Palpations

Question 1

Trachea Location

Answer 1

test one side at a time

• finger on medial clavicle, nail facing outwards
• measure in cm
• look for equal distances

Question 2

Chest expansion and vocal and tactile fremitus

Answer 2

Breathe in, breathe out, say 99

• 5 spots anterior
  - 2 under clav, 1 on sternum, 2 under breasts
• 2 spots lateral
  - spread out fingers over sides
• 6 spots posterior
  - 2 over scap, 2 on scap, 2 under scap

Question 3

Evaluative Percussion

Answer 3

on bare skin at the ICS, assess air, liquid, or solid content in lungs
- test all ICS, ant, lat, and post

Question 4

Evaluative Percussion

Dull

Answer 4

heard over solid organs

• low amp, med-high pitched
• heart: left 3rd-5th ICS
• liver: right 5th-7th ICS

Question 5

Evaluative Percussion

Tympanic

Answer 5

heard over hollow organs

• high pitch
• lungs: left 6th ICS

Question 6

Evaluative Percussion

Resonant

Answer 6

heard over normal air filled organs
- hyper-resonant in emphysema

• if dull where you expect resonant - FLUID BUILD-UP*
• *if tympanic where you expect resonant - AIR BUILD UP**

Question 7

Evaluative Percussion

Flat

Answer 7

heard over muscle mass

Question 8

Diaphragmatic Excursion

Answer 8

how much does the diaphragm move in normal breathing

• percuss post rib 8 down until hear resonance –> dull
  - mark level
• instruct pt to take a deep breath and hold
• percuss mark down until hear resonance –> dull
  - mark level
• measure distance between levels
  - 3 - 5 cm is normal

will be decreased in COPD

Question 9

Heart outline

Answer 9

1. 2nd sternal junction on left
2. 3rd ICS 4cm from sternum on right
3. 6th costal sternum border on the right
4. 5th ICS at MCL on the left (PMI/mitral area)