1. Examination of the chest and lung
Complaints
Physical examination
1.Inspection
2.Palpation
3.Percussion
4.Auscultation

2. Complaints
Chest pain
Cough
Shortness of breath - dyspnea

3. Chest pain Important questions: Is it related to? Localisation
Breathing?
Movements? (muscle, bone, nerves)
Physical activity?
Localisation
Pain receptors
larynx, trachea, main bronchi, pleura
Duration?
Type?

4. Chest pain
Sudden onset pain
Pulmonary embolism
Pneumothorax

5. Cough Improductive – dry viral pneumonia Productive
White, foamy pulmonary oedema
Mucoid bronchial asthma
Purulent lung abscess
Brownish pneumonia
Blood-streaked sputum hemoptysis

6. Hemoptysis Tuberculosis Pulmonary embolism Coagulation disorder
Lung cancer
Tuberculosis
Pulmonary embolism
Coagulation disorder

7. Cough Purulent sputum 24 hr collection Three layers
Foul-smelling putrid

8. Shortness of breath Dyspnea
Subtypes
Exspiratory
Inspiratory
Severity
Dyspnea on exertion
Dyspnea at rest

9. Dyspnea Episodic (paroxysmal) dyspnea asthma
What is the causative factor?

10. Physical examination

11. Inspection
Shape of the chest
1.Symmetrical
2. Asthenic

12. Inspection Deformities Pectus carinatum or pigeon chest
sternal protrusion
Pectus excavatum
or funnel chest

13. Inspection Deformities of the vertebral column Retractio thoracis
Kyphosis
Scoliosis – lateral curvature
Kyphoscoliosis
Gibbus
Retractio thoracis

14. Inspection
Cyanosis
Chest expansions

15. Palpation Breasts Lymph nodes Lesions in the chest wall
Masses, tender areas
Bone, muscle, nerve lesions
Chest expansion
Tactile fremitus

16. Tactile fremitus normal = symmetrical

17. Tactile fremitus
Pleural effusion,
Scar, etc.

18. Tactile fremitus
Pneumonia

19. Percussion

20. Percussion

21. Percussion

22. Percussion
1. Topographic percussion

23. Percussion Lower border of the lung Paravertebral XI. vertebra
Scapular line IX. rib
Midaxillary line VIII. rib
Midclavicular line VI. rib

24. Percussion the level and excursion of the diaphragm

25. Percussion
Comparative percussion
Krőnig’s
space

26. Percussion 2. Comparative percussion Percussion notes
Resonance normal lung

27. Percussion Percussion notes Tympany large pneumothorax
Resonance – normal lung

28. Percussion Percussion notes Tympani pneumothorax
Hyperresonance emphysema
Resonance normal

29. Percussion Percussion notes Tympany pneumothorax
Hyperresonance emphysema
Resonance normal
Absolute dull or flatness
pleural fluid (effusion)

30. Percussion Percussion notes Tympany pneumothorax
Hyperresonance emphysema
Resonance normal
Relative dull pneumonia
Absolute dull pleural fluid

31. Auscultation

32. Auscultation Lung (or breath) sounds Adventitious (added) sounds
Vesicular
Bronchovesicular
Bronchial
Adventitious (added) sounds

33. Auscultation – Adventitious (added) sounds
1. Extrapulmonary pleural friction rub
pleuritis
2. Intrapulmonary
A. Wheezes and rhonchi asthma, COPD
B. Crackles or rales bronchitis, left heart failure
Fine crackles
Coarse crackles
C. crepitation pneumonia

34. Bronchophony – transmitted voice sound
Pneumonia - increased
Pleuralis effusion
- decreased