Ask the patient to hold out their arms and bend their wrists so that their palms are vertical pointing away from them.

Respiratory causes of clubbing include: Empyema, Bronchiectesis, Non-small cell carcinoma, Lung fibrosis, CF, Abscesses, suppurative diseases – diseases that produce a lots of pus!.

Also look for a drip, any medications, sputum pots, nasal specs or masks.Ĭheck for signs of clubbing. as these are clues to possible respiratory disorders. is there oxygen, inhalers or a nebulizer etc.

listen if there are any audible breathing sounds (normally there aren’t.).

Normally expiratory time is shorter than inspiratory time, however, in lung diseases, often there is very short inspiration followed by prolonged expiration.

look at the patient’s expiratory time.

see if the patient is pursing their lips on breathing.

This may be present if the patient suffers from COPD)

see if there is any wasting of the accessory muscle of breathing.

see if there is any ‘’breathlessness’’ – see if they are already propped up on many cushions (heart failure).

see if there are any obvious signs of weight loss.

Patient comfort is the most important factor. If the patient is very breathless in this position, then allow them to sit up straight.

patient should be sat at 45’ for this examination.

You may get very suspicious if they also have a hoarse voice and/or weight loss.Look for signs of blood – could be infection, could be malignancy.Massive amounts of sputum – most likely bronchiectasis.Yellow/green sputum – sign of infection.About 90% of diagnostic information will be gained from patient history – therefore examination should only ever be used as a subsidiary! Never just dive in and examine someone without knowing the proper history first.The middle lobe of the lung can only be auscultated from the axilla and back of the patient.Always ask the patient to strip to the waist, even women! Check they feel comfortable, women may want to keep a bra on, and always explain what you are doing, so that they don’t think you are just having a grope!.You may also be asked to palpate the apex beat to see if it has been displaced.Practice lots so you know what normal is. Remember you are always comparing the two lungs.Make sure you get consent at the start of the examination, but then you don’t need to keep asking the patient again as you do the rest of the examination! You should still explain what you are going to do, but don’t keep asking them if its ok.Always examine the patient from their right.For additional information visit Linking to and Using Content from MedlinePlus.For a quick overview of the respiratory system exam, please see the Introduction to Respiratory Exam article General Instructions Any duplication or distribution of the information contained herein is strictly prohibited without authorization. Links to other sites are provided for information only - they do not constitute endorsements of those other sites. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. This site complies with the HONcode standard for trustworthy health information: verify here. Learn more about A.D.A.M.'s editorial policy editorial process and privacy policy.

is among the first to achieve this important distinction for online health information and services. follows rigorous standards of quality and accountability. is accredited by URAC, for Health Content Provider (URAC's accreditation program is an independent audit to verify that A.D.A.M. Wheezing and other abnormal sounds can sometimes be heard without a stethoscope.Ī.D.A.M., Inc. They are most often heard when a person breathes out (exhales). High-pitched sounds produced by narrowed airways. Usually it is due to a blockage of airflow in the windpipe (trachea) or in the back of the throat. Wheeze-like sound heard when a person breathes. They occur when air is blocked or air flow becomes rough through the large airways. Rales can be further described as moist, dry, fine, and course. They are believed to occur when air opens closed air spaces. They are heard when a person breathes in (inhales). Small clicking, bubbling, or rattling sounds in the lungs. There are several types of abnormal breath sounds. Over-inflation of a part of the lungs ( emphysema can cause this).Air or fluid in or around the lungs (such as pneumonia, heart failure, and pleural effusion).Using a stethoscope, the health care provider may hear normal breathing sounds, decreased or absent breath sounds, and abnormal breath sounds. Normal lung sounds occur in all parts of the chest area, including above the collarbones and at the bottom of the rib cage. The lung sounds are best heard with a stethoscope.

Diseases with vesicular breath sounds