Physical Examination

The Thorax And Lungs

Erwin Azmar

Division of Cardiology Faculty of Medicine

University of Sriwijaya Palembang
2017
 The examination

May confirm or refute a diagnosis suspected

from the history
by adding this information to the database we
will be able to construct a more accurate
problem list
Structured to record both positive and
negative findings in detail
Adapted from medical record, medical history, and Interviewing technique, In Epstein's
Clinical examination, 1997
The examination really begins from the
moment you set eyes on the patients

Beginning the exam: setting the stage

Approach
Professional demeanor
Make pts comfortable and relaxed
Lighting and surrounding environment
 Approaching the physical exam

General conduct

1. Doctors and medical professionals are in a position

of trust
act with professionalism, integrity, honesty, respect
for the dignity and privacy of the patients
2. Established an appropriate rapport during history- taking
3. Alert to the cultural and religious differences
4. Same gender chaperone when perform intimate exam
 Preparing for physical
examination

Reflect on your approach to the pts

Adjust the lighting and the environment
Make the pts comfortable
Check your equipment
Choose the sequence of examination
Handshake serves as a gentle introduction to physical
contact during physical exam

Adapted from Epstein's Clinical examination, 1997

 Equipment for the physical
examination
Ophthalmoscope Stethoscope
Otoscope Gloves, lubricant
Flashlight Vaginal specula
Tongue depressors Reflex hammer
Ruler, tape measure Tuning forks
Thermometer Q-tips, safety pins
Watch (second) Cotton
sphygmomanometer Paper and pen
 Cardinal techniques of examination
( the framework )

INSPECTION (looking )

PALPATION (feeling )

PERCUSSION (tapping)

AUSCULTATION (listening )
 Standard and Universal Precautions

Standard and MRSA precautions :

transmissible infectious agents
Universal precaution : blood-borne
transmission
 Scope and positioning

Minimize how often you ask the patient to

change position
Examining the patient from the patient's right
side
Left handed students are encouraged to adopt
right-sided positioning
The position of the patient at the start of physical
examination

Adapted from Epstein's Clinical Examination 1997

 Overview-The Physical Examination
( the systems examinations )
Head-to-toe
General survey
Vital signs
HEENT
Neck
Back
Posterior Thorax and Lungs
Breast, axillae, epitrochlear nodes
 Anterior thorax and lungs
Cardiovascular system
Abdomen
Lower extremities
Nervous system
Additional examinations
 General consideration

Sensorium Habitus
Respiratory rate Height
Blood pressure Position
Pulse rate Gait
Temperature Nutritional status
Topography
 Vertical Lines
Angulus Sterni Ludovici
 Inspection
A. Statis : Shape, Deformity, Skin n Surface,
Pulsation

B. Dinamic : RR, Respiratory Type n

Rhythm.

C. Positional changes
Kyphosys
Barrel Chest
Pectus Excavatum
Blue bloater Pink puffer
 Palpation
Points/ Borders
Stem Fremitus
Pain
Thrill
Ictus cordis
Crepitation
Palpation of Trachea
Inspiration Expiration
Palpating the precordium
 Percusion
Borders

Sounds

Pain
 Percussion
Anterior Apex pulmonum
 Auscultation
Pulmonary sounds

Heart sounds
Auscultasion
Cardiac Auscultation
Cardiac Auscultation
Emphysema pulmonum
Pleural fluid
Mediastinal displacement
Mokaseh Ye