1. Fundamentals of Physical Examination
Chapter 5

2. Physical Examination
Inspection
Palpation
Percussion
Auscultation

3. Physical Exam Determine the correct diagnosis
Proficiency is attained through practice
Typical format for recording the exam includes:
Initial impression
Vital signs
HEENT
Neck
Thorax
Abdomen
Extremities

4. Head
Facial expression
Nasal flaring
Cyanosis
Pursed lip breathing

5. Eyes Pupillary reflexes – PERRLA Mydriasis Miosis Ptosis Diplopia
Nystagmus

6. Neck JVP Accessory muscle use Tracheal position Lymph nodes
Carotid pulse

7. Lung Topography
Anterior Chest
Posterior Chest

8. Lung Topography
Lateral Chest

9. Thoracic Cage Landmarks
Anterior Chest
Posterior Chest

10. Lung Fissures

11. Thoracic Inspection Thoracic configuration Central cyanosis
Pectus carinatum
Pectus excavatum
Kyphosis
Scoliosis
Kyphoscoliosis
Flail chest
Central cyanosis
Breathing patterns
Apnea
Biots
Cheyne stokes
Kussmauls
Apneustic
Paradoxical
Asthmatic
Breathing Effort
Retractions/bulging
Abdominal paradox
Respiratory alterans
Hoover’s sign

15. Thoracic Palpation Vocal fremitus Tactile fremitus Thoracic expansion
Skin and subcutaneous tissues

17. Thoracic Percussion Indirect percussion Lung fields
Normal resonance
Increased resonance
Decreased resonance
Diaphragmatic Excursion

18. Lung Auscultation Tracheal breath sound Bronchovesicular Vesicular
Bronchial
Adventitious
Wheeze
Crackles
Rhonchi
Stridor
Pleural friction rub

19. Figure Location on chest wall where normal bronchovesicular and vesicular breath sounds are heard. A, Anterior bronchovesicular. B, Posterior bronchovesicular. C, Anterior vesicular. D, Posterior vesicular. (From Wilkins RL, Hodgkin JE, Lopez B: Fundamentals of lung and heart sounds, ed 3, St Louis, 2004, Mosby.)

20. Wheezing vs Crackles

21. Voice Sounds
Brochophony
Egophony
Whispering pectoriloquy

22. Precordium Heart topography Point of maximal impulse – PMI
Heart sounds

23. Neurologic Exam Suspected brain or spinal cord injury
Assessment of LOC
Brainstem

24. Abdomen
Hepatomegaly
Ascites

25. Extremities Clubbing Cyanosis Pedal edema Capillary refill
Peripheral skin temperature