1. Chest/Pulmonary Exam
Inspection, palpation (including tactile fremitus), percussion, auscultation of the posterior, lateral, and anterior chest.
Examination of the anterior chest may be conducted with the patient supine or sitting
Examination of the lateral chest may be incorporated into examination of the anterior and/or posterior chest
Chest/Pulmonary Exam
Inspection, palpation (including tactile fremitus), percussion, auscultation of the posterior, lateral, and anterior chest.
Examination of the anterior chest may be conducted with the patient supine or sitting
Examination of the lateral chest may be incorporated into examination of the anterior and/or posterior chest

2. Anterior Chest Anterior Chest (lying or sitting or at 30 0)
73. Inspection: For symmetry, fully exposed (in female patient may cover with gown as in photo)
Anterior Chest (lying or sitting or at 30 0) 73. Inspection: For symmetry, fully exposed (in female patient may cover with gown as in photo)

3. Anterior Chest
74,75. Palpation: For tactile fremitus Palpation: Alternates from side to side or may use both hands simultaneously
Anterior Chest 74,75. Palpation: For tactile fremitus Palpation: Alternates from side to side or may use both hands simultaneously

4. Anterior Chest: Percussion: 76-78
Must be done:
Bilaterally
Symmetrically
Good tone
Must alternate from
side to side
Anterior Chest: Percussion: 76-78
Percussion:
Must be done:
Bilaterally
Symmetrically
Good tone
Must alternate from side to side

5. Anterior Chest: Auscultation
(Starting above clavicles, 3-4 places, listens throughout inspiration and expiration)
Patient instructed slow, deep breath, mouth open
Auscultation: Alternates from side to side
Auscultation: At least 3-4 areas auscultated on each side
Anterior Chest:Auscultation: 79-83
Auscultation: Done correctly
(Starting above clavicles, 3-4 places, listens throughout inspiration and expiration)
Auscultation: Patient instructed slow, deep breath, mouth open
Auscultation: Alternates from side to side
Auscultation: At least 3-4 areas auscultated on each side

6. Posterior Chest Posterior Chest 84. Inspection: For symmetry

7. A. B. Posterior Chest: Palpation
A. Place hands on the patient’s posterior/lateral chest
Apply moderate pressure--
Move hands up and towards the midline creating a “dimple” in the skin between the thumbs.-
B.Ask the patient to take a deep breath
Feel and visualize the chest expanding
Your thumbs will move apart and the “dimple’ in the skin will go away
85. Chest Expansion:
A. Place hands on the patient’s posterior/lateral chest
Apply moderate pressure--
Move hands up and towards the midline creating a “dimple” in the skin between the thumbs.--
Arrows indicate direction of hand movement
B. Ask the patient to take a deep breath
Feel and visualize the chest expanding
Your thumbs will move a part and the “dimple’ in the skin will go away
Note the patient’s position during the posterior chest exam: Ask the patient to cross his/her arms in front and to place their hands on the opposite shoulder. This position moves the scapula apart and allows for a better exam
Arrows denote direction of hand movement

8. Posterior chest: Palpation
86-87:Tactile Fremitus
Start above the scapula
Use the ulnar aspects of the hands
May use one hand and alternate from side to side or may use both hands moving inferiorly
Ask the pt to say “99” and feel the vibrations
86-87:Tactile Fremitus
Start above the scapula
Use the ulnar aspects of the hands
May use one hand and alternate from side to side or may use both hands moving inferiorly
Ask the pt to say “99” and feel the vibrations

9. Posterior Chest--Percussion
88-91: Percussion: includes percussion, diaphragmatic excursion, and percussion over the costovertebral angle
Posterior Chest--Percussion
88-91: Percussion: includes percussion, diaphragmatic excursion, and percussion over the costovertebral angle
Percussion--(At level of the diaphragm)
This is done during normal (tidal) breathing
Start above the scapula
Alternate from side to side
Continue inferiorly until dullness of percussion occurs
Percussion--(At level of the diaphragm)
This is done during normal (tidal) breathing
Start above the scapula
Alternate from side to side
Continue inferiorly until dullness of percussion occurs

10. Posterior Chest-Percussion
Diaphragmatic movement
Once the level of the diaphragm has
been detected during tidal respiration
ask the patient to take a deep breath and hold it
This will move the diaphragm more inferiorly
Begin to percuss moving more inferiorly until dullness is encountered again
Posterior Chest-Percussion 88-91:
Diaphragmatic movement
Once the level of the diaphragm has been detected during tidal respiration ask the patient to take a deep breath and hold it
This will move the diaphragm more inferiorly
Begin to percuss moving more inferiorly until dullness is encountered again
The distance between the initial area of dullness during tidal respiration and the area of dullness during full inspiration is the diaphragmatic excursion (movement)
Repeat this process for the other side
Begin to percuss moving more inferiorly until dullness is encountered again
Repeat this process for the other side

11. Anterior Percussion over costovertebral angle
Place the ball of one hand firmly over the patient’s costovertebral angle. Use the ulnar side of your other hand to strike the hand you have placed on the patient.
Use enough force to cause a perceptible but painless jar or “thud”
Repeat on the opposite side
Place the ball of one hand firmly over the patient’s costovertebral angle.
Use the ulnar side of your other hand to strike the hand you have placed on the patient.
Use enough force to cause a perceptible but painless jar or “thud”
Repeat on the opposite side

12. Posterior Chest Auscultation: 92-96
Patient needs to be in the correct position with arms folded and hands on opposite shoulders
Use the diaphragm of the stethoscope
Start above the scapula
Ask the patient to take deep breaths with his/her mouth open
Listen to complete inspiration and expiration
Move from side to side working your way inferiorly
Listen to at least 3-4 places
Posterior Chest Auscultation: 92-96
Patient needs to be in the correct position with arms folded and hands on opposite shoulders
Use the diaphragm of the stethoscope
Start above the scapula
Ask the patient to take deep breaths with his/her mouth open
Listen to complete inspiration and expiration
Move from side to side working your way inferiorly
Listen to at least 3-4 places
Lateral Chest
Do not forget to include tactile fremitous, percussion, and auscultation of the lateral chest.