Examination

Obviously a full examination but in particular 

General mobility of patient getting onto couch and walking across clinic room

Smell of cigarettes or tobacco staining

Previous scars especially on chest

Shape of chest emphysematous / barrel

Is the patient wasted or obese

Amount of coughing and sputum produced in clinic.

Cyanosis

Lymph nodes especially supraclavicular (?M1 disease)

Locally tender vertebral column and ribs ? metastasis or fracture

Trachea central

Air entry

Presence of wheeze

Cardiac murmurs