Physical Assessment- Chest & Thorax

Question 1

What is in the respiratory upper tract?

Answer 1

– Nose
– Pharynx
– Larynx
– Upper trachea

Question 2

What is in the respiratory lower tract?

Answer 2

– Lower trachea

– lungs

Question 3

What are the lung borders in the thoracic cavity?

Answer 3

– apex, highest point of lung
tissue, above mid clavicles.
– Base, rests on diaphragm

Question 4

The lungs are composed of?

Answer 4

– 3 lobes on right

– 2 lobes on left

Question 5

What is a Pleurae?

Answer 5

forms an envelope between lungs & chest wall

Question 6

What is a Visceral pleurae?

Answer 6

lines outside of lungs dipping into fissures.

Question 7

What is breathing?

Answer 7

• Air rushes into lungs as 
chest size increases 
– Inspiration (active) 
• Air expelled from lungs as 
chest recoils 
– Expiration (passive)

Question 8

What is a health history in thorax assessment?

Answer 8

– Common chief complaints:

Dyspnoea, cough, sputum, chest pain

Question 9

What is a past history in thorax assessment?

Answer 9

– Medical: Asthma, bronchitis, emphysema, pneumonia, PE, CF, TB
– Surgical: bronchoscopy, lobectomy, pneumonectomy, chest trauma
– Medications : bronchodilators, cough suppressants, oxygen, steroids

Question 10

What is family history in thorax assessment?

Answer 10

Cystic fibrosis, Asthma, bronchitis, TB

Question 11

What is social history in thorax assessment?

Answer 11

– Diet: alcohol
– Environment: smoker, stress, bird keeper, scuba diving, asbestos,
– Home: passive smoker

Question 12

What equipment do you need for thorax examination?

Answer 12

– Stethoscope 
– Tape measure 
– Watch (with second hand) 
– Pen light 
– Washable marker

Question 13

What to inspect in a thorax examination?

Answer 13

– Skin, colour & 
condition: scars 
– Shape & configuration 
– Respiratory rate, 
rhythm, depth, 
audibility, symmetry, 
position, mode 
– Presence of superficial 
veins

Question 14

How to palpate the chest?

Answer 14

Using fingers palpate entire 
chest wall anterior & posterior 
– Note areas of tenderness, lumps 
or masses 
– Skin temp, moisture & lesions

Question 15

How to do symmetrical expansion?

Answer 15

– Place clean warm hands outstretched 
– Posteriolateral chest wall 
– Thumbs at level of T9/T10 either 
side of vertebral column 
– Slide hands medially 
– Ask patient to take a deep breath 
in and out 
– Observe movement of thumbs 
bilaterally 3-5cm

Question 16

How to palpate the fremitus?

Answer 16

– Palpable vibration of chest wall during speech
– Assess anterior, posterior and lateral chest for fremitus
– Can use 3 different aspects of the hand:
• Palmar base of fingers
• Ulnar aspect of hand
• Ulnar aspect of closed fist
– Follow sequence as indicated, asking patient to say “99”, with same
intensity each time you place your hand
– Compare bilateral sides, symmetry most important

Question 17

How to percuss the chest?

Answer 17

• Sit patient upright
• Percuss 2-3 strikes each time
• Move from right to left then down
every second intercostal space and percuss again
• Start along right lung apex and
continue until entire lung has been percussed

Question 18

What is Diaphragmatic excursion?

Answer 18

Measures depth of ventilation

Question 19

In diaphragmatic excursion, instruct the patient to?

Answer 19

– inhale as deeply as possible
– Exhale fully and hold exhale, instruct ‘hold it’
– Percuss right lung, below scapula (scapular line) to where resonance
changes to dullness
– Mark this point and tell patient to breathe normally

Question 20

After instructing the patient?

Answer 20

• Patient inhale as deeply as possible and hold breath.
– ‘take a deep breath and hold it’
– Continue percussion from marked point downward to where sound
changes to dull on deep inspiration
– Mark this point
• Using a ruler measure the difference between 2 marks: 3-5cm