation, pulse, blood pressure, temperature and conscious level contextualise the examination; device, oxygen flow and baseline targets must accompany saturation.
Worked reasoning
A fictional assessment case supplies progressive breathlessness, right-sided reduced chest expansion, a markedly dull percussion note and reduced breath sounds at the right base; respiratory observations are stable.
- Confirm stability, consent and comfort first; position the person as tolerated, compare both sides, and verify that the asymmetry persists across expansion, percussion and auscultation rather than relying on one pass.
- Translate the observations into a pattern: concordant basal volume, percussion and sound changes suggest a local pleural-space or adjacent lung process, with pleural fluid an important hypothesis rather than a proven diagnosis.
- Build alternatives by mechanism, including consolidation, collapse, substantial pleural thickening or technical limitation; use fever, pain, malignancy risk, procedure history and tracheal position only if they were actually provided.
- Synthesise aloud: the patient is currently physiologically stable with a right basal pleural-pattern examination; request suitable imaging and relevant clinical tests, and escalate sooner if breathlessness or observations worsen.
- Verify the reasoning by checking the documented location and reproducibility, ensuring the proposed test can distinguish alternatives, explaining uncertainty in plain language, and seeking feedback on comparison technique and closure.