CHEST

PHYSICAL EXAMINATION
Paltep, Rashell Anne C.
Family Medicine PGI September, 2020
 Introduction
• Introduce yourself
• Confirm the patient’s name and date of birth
• Briefly explain what the examination
• Wash your hands
 general observation
• Observe hands and note for:
– Color
– Tar staining
– Skin changes
– Joint swelling
– Finger clubbing
– Fine tremors
 general observation
• Capillary refill time (CRT)
- Apply five seconds of
pressure to the distal
phalanx of one of a
patient’s fingers and then
release.
 general observation
• Palpate the brachial pulse
 general observation
• Collapsing pulse
– forceful pulse that
rapidly increases and
subsequently collapses.
– It is also sometimes
referred to as a ‘water
hammer pulse’.
 general observation
• Observe hands and note for:
– Peripheral pulses
– temperature
 Measure the JVP
• Position the patient in a semi-recumbent position (at
45°).
 Inspection of the chest
• Scars
• Chest wall deformities
– Asymmetry
– Pectus excavatum
– Pectus carinatum
– Hyperexpansion (a.k.a. “barrel chest”)
 Palpation of the chest
• Palpate the apex beat
– Palpate the apex beat with your fingers placed
horizontally across the chest
– typically located in the 5th intercostal space in
the midclavicular line
Palpation of the chest
• Assess chest expansion
Palpation of the chest
• Palpate the carotid pulse
 Palpation of the chest
Heaves
• precordial impulse that can be palpated.
Thrills
• palpable vibration caused by turbulent
blood flow through a heart valve
 Palpation of the chest
Valve locations

• Mitral valve:
• 5th intercostal space in the midclavicular line.

• Tricuspid valve:
• 4th or 5th intercostal space at the lower left sternal edge.
 Palpation of the chest
• Pulmonary valve:
• 2nd intercostal space at the left sternal edge.

• Aortic valve:
• 2nd intercostal space at the right sternal edge.
Percussion of the chest
Areas to percuss:
• Supraclavicular region
• Infraclavicular region
• Chest wall
• Axilla
 Auscultation of the chest
• Assess the quality and volume of breath sounds and
note any added sounds.
 Auscultation of the chest
Assess vocal resonance
• Ask the patient to say “99” repeatedly at the same
volume and in the same tone.
• Auscultate the four heart valves

• The bell of the stethoscope is more effective at

detecting low-frequency sounds

• The diaphragm of the stethoscope is more

effective at detecting high-frequency sounds
• Assess for evidence of pitting sacral and
pedal edema
• Assess the posterior chest including
inspection, chest expansion, percussion, and
auscultation

• Ask them to fold their arms across their

chest so that their hands are touching the
opposite shoulder.
To complete the examination
• Explain to the patient that the examination is now
finished.
• Thank the patient for their time.
• Wash your hands.
THANK YOU!!!