Introduces self
0
1

Confirms name & age of patient
0
1

Explains & gains consent
0
1

Washes hands
0
1

Exposes patient from waist up and positions at 45 degrees
0
1

Asks if patient is in pain
0
1

General inspection around bed & patient (comfortable, respiratory distress, pursed lips, added breath sounds, scars, chest deformities, sputum pot, oxygen, medication
0
1

Asks patient to take deep breath in and out to inspect symmetry of chest expansion.
0
1

Assesses hands for temperature, peripheral cyanosis, tar stains, clubbing, wasting and tremor
0
1

Checks for CO2 flap
0
1

Pulse (rate, rhythm, bounding pulse), respiratory rate and offers to assess blood pressure
0
1

Inspects JVP
0
1

Warns before assessing tracheal deviation
0
1

Inspects face for conjunctival pallor, horner's syndrome and tongue for central cyanosis
0
1

Palpates for apex beat
0
1

Assesses chest expansion of front
0
1

Percusses over front of chest comparing both sides
0
1

Checks tactile vocal fremitus or whisper perilolquy on front of chest
0
1

Auscultates over front of chest comparing both sides
0
1

Inspects back and assesses expansion
0
1

Percusses over back avoiding scapulae
0
1

TVF or WP on back
0
1

Auscultates back
0
1

Examines lymph nodes of neck
0
1

Checks for sacral & ankle oedema
0
1

Thanks patient and offers help to redress
0
1

Washes hands
0
1

Requests oxygen saturations, temperature, chest xray, peakflow, sputum (microbiology, culture, cytology) and observations chart
0
1

Summarise appropriately with only key findings.
0
1

Offer appropriate differential diagnoses.
0
1

Patient global score
0
1
2
Potential differentials
  • COPD
    • Look for sputum pot, inhalers, nebulisers, dyspnoea, pursed lipped breathing, use of accessory muscles
    • CO2 retention flap, bounding pulse, tar stained fingers
    • Hyperexpanded (cannot palpate apex beat)
    • Resonant percussion note
    • Expiratory wheeze
    • Look for signs of cor pulmonale (raised JVP, right ventricular heave, ankle oedema)
  • Pulmonary fibrosis
    • Clubbing, possible central cyanosis, tachypnoea
    • Fine end-inspiratory crackles (like velcro)
    • Lack of sputum
    • Look for signs of autoimmune conditions in face and hands (e.g. SLE, rheumatoid arthritis) or cushingoid appearance from steroid treatment
  • Pneumonectomy
    • Scar on side or posteriorly
    • Trachea deviated towards 
    • Reduced expansion, dullness to percussion and absent breath sounds (may hear from other side)
  • Lobectomy