Abstract
The first step in pulmonary examination is taking a careful history. If the patient is suffering from shortness of breath, it may be worthwhile to gain information by observing them walking a short distance with you. Pulmonary examination then begins with the patient sitting on the examination table as comfortably as possible, with the upper body completely uncovered. The colour of the skin and tongue, the respiratory rate, pattern and effort can now be examined. Palpation is used to determine chest expansion and check for any vibration, tenderness and/or subcutaneous emphysema. Percussion will reveal any dullness (e.g. due to pleural fluid) or hyperresonant area (e.g. due to pneumothorax). This is followed by auscultation of the various parts of the lungs: abnormal breath sounds with or without adventitious sounds sounds, such as rhonchi, crackles and pleural rub, may provide clues to particular lung diseases. More and more pneumonologists are adding ultrasound scanning of the chest and lungs to their examinations: if the ultrasound technician is adequately skilled, this provides accurate detection of common causes of respiratory failure such as pneumonia, pleural effusion and pneumothorax.