LOCAL EXAMINATION OF CHEST

A) INSPECTIONB) PALPATION C) PERCUSSIOND) AUSCULTATION

A) INSPECTION

1) Shape & sizea. Symmetrical or notb. Bulging

2) Respiratory movementa. Rate b. Rhytm c. Type d. Depth e. Chest expansionf. Accessory muscleg. Inspiratory retraction of lower intercostal spaceh. Noisy breathingi. Costal margin – if inward ( + Hoover sign )

3) Pulsations a. Apex b. Epigastric

i. Rt ventricular originii. Liver origin

iii. Aortic originc. Lt parasternald. Lt 2nd and Rt 2nd spacee. Suprasternal

4) Lesions of the chest walla. Pigmentation , scar , ulcers , sinusesb. Dilated veins & direction of blood flwc. Erythema and vesicle of herpes zosterd. Subcutaneous emphysema

b) PALPATION

1) Confirm the informations got by inspection

a.

2) Position of mediastinum

a. Position of trachea

b. Position of apex beat

3) Tactile vocal fremitus ( T.V.F)

a. 44 in arabic

b. Placing palm or ulnar border on chest wall

4) Palpable Rhonchi

a. Bronchial narrowing

c) PERCUSSION

HOW?

-3 AREAS WITH PATIENT LYING DOWN

1) Percussion of heart

2) Percussion of the front of chest

3) Percussion of Traube ‘s area

-3AREAS WITH PATIENT SITTING

1) Percussion of the back of chest

2) Percussion of Kronig’s Isthmus

3) Tidal percussion

d) AuSCULTATION

Auscultation of heart

i. Heart sound

ii. Murmur

iii. Addtional sounds

2) Auscultation of chest

i. Air entry

1. Normal or abnormal

2. Equality on both side

ii. Type of breathing

1. Vesicular

2. bronchial

iii. Vocal resonance

iv. Adventitia sound

1. Wheezes (Rhonchi )

a. Site (generalized or localized )

b. Type ( low or high pitched )

c. Timing

d. Relation to cough

2. Pleural rub 3. Crepitation