Lung and Thorax Examination Lecture Notes

Introduction

• Speaker: Jessica, nurse practitioner.
• Purpose: Demonstrating lung and thorax examination for educational purposes.
• Two-part examination: Anterior and posterior chest.

Anterior Chest Examination

Inspection

• Observe breathing patterns: rate, effort, and symmetry.
• Check for signs of respiratory distress.

Palpation

• Look for subcutaneous air trapping and tactile fremitus.
• Use the palmar aspect of hand; have the patient say "99".
• Compare vibrations from side to side for symmetry.

Auscultation

• Use stethoscope diaphragm.
• Instruct patient to take deep breaths.
• Listen in a ladder pattern, comparing both sides at equivalent areas.
• Start above the clavicle, consider breast tissue in women or men with large breast tissue.

Posterior Chest Examination

Inspection

• Symmetry in chest rise and fall, breathing rate, and work of breathing.
• Check for intercostal muscle use.

Percussion

• Stay away from scapula (dull sound).
• Use middle finger to strike DIP joint for a resonant sound (indicates air-filled lungs).
• Map lung borders.

Diaphragmatic Excursion

• Measure diaphragm movement during inhalation and exhalation.
• Percuss from resonance to dullness to mark diaphragm position.
• Normal range: 3-6 cm, up to 7-8 cm in well-conditioned athletes.

Palpation

• Check for tenderness, pain, and symmetry.
• Assess tactile fremitus ("99" test again).
• Lung expansion test: hands on 10th rib, thumbs near spine, watch thumb movement during deep breaths.

Auscultation

• Compare both sides, use ladder approach to listen to lung fields.
• Check lateral aspects under arms for right middle lobe.
• Listen for vesicular, tracheal, and bronchial sounds; identify abnormal sounds like crackles, wheezing, and rhonchi.

Special Tests

Bronchophony

• Patient says "99" during auscultation.
• Normally muffled; clear sound indicates consolidation.

Whispered Pectoriloquy

• Patient whispers "1, 2, 3".
• Normally inaudible; clear sound indicates consolidation.

Egophony

• Patient says "E".
• "E" to "A" change indicates consolidation.

Conclusion

• Comprehensive examination includes both anterior and posterior lung fields.
• Important to assess different lobes of the lung: lower lobes posteriorly, upper and middle lobes anteriorly.