PHYSICAL EXAMINATION

OF CHEST AND LUNGS

EXAMEN OBIECTIV AL APARATULUI RESPIRATOR

METHODS STEPS

INSPECTION – STATIC
– DYNAMIC

– STATIC
PALPATION
– DYNAMIC

PERCUSSION – DIRECT
– MEDIATED

AUSCULTATION – DIRECT
– INDIRECT
 ANATOMICAL REFERENCE POINTS
ANTERIOR MIDSTERNAL
STERNAL LINES LATEROSTERNAL

PARASTERNAL

MIDCLAVICULAR LINE
LATERAL ANTERIOR

AXILLARY LINES MIDAXILLARY

POSTERIOR
POSTERIOR
VERTEBRAL LINE
INTERSCAPULOVERTEBRAL SPACE
SCAPULA SCAPULAR LINE
MEDIAL MARGIN
SPINAL LINE
ANATOMICAL PROJECTIONS

PULMONARY APICES

LOBES AND FISSURES

HEART

TRAUBE SPACE OF THE STOMACH

LIVER

SPLEEN
apex

lower border
 INSPECTION: STATIC
OF THE CHEST (CAGE)
 SKIN

 BREASTS/ MAMARY GLANDS

 THORAX: regarding the shape

generalized
localized
Modifications
can be
symmetrical
asymmetrical
MODIFICATION IN THORAX’ SHAPE
 LONG
 PYCNIC
 ATHLETIC
 ASTHENIC
 EMPHISEMATOUS (BARREL CHEST)
 PECTUS GALLINACEUM (CARINATUM)
 PECTUS EXCAVATUM
 KYFOTIC
 POTTIC
 INSPECTION: DYNAMIC
OF THE CONTENT
 DURING NORMAL BREATHING
 TYPE

 FREQUENCY

 DURING DEEP BREATHING

 RETRACTIONS

 BULGING
 PALPATION: STATIC

Is morphological, regards the cage

 SKIN

 BREASTS

 THORAX
– SHAPE
– DIAMETHERS
– PRESENCE OF ASYMMETRY
– PASSIVE MOBILITY
 PALPATION: DYNAMIC

TACTILE FREMITUS

CHEST EXPANSIONS
– APICES

– BASES
 TACTILE FREMITUS
Can be
 NORMAL

 ACCENTUATED

 DECREASED

 ABSENT

ACCENTUATED
 Consolidation syndromes with free bronchi
(pneumonia, atelectasis)
 Cavitary syndrome
 TACTILE FREMITUS
DECREASED OR ABSENT

 Consolidation syndromes with obstructed bronchi

 Hyperinflation syndromes

 Pulmonary edema

 Pleural diseases
– Pneumothorax
– Pleurisy
– Pleural thickening
 PERCUSSION

 DIRECT — CLAVICLE
 MEDIATED
– POSTERIOR

– LATERAL

– ANTERIOR

– HIRTZ
 PERCUSSION- MODIFICATIONS
a) HYPERRESONANCE
– Hyperinflation syndrome
– Cavitary syndrome
– Pneumothorax
b) TYMPANY
– Cavitary syndrome
– Massive pneumothorax
c) METHALIC SOUND
– Superficial cavities larger than 6 cm with no
bronchial communication
 PERCUSSION- MODIFICATIONS
d) DULLNESS
– PULMONARY– consolidation sdr.
– PLEURAL
 Syndrome of pleural effusion
PITRES
 large Δ GARLAND
Δ GROCCO-RAUCHFUSS
DAMOISEAU ELLIS curve
SKODISM
 medium Dull Traube space

 Pleural tickening