Pulmonary History/Physical Examination

I. History Taking
a. Chief Complaint
b. History of Present Illness
i. Current and any previous respiratory problems (including cough, sputum
production, dyspnea, hemoptysis, wheezing and chest)
1. Do you have any chest pain with breathing?
a. If so, what is the pain like, when does it occur, and what
relieves it?
2. Do you have a cough?
a. If yes:
i. What does the cough sound like?
ii. When does it occur?
iii. Do you bring up any phlegm (sputum) when you
cough?
iv. What does the phlegm look like?
1. Normal sputum is thin, clear to white in
color, and tasteless and odorless.
2. Yellow-green colored sputum
a. May indicate a bacterial infection
and rust-colored sputum is
characteristic of pneumonia.
3. Are you ever short of breath?
a. If so, does your shortness of breath occur at rest or with
activity?
b. Does it affect daily living? (such as being able to carry
groceries from a car, or being able to clean floors or do
laundry)
4. Change in the number of pillows needed to sleep at night
a. Do certain positions make you feel more comfortable?
b. How often does this occur? How long has this been
occuring?
c. Do you have any problems breathing at night?
i. If so, do you use pillows to help you get in a
position to breathe easier?
c. Past medical history
i. Have you had any past hospitalizations related to lung problems?
Surgeries?
d. Review of Systems
i. Recent changes in:
1. Exertional capacity
2. Fatigue
a. When do you feel short of breath?
 b. What activities bring on shortness of breath? (Be specific:
Walking up 2 flights of stairs, walking 1⁄2 mile level
ground, mowing lawn)
c. Could you do these same activities without symptoms 3m
ago? 6 m ago?
d. What is your usual level of activity?
3. Any significant weight change
4. History of night sweats
5. Hand or leg swelling.
e. Family History
i. Do you have a personal or family history of asthma, tuberculosis, lung
cancer, cystic fibrosis, bronchitis, emphysema, or any other lung disease?
f. Personal and Social History
i. Do you smoke now or have you ever smoked?
1. If yes, how many years did you smoke and how many packs of
cigarettes did you smoke daily?
ii. What kind of work do you do/did you do?
1. In your work are/were you exposed to substances such as
asbestos, chemicals, or cigarette smoke?
2. Occupation ie high risk occupations – e.g mining, farming,
shipyards / type of dust? asbestos? Duration
II. Focused Pulmonary Exam
a. General Survey
i. Habitus/position, cyanosis, presence of respiratory distress, pursed-lip
breathing
b. Vital signs : BP, CR, RR, temp.
c. Inspection
i. Chest variations
1. Pectus excavatum or carinatum
2. Kyphoscoliosis
3. Barrel chest
ii. Breathing patterns (normal 10-14 breaths/min)
iii. Rate, rhythm, depth and effort of breathing in impending respiratory
failure, Cheyne Stokes respiration with apneic periods alternating with
progressive increasing then decreasing respiration often in uremia, CHF,
or central depression
iv. Retractions & use of accessory muscles
v. Asymmetry
vi. Trachea if midline
vii. Cyanosis in nailbeds, conjunctival pallor, clubbing of the fingers
(Shamroth’s sign)
1. Include extremities for cyanosis, clubbing, edema
Report: Upon inspection:
- Chest has a normal shapee.
- No bony deformities. No pectus carinatum, pectus excavatum, barrel chest or kyphosis
- No abnormalities in chest movement
- No signs of respiratory distress. No ala flaring, no retractions nor use of accessory
muscles
- No signs of cyanosis. Mucus membranes and nail beds are pink
- No noted masses or lesions, no surgical scars
- No clubbing. Schamroth’s window is observed
- No pitting edema is observed

d. Palpation
i. Areas of tenderness, deformity
ii. Chest lag: expansion, asymmetry
iii. Tactile fremitus/ vocal fremiti
iv. Check for cervical, axillary lymph nodes

Report: Upon palpation:

- No areas of tenderness
- Symmetric chest expansion and no chest lag
- Tactile fremitus is equal on all lung fields
 e. Percussion
i. Normal, dull, hyper-resonant
ii. Diaphragmatic excursion

Report: On percussion:
- Equal lung resonance on all lung fields
- There is normal dullness over the liver on the right lung base

f. Auscultation
i. Normal breath sounds: vesicular, bronchi vesicular, bronchial, tracheal
ii. Decreased or absent breath sounds
iii. Abnormal breath sounds
1. Crackles
2. Rhonchi
3. Stridor, Wheezing
iv. Transmitted voice sounds:
1. Vocal fremiti
2. Bronchophony
3. Whispered pectoriloquy
a. Increased quality and loudness of whispers that are heard
with a stethoscope over an area of lung consolidation
4. Egophony

Report: On auscultation:
- Clear and equal breath sounds in all lung fields
- No adventitious sounds. No crackles, wheezes or rhonchi
- Equal vocal fremiti.
- No broncophony, no egophony and no whispered pectoriloquy