RS Physical

Examination Hadeel Khadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-

Qura University

General Approach Vital Signs Position

45 sitting over the edge of bed

or on chair

Introduction Coughing/

Sputum Strider/

Wheezing

Peripheral Exam Chest Exam

Hand Wrist Face Neck ?

Inspection Palpation Percussion Auscultation

RS Exam

Hand

Nail Fingers Dorsum

Nail Clubbing / HPO

Peripheral Cyanosis

What are the causes of clubbing?

Hand

What is the chronic respiratory disease that dose not cause clubbing?

Fingers Nicotine Stain

Hand

Dorsum Muscle Wasting

Hand

Flapping tremor (Asterixis)

Wrist

What are the causes of flapping tremor?

What is fine tremor?

Face

Eyes Nose Mouth Sinuses

FaceEye Pallor

Horner’s Syndrome Meiosis

Partial ptosis Loss of

sweating

FaceNose Deviated nasal

septum

Polyps

Enlarged turbinate

FaceMouth Peripheral cyanosis Central cyanosis Signs of URTI Infected teeth

FaceSinuses

Neck ? JVP

Chest Exam

Expose the chest properly to the waist including the axilla.

Exam the anterior and posterior chest.

Inspection, Palpation, Percussion, Auscultation

Always compare the right and left sides.

Surface Anatomy of the Lung

Ant. Chest

Ant. Chest Inspection (5S) Symmetrical chest

movement (decrease)

Shape of the chest

Scar

Prominent veins in SVC obstruction

Subcutaneous emphysema

Ant. Chest What is Paradoxical breathing?

What are the causes of bilateral decrease chest movement?

What are the causes of unilateral decrease chest movement?

Ant. Chest Palpation Trachea

Centralized OR displaced. Normally, trachea is

slightly displaced to the right side.

What is Tracheal Tug?

What are the causes of trachea displacement away from the side of lung lesion?

What are the causes of trachea displacement toward the side of lung lesion?

Ant. Chest Palpation Chest Expansion

Apical Supra

mammary Infra

mammary Inspiration

Thumbs move symmetrically

apart for 3-4 cm

Ant. Chest Palpation Apex beat Site

Size Character

What are the causes of apex beat displacement away from the side of lung lesion?

What are the causes of apex beat displacement toward the side of lung lesion?

What is the lung disease causes of impalpable apex beat ?

Ant. Chest Palpation Tactile Vocal

Fremitus Use ulnar side of the hand. Ask the patient to say 99 in Eng.

Or 44 in Arab. Move in zigzag and compare

both sides. Comment as: equal, decrease,

or increase TVF. Sites Supra clavicle Infra clavicle Supra mammary Infra mammary Upper axillary Lower axillary

What are the causes of decrease TVF?What are the causes of increase TVF?

Ant. Chest Palpation Tactile Vocal

Fremitus

Ant. Chest Palpation Ribs For tenderness

Ant. Chest Palpation Trachea

Chest Expansion

Apex beat

Tactile Vocal Fremitus

Ribs

Ant. Chest Percussion Sites Supra clavicle clavicle Infra clavicle Supra mammary Infra mammary Upper axillary Lower axillary

Move in zigzag and compare both sides

Ant. Chest Percussion Comment as:

Resonant ………….. Hyper resonant …….. Dullness …………..... Stony Dullness ……...

Normal Pneumothorax Pneumonia Pleural effusion

Ant. Chest Auscultation Sites Supra clavicle =

Apical Infra clavicle Supra mammary Infra mammary Upper axillary Lower axillary

Move in zigzag and compare both sides

Ant. Chest Auscultation Comment on:

Breath sounds, equal, decrease, or absent

Quality of breath sounds, vesicular vs. bronchial

Added sounds, wheezing, crackles

Vocal resonance, equal, decrease, or increase

Ask the patient to say 99 in Eng. Or 44 in Arab

Ant. Chest Auscultation

Vesicular breathing …Normal

Bronchial breathing …Consolidation

No gap Insp > Exp

Gap Insp = Exp

Quality of breath sounds

Ant. Chest Auscultation Added breath sounds

Wheezing…

Crackles… Fine……… Medium… Coarse……

Asthma

Lung fibrosisLVF, pneumonia Bronchiectasis

Ant. Chest Auscultation Vocal Resonance

What are the causes of decrease vocal resonance?

What are the causes of increase vocal resonance?

What is Aegophony?

What is Whispering Pectoriloquy?

Ant. Chest Auscultation

What is the indication of silent chest in asthmatic patient?

Post. Chest

Post. Chest Ask the patient to sit at the edge of the bed and you face his/her back. Ask the patient to make cross his/her arms on front chest to rotate the scapula anteriorly.

Post. Chest Inspection

Shape of the chest

Scar

Post. Chest Palpation Chest Expansion

Basal

Thumbs move symmetrically

apart for 3-4 cm

Post. Chest Palpation Tactile Vocal

Fremitus Sites Supra scapular Intra scapular Infra scapular basal Upper axillary Lower axillary

Move in zigzag and compare both sides

Post. Chest Palpation Chest Expansion

Tactile Vocal Fremitus

Post. Chest Percussion Sites

Supra scapular Intra scapular Infra scapular basal Upper axillary Lower axillary

Move in zigzag and compare both sides

Post. Chest Percussion Comment as:

Resonant ………….. Hyper resonant …….. Dullness …………..... Stony Dullness ……...

Normal Pneumothorax Pneumonia Pleural effusion

Post. Chest Auscultation Sites Supra scapular Intra scapular Infra scapular basal Upper axillary Lower axillary

Move in zigzag and compare both sides

Post. Chest Auscultation Comment on:

Breath sounds, equal, decrease, or absent

Quality of breath sounds, vesicular vs. bronchial

Added sounds, wheezing, crackles

Vocal resonance, equal, decrease, or increase

Ask the patient to say 99 in Eng. Or 44 in Arab

Pemberton’s Sign

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