EXAMINATION OF THE THORAX AND LUNGS

1. Introduce yourself to the patient.

“Good morning ma’am, my name is ____, a 2nd year
BUILD RAPPORT WITH THE PATIENT medical student.

2. Confirm patient details May I ask your last name?

May I ask for your date of birth?

3. Explain the procedure Today, we will be having a physical examination of your

chest and lungs.

4. Get consent Is it okay for me examine your chest?

5. Initial survey a. Check for signs of respiratory distress: tachypnea,

cyanosis (central/peripheral), audible sounds of
breathing, accessory muscle contractions

b. Check for the shape of the chest: normal chest ratio

should be Lateral diameter > AP diameter; Abnormal:
barrel chest, funnel chest, flail chest, pigeon chest

Normal ratio of AP to lateral: 0.7 to 0.9

c. Check for clubbing of fingers: Schamroth’s window

d. Check for signs of trauma and scars

e. Check for presence of chest drains, thoracotomies,

pacemakers

6. Take vital signs Check for:

Temperature, Pulse rate, Respiratory rate, Blood pressure

EXAMINATION PROPER
(ANTERIOR AND POSTERIOR)

Inspection a. Check for deformities

b. Check for asymmetry in chest expansion

c. Check for abnormal muscle retraction of the

intercostal spaces during inspiration

Palpation a. Identify tender areas carefully

b. Note crepitus - crackling sound over bones and joints

due to air in the subcutaneous tissue

c. Test chest expansion by placing hands at the level of

the 10th rib, with both thumbs at midline

d. Palpate both lungs for symmetric tactile fremitus - ask

patient to say “99”

Percussion a. Refer to Bate’s for instructions

b. Use the ladder or battlefield technique of

examination — mnemonic: 6AM-7PM (6 anterior pairs,
7 posterior pairs)

c. Percussion notes: Flat, dull, resonant, hyperresonant

d. Identify areas of normal dullness (cardiac, liver), and

gastric tympany (normal)

e. Identify descent of diaphragm or diaphragmatic

excursion

JAMERO
Auscultation a. Before auscultation, ask patient to cough once or
twice to clear mild atelectasis or airway mucous

b. Refer to Bate’s for instructions

c. Same ladder technique as percussion

d. Listen to normal breath

e. Listen to adventitious lung sounds

f. Listen to sounds of patient’s spoken or whispered

voice
• Egophony
- let the patient say “e”

- Normal: “e” to “e”

- Abnormal “e” to “a”
• Bronchophony
- let the patient say “99” or “123”

- Normal: muffled, indistinct

- Abnormal: loud, distinct
• Whispered pectoriloquy
- whisper “99”

- Normal: muffled
- Abnormal: loud

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