CLPR 5030 Pulmonary Exam Practical Grading Rubric Name:_______________________________________ Examiner: ____________________________ Start Time_____________ End Time______________ 20 minute

maximum Points Exam item (50) 0 GENER L (Points are s!btracted "or t#ese$ %& "or an' o" t#ese items not satis"ied) Pertinent negatives Expectations and point breakdown

(t!dent is on time (t!dent was#ed #ands or app)ied #and saniti*er immediate)' prior to beginning exam (t!dent is wearing c)inic attire according to s'))ab!s dress code and "o))owing no scent po)ic' (t!dent+s nai)s are trimmed to a)most no w#ite s#owing (t!dent !ses appropriate draping and demonstrates a pro"essiona) approac# to modest' "or t#e patient (t!dent "inis#ed exam wit#in a))otted ,0 min!tes ( Examiner: check each box above in left column; if not satisfied, mark -1 in column to right)

-bserve. (#ape$ ('mmetr'$ Co)or$ ccessor' m!sc)es$ nta)gic position$ !dib)e so!nds$ Rate$ /ept#$ and E""ort o" 0reat#ing$ C)!bbing Pa)pate and inspect position o" trac#ea C#est compression. ( %P and )atera)) 2acti)e "remit!s

Normal thoracic shape and motion ith respiration, no accessor! muscle use, antalgic position, clubbing or c!anosis noted

( Examiner: from this point for ard, enter points) (t!dent made observations be"ore beginning exam (t!dent made a visib)e attempt to inspect t#e t#orax (t!dent verba)i*ed pertinent negatives correct)'

& & &

"rachea midline

(t!dent pa)pated t#e s!prasterna) notc# (t!dent pa)pated t#e trac#ea and noted its position re)ative to t#e s!prasterna) notc# (t!dent verba)i*ed pertinent negatives correct)' (t!dent pressed "irm)' over c#est and !pper back (t!dent pressed "irm)' over bot# sides o" ribcage (t!dent asked patient i" t#ere was an' pain (t!dent verba)i*ed pertinent negatives correct)' (t!dent pa)pated a)) "o!r standard positions in t#e correct )ocations (tracing conto!r o" )!ngs) (t!dent gave patient correct directions 4P)ease sa' 55 eac# time 6 p)ace m' #ands7 (t!dent pressed moderate)' "irm)' into c#est wa)) (t!dent verba)i*ed pertinent negatives correct)'

& & & & & & & & & & &

No pain on compression of the thorax

"actile fremitus is ade#uate and e#ual bilaterall!3

Respirator' expansion

$espirator! expansion is e#ual bilaterall!

(t!dent p)aced #ands in t#e )ower t#oracic area (t!dent p)aced t#!mbs pointing toward mid)ine$ wit# same distance "rom t#e spine$ and took o!t s)ack (t!dent gave patient correct directions 42ake a deep breat# in$ and t#en )et it go37 (t!dent verba)i*ed pertinent negatives correct)' (t!dent perc!ssed in a)) 9 posterior )!ng "ie)ds bi)atera))'$ in correct )ocations (t!dent kept on)' one "inger contacting t#e patient+s skin (t!dent !sed a perpendic!)ar striking motion (t!dent was ab)e to create an ade:!ate perc!ssive so!nd (t!dent verba)i*ed pertinent negatives correct)' (t!dent )ocated t#e diap#ragm;base o" )!ngs acc!rate)' (t!dent gave patient correct directions 442ake a deep breat# in$ and t#en #o)d it37 (t!dent remembered to te)) patient to )et go o" #e)d breat# wit#in a reasonab)e time"rame (t!dent acc!rate)' described t#e < o" cm o" exc!rsion (t!dent verba)i*ed pertinent negatives correct)' (t!dent gave patient ade:!ate directions 4P)ease breat#e in and o!t deep)' t#ro!g# 'o!r mo!t# eac# time 6 p)ace m' stet#oscope7 (t!dent to)d patient to raise #and i" needing break (t!dent a!sc!)tated in a)) 8 anterior )!ng "ie)ds bi)atera))'$ in correct )ocations (t!dent a!sc!)tated in a)) 9 posterior )!ng "ie)ds bi)atera))'$ in correct )ocations (t!dent )istened on skin (t!dent )istened "or t#e entire breat# c'c)e in eac# position (t!dent verba)i*ed pertinent negatives correct)' (t!dent a!sc!)tated in a)) 9 posterior )!ng "ie)ds bi)atera))'$ in correct )ocations (t!dent gave patient correct directions 4P)ease sa' 55 eac# time 6 p)ace m' stet#oscope7 (t!dent verba)i*ed pertinent negatives correct)' (t!dent a!sc!)tated in a)) 9 posterior )!ng "ie)ds bi)atera))'$ in correct )ocations (t!dent gave patient correct directions 4P)ease sa' 4e7 eac# time 6 p)ace m' stet#oscope7 (t!dent verba)i*ed pertinent negatives correct)'

& & & & , & & & & & & & & & & & , , & & & & & & & & &

Perc!ssion. Posterior "ie)ds

%osterior lung fields are resonant on percussion

/iap#ragmatic exc!rsion

&iaphragmatic excursion is '' cm and e#ual bilaterall!

!sc!)tation. nterior )!ng "ie)ds$ posterior )!ng "ie)ds

(ungs are clear to auscultation, )nterior and %osterior ithout adventitious sounds*

0ronc#op#on'

Negative bronchophon!

Egop#on'

Negative egophon!

=#ispered Pectori)o:!o'

Negative +hispered pectorilo#u!

L!ng so!nd (mode)) (ma' be norma) )!ng$ w#ee*es$ "ine crack)e$ r#onc#i$ "riction r!b$ or stridor)

(t!dent a!sc!)tated in a)) 9 posterior )!ng "ie)ds bi)atera))'$ in correct )ocations (t!dent gave patient correct directions 4P)ease w#isper &%,%3 eac# time 6 p)ace m' stet#oscope7 (t!dent #ad patient t!rn #ead to t#e side so #e;s#e co!)d see patient w#ispering (t!dent verba)i*ed pertinent negatives correct)' (t!dent )istened in one )!ng position on posterior (t!dent identi"ied so!nd correct)'

& & & & 035 &35

Charting Pertinent Negative : C#est;L!ng. Normal thoracic shape and motion ith respiration* No accessor! muscle use, antalgic position, clubbing or c!anosis noted* "rachea midline* No pain on compression of the thorax* "actile fremitus ade#uate and s!mmetrical bilaterall!* $espirator! expansion is e#ual bilaterall!* %osterior lung fields resonant on percussion* &iaphragmatic excursion is ''cm and e#ual bilaterall!* (ungs are clear to auscultation anterior and posterior ithout adventitious sounds* Negative bronchophon!, egophon! and hispered pectorilo#u!* Comment :