Inspection – sitting up – 
Sputum mug and type of cough 
Respiratory pattern – depth and rate –  eg – Respiratory distress  , Dypsnic 
Accessory muscle use Cyanosed, 
 
Hands – clubbing,  cyanosis, nicotine stain 
     , Wrist tenderness ( hypertrophic pumonary OA ) 
        Wasting of muscle in hand – FINGERS ABDUCTION AND ADDUCTION against resistance – 
    flapping tremor
         . temperature and
 pulse – rate / rhythm 
    ( JUST LIKE PULSE RESPIRATORY RATE AND RHYTHM IS IMPORTANT IN THIS CASE) 
 
face – 
Horners,- ptosis, miosis, enopthalmus and anhydrosis, 
sinnus tenderness 
conjuctive palor, icturis 
hoarseness of voice – 
mouth ulcers and cyanosis 
 
palpate for trachea – central or moved
 
then get the patient to sit at the end of the bed to examine the back – 
from  the back – 
shape of chest and spine – 
scars, 
cervical LN 
Supraclaviculer LN 
check for chest expanshio n – from top with out palptaiton and then with both hands on the back 
 
tactile fremitus with hand – 
Puscuss the back of lung – supra claviculer area and axila 
Auscultate – breath sounds , 
vocal fremitus with stets
 
Then get the patient to lay on the back exposing the chest – 
 
inspection – scars, swelling. rash or wasting 
expanshion – by inspection or hands 
Tactile fremitus  – 
percuss the anterior chest and clavicles – 
Auscultate  – breath sounds
vocal fremius 
 
Then look for cardiac auscultation , JVP and leg oedema 
 
I would do , if needed 
Chest Xray, Spirometry, 
 
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