Pulmonary Exam

Question 1

Assess

Answer 1

• RR: Count breaths for 15 seconds and multiply by 4

- Observe breathing pattern for regularity

Question 2

Inspection

Answer 2

Size, shape, and symmetry:
- Back
- Front
- Ribs
Observe for use of accessory muscles
Observe for retractions
Skin for cyanosis
Nails for clubbing

Question 3

Palpation

Answer 3

• Sternal notch
• Sternal angle
• Costal-sternal articulation of the 2nd rib
  Thoracic muscles and skeleton for:
• Tenderness/masses
• Expansion
• Tactile fremitus (“99”; compare side to side)

Question 4

Percussion

Answer 4

• Anterior chest: minimum 2 regions
• Posterior chest: minimum 3 regions (ask patient to cross arms)
• Diaphragmatic excursion

Question 5

Auscultate

Answer 5

• Anterior chest: minimum 2 regions
• Posterior chest: minimum 3 regions
• Axillae: minimum 1 region
• Egophony (“E”)
• Bronchophony (“99”)