Pulmonary/Chest Std Exam

Question 0

Palpate:

Answer 0

Tell me if you notice any discomfort while I palpate for tenderness and masses along spinal processes, along ribs, percuss lung fields (6 spots) (including posterior and lateral, percuss spinal processes and CVA (costo-vertebral angle)
(use finger PADS to press against chest wall)

Question 1

First inspect

Answer 1

From back: I am going to open your gown in the back and do a general inspection of skin for lesions, discoloration and texture.
From front?: I am checking chest contour, symmetry, deformities, AP diameter, skin lesions, respirations are unlabored, no retractions. I am going to check lung expansion - please breath in and out and again.

Question 2

Percuss for resonance:

Answer 2

Posterior thorax (compare sides)
Lateral thorax (compare sides)
Compare symmetric regions

Question 3

What and how to Percuss for tenderness

Answer 3

Spine and costovertebral angles using gentle/moderate fist percussion

Question 4

Auscultate for breath sounds

Answer 4

“each time I move my stethoscope, take a moderate size breath in and out through your mouth”
“BREATH SOUNDS ARE VESICULAR AND SYMMETRICAL” or
“No adventitious breath sounds are heard”

Question 5

Now inspect anterior chest

Answer 5

Pull the gown down.”I am inspecting the skin for lesions, discoloration, checking for anterior chest for symmetry, deformities, breathing effort, respirations (unlabored), retractions, AP diameter.

Question 6

Percuss anterior chest for resonance and auscultate the anterior lung fields (for breath sounds)
(Don’t forget to use a drape for female pt)

Answer 6

above and under clavicle
under chest
“Breath sounds are vesicular and symmetric”

Question 7

Palpate anterior chest

Answer 7

I am palpating for tenderness on clavicles, sternum and anterior ribs. Now please pull your gown up to chest level - I am palpating lower ribs for tenderness.

Question 8

Tactile fremitus

Answer 8

Use side of hand:

“every time I put my hands on your chest/back, say 99”

Question 9

bronchophony

Answer 9

“each time i put my stethoscope on your chest, please say 99”

Question 10

Egophony

Answer 10

eee-to-A

Each time I put my stethoscope on your back, say “eee”

Question 11

Whistpered pectoriloquy

Answer 11

Each time I put my stethoscope on your back, whisper 99

Question 12

Percuss for diaphragmatic excursion

Answer 12

Ask pt to exhale and hold it, then percuss for dullness, mark with pen.
Then ask pt to inhale and hold, percuss till reach dullness, mark with pen. Ask pt to release breath.
“Diaphragmatic excursion is 3-5cm (normal) on the L and ___ cm on the R”

Question 13

Respiratory expansion

Answer 13

Spread fingers of each hand on either side of the spine posteriorly, then watch the fingers separate as pt inhales.