Pulmonary

Question 1

Inspect Posterior Chest

Answer 1

• size, shape, and symmetry of back of chest
• observe for use of accessory muscles (SCM, trapezius)
• observe for retractions (usually lower intercostal spaces)

Question 2

Percuss Posterior Chest

Answer 2

Percuss three region going side to side. Can be flat, dull, resonant, hyperresonant, or tympanic.

Question 3

Auscultate Posterior Chest

Answer 3

Listen to full breath, go side to side, listen to minimum of three regions. Want vesicular symmetric breath sounds with no adventitious sounds (wheezes, rales, rhonchii)

Question 4

Inspect Anterior Chest

Answer 4

• inspect for shape, size, and symmetry
• observe for accessory muscle usage (SCM, trapezius, alae nasi)
• observe for retractions (lower intercostals)
• Inspect for cyanosis of mouth
• inspect nails for clubbing (look for diamond shape)

Question 5

Auscultate Anterior Chest

Answer 5

Listen to two regions side to side for vesicular symmetric breath sounds and no adventitious breath sounds (wheezes, rales, ronchii)

Question 6

Palpate posterior and lateral chest

Answer 6

• palpate thoracic muscles and skeleton looking for tenderness/masses
• place hands at level of tenth ribs, squeeze flap of skin together, have patient inhale, flap should tighten as rib cage expands
• check for fremitus by using ulnar surface of hand and having patient say 99 at 4 areas of back. Check both sides at the same time

Question 7

Palpate Anterior Chest

Answer 7

• suprasternal notch, sternal angle, costal-sternal articulation of 2nd rib
• palpate thoracic muscles and skeleton for tenderness/masses

Question 8

Percussion of lateral chest

Answer 8

patient holds arms out or over head, compare side to side

Question 9

diaphragmatic excursion

Answer 9

percuss until you find diaphragm. Have patient inhale fully and percuss down until you find where diaphragm moved to. Have patient exhale fully and percuss upwards until you find where diaphragm moved to. Measure space in between.

Question 10

Percuss anterior chest

Answer 10

compare side by side

Question 11

Auscultate lateral chest

Answer 11

have patient lift arms and compare side by side, only need 1 region

Question 12

Special Tests

Answer 12

Test at 3 sites and compare side-to-side
Egophony: Have patient say E
Bronchophony: have patient say 99