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Physical Examination ofthe Respiratory System
By ScholarRx
Updated May 27, 2021
access_time19 min
Learning Objectives (3)
After completing this brick, you will be able to:
● Develop a systematic approach to examining the respiratory system
that involves inspection, palpation, percussion, and auscultation.
● 1
● Differentiate between crackles and wheezes on auscultation.
● 2
● Identify signs and symptoms of respiratory distress in both adult and
pediatric patients.
● 3
cableCASE CONNECTION
HD is a 55-year-old man who has just been admitted to the hospital
for fever and cough. His chest x-ray shows a lobar pneumonia. His
daughter, GD, is present as you perform an admission history and
physical. “She’s headed for medical school next year,” HD says while
smiling at her. During the lung exam, you note findings that are
particularly consistent with the presence of an infiltrate and offer to GD
listen to what you are hearing.
,What lung auscultation findings might you be sharing with GD?
Consider your answer as you read, and we’ll revisit at the end of the
brick.
GO TO CONCLUSIONarrow_downward
Our discussion of the physical exam on the respiratory system begins
with a piece of advice: When doing this exam, it is best if you can
picture in your mind where the underlying structures are located.
Visualizing this way will help you identify what structure is affected
when there is a pathologic finding. To that end, let’s start by
reviewing the anatomy of the lungs.
Anatomy of the Lungs
When you are looking straight at the patient’s chest, you will not see
the lungs, or the airways, or the pleura beneath the skin. However,
you will be able to feel for the sternum and the ribs. These will be the
landmarks that guide you to pinpoint the locations of each structure.
(Note that we will only be discussing the essential landmarks for
doing a physical exam.)
Pleura
Pleura is the double-layered membrane that separates the lungs from
the chest wall. Its “location” follows the contour of the lung and will
be discussed below with the lungs.
Airway and Respiratory Tract
,The airway is an important structure in the respiratory system because
it provides the passage for air from the environment to the alveoli. It
is divided into the upper and lower respiratory tract. The upper
respiratory tract includes the nasal cavity, pharynx, and larynx. The
lower respiratory tract includes the trachea, main bronchus, lobar
bronchus, and other divisions down to the alveoli. For purposes of a
physical exam, you only need to be able to visualize the trachea, the
main bronchus, and the lobar bronchi.
The trachea is a midline structure that descends down to the carina
(where the trachea bifurcates into the right and left bronchi). The
carina is located at the sternal angle, where the manubrium and the
body of the sternum meet (Figure 1). It is the most prominent
landmark on the sternum and also where the second rib articulates
with the sternum.
, Figure 1
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