Chest

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GENERAL EXAM

INSPECTION
  • Skin
    • Color: erythema, ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
    • Abrasions, deformities
  • Muscle tone: atrophy, hypertrophy
  • Deformity: asymmetry, rotation, amputation
  • Respiratory status
    • Rate: tachypneic, bradypneic or eupneic?
    • Ventilation: hyperpnea, hypopnea?
    • Accessory muscle use?
    • Position of patient: upright, tripod position
    • Speaks in complete sentences
    • Symmetric chest rise
    • Trachea is midline
    • Color: cyanotic or acyanotic
  • Chest
    • Pectus excavatum or carinatum
PALPATION
  • Palpate for
    • Effusion
    • Clicking
    • Snapping
    • Crepitus
    • Tenderness
    • Temperature
    • Masses
  • Areas of Emphasis
    • Tactile fremitus
    • Peripheral pulses (regular, irregular, weak, bounding)
PERCUSSION
  • Sounds
    • Resonant: normal
    • Flat or dull: abnormal suggesting soft tissue or fluid
    • Hyperresonant: abnormal suggesting air such as pneumothorax
    • Tympanic
AUSCULTATION
  • Lung sounds
    • Normal (vesicular)
    • Wheezing
    • Rales (crackles)
    • Ronchi
    • Pleural Rub
    • Stridor
    • Absent
  • Cardiac
    • S1 and S2
    • Rate (slow, fast, normal)
    • Rhythm (regular or irregular)
    • Murmur
    • Rub
    • Gallop

SPECIAL TESTS / VIDEOS

  • Egophony: ask the patient to say “Eeeee,” and it will sound like an “A.”
    • Suggestive of consolidation, pleural effusion.
  • Pectoriloquy:

OTHER

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