You mentioned that you were having shortness of breath so now we're going to be doing an assessment of your thorax and lungs. We're gonna start posterior - so I'm just to get you to turn around in the chair, I note that the shape of your chest is elliptical or conical, downward sloping ribs, your spinous process is straight, your thorax is symmetrical as evidenced by the base of your scapula, your neck muscles are normal developed, and I'm going to have a look at your AP diameter so and in your anterior posterior diameter is 1:2 which is normal. Your skin color- I'm going to note two findings: there's no redness, no cyanosis, skin color is uniform and consistent with your genetic background. Now we are going to palpate. I'm going to palpate using my fingers, I'm gonna palpate your whole thorax here, so at any time during this if you feel any pain or tenderness please let me know. So no pain or tenderness, no masses felt, no lesions, the skin is warm to the touch and that's good there. Now we are going to do symmetrical chest expansion. I'm going to landmark at your ninth to tenth vertebrae, so finding the base of your scapula that would be six or seven, go down two vertebrae. I'm going to pinch up some skin here and you get you take a big deep breath in. I note symmetrical chest expansion with no lag and then I'm going to do tactile fremitus here using the ulnar aspect of my hand. You can either do this with both hands or with one hand. I'm going to get you to say 99, 99, 99, 99, 99, so we're going to do five areas and I note that the vibrations are equal throughout. Now we are going to move to percussion. We are going to percuss nine areas, we're going to take our finger just put the flexameter just on the skin here, the rest of the hand and the finger off. I'm going to two taps starting at the apices, up at your c7 t1 and then we're going to come down nine areas, between the scapula and vertebrae and then compare bilateral. So I heard resonance throughout which is normal and then we are going to auscultate. Now I'm just bringing my equipment here. I'm just gonna get you lean forward with your forearms on your thighs, I'm gonna get you taking a deep breath in - deeper than normal - through your nose out your mouth and at any time during this if you feel dizzy just let me know that we can stop. Every time I place my stethoscope on your thorax I want to take a big deep breath in and exhale. Listening for a full respiratory cycle, same nine areas that we percussed. So equal air entry throughout, bilaterally breath sounds, they were clear to auscultation, I heard no adventitious sounds, I also heard Broncovesicular sounds of between your scapula and vesicular sounds to your peripheral. Now we're going to turn you around and we're going to assess your anterior thorax. Here we're gonna note the shape and configuration again, so you our thorax is symmetrical, normal development of your abdominal muscles, downward sloping of your ribs, and we also have a ninety degree angle at your costal margin, your skin is uniform, there's no redness, no cyanosis, your lips are nice and pink, there's no cyanosis there. Can I have a look at your hands, I'm gonna look at your cap refill which is less than 3. I'm gonna do my profile sign so your angle is 160 degrees so no evidence of clubbing there. Your facial expressions are calm and relaxed your respirations are silent, benign and effortless. Since we already did your symmetrical chest expansion to the posterior, we're not going to do it to the anterior but if you didn't you could do the other way. We're going to palpate your chest here any pain or tenderness to let me know. No pain or tenderness, warm to the touch, it's dry, no moisture felt, no masses, no bulges, no lesions felt. Now we're going to do our tactile fremitus again - so 99 - when we do this on the anterior we're going to come down the midclavicular line in five areas. And the same thing if we have breast tissue, we'll just displace the breast tissue to the medial - 99 99 99 99 99. Equal vibrations felt throughout, now we are going to percuss. We are going to percuss the same five areas using the same technique starting at the apex - so above the clavicle ,come down if we have breast tissue we're not going to do it we're going to displace it. We heard resonance throughout plus we're gonna give one additional finding, so we can say that we heard liver dullness to the right lower lobe, potentially some cardiac dullness closer to the sternal border here, potentially some splenic dullness to our mid axillary line, or potentially some tympany over the stomach there. Now we are going to auscultate again in those same five areas using the same technique -big deep breath in your nose and out your mouth and if you feel dizzy at any time let me know. Cleaning my equipment and we're going to use the diaphram. Starting at the apex, so again we heard bilateral breath sounds, equal entry throughout, clear to auscultation, no adventitious sounds heard, I heard tracheal sounds up near your throat here, bronchial breath sounds in the mid chest area, and particular sounds to the peripheral. That concludes our lungs and thorax assessment any questions?