1. Inspection

2. Palpation

3. Percussion

4. Auscultation

"Pigeon chest"

prominent sternal protrusion

abnormally shaped chest-->distortion of lung structures

"Funnel chest"

Indentation of lower sternum above xiphoid process

Causes thoracic vertebrae to straighten; flat chest

Impacts on the airway, lung parenchyma

results in compromised respiration as in, for example, chronic asthma, emphysema, COPD or cystic fibrosis

ribs are more horizontal, spine somewhat kyphotic, sternal angle more prominent

the ratio of anteroposterior to transverse diameter are approx equal as AP enlarges. (AP:transverse is 1:2 in healthy patient). 

Exaggerated thoracic curvature of spine (Anatomy-recall "humpback" table 22. POM notes-can affect cervical spine too).

Marked by posture change, abnormal breathing

Diminished lung capacity. Pulmonary hypertension

varying periods of increasing depth interspersed with apnea (no breathing)

indicative of congestive HF

always deep and usually rapid breathing (deeper and faster than hyperventilation)

associated with metabolic acidosis

Irregular respirations varying in depth and interrupted by intervals of apnea

Associated with severe and persistent increased intracranial pressure, medulla (brainstem damage), or respiratory compromise from drug poisoning

The more extreme version of biot

significant disorganization with irregular and varying depths of respiration

Acidosis (metabolic)

Anxiety

Aspirin poisoning

CNS lesions (pons)

Fever

Oxygen need (hypoxemia)

Pain

Alkalosis (metabolic)

CNS lesions (cerebrum)

Myasthenia gravis

Narcotic overdose

Obesity (extreme)

1. Cyanosis of lips and nails

2. Pursed lips

3. Clubbing of fingers

4. Flared nostrils

5. Barrel chest

a crackly or crinky sensation. 

sounds like rubbing leather or popping bubble wrap

indicates air in subcutaneous tissue from rupture somewhere in respiratory system or infection with gas producing organism

Inflammation of pleural surfaces

Indicated by palpable, coarse grating vibration on inspiration

palpable vibration of chest wall resulting from speech or other verbalizations.

have patient say a few numbers or words (ex. 99). you'll feel fremitus best parasternally at second intercostal space where bronchi bifurcate

Excess air in lungs or emphysema

Pleural thickening or effusion

Massive pulmonary edema

Bronchial obstruction

Preence of fluids or solid mass within lungs

Lung consolidation

Heavy but nonobstructive bronchial secretions

Compressed lung 

Tumor

Diaphragm range of motion

Dullness may indicate fluid or mass

Heard over most lung fields

low pitched, low intensity sounds heard over healthylung tissue

Heard over main bronchi

Moderate pitch and intensity

Heard only over trachea. High pitch.

On auscultation, 'e' sound transformed into 'a' sound. 

Present in lung consolidation

adventitious sound indicating airway obstruction, asthma, interstitial edema

auscultation: sounds squeaky, like whale call

adventitious sound, indicates pulmonary edema, pneumonia

auscultation: rubbing hair between fingers.

heard more frequently during inspiration

secretions in large airways

indicative of serious bronchitis

tend to disappear after coughing (unlike crackles)

Sign patient has a 'bad disease' (ex congenital heart disease, heart failure, cystic fibrosis, COPD, endocarditis, cirrhosis, lung cancer, lethal pulmonary fibrosis...young patients-usually CF or cong HD)

look at small concave depression by the cuticle (phalangeal depth). normal fingers are at 160 degrees. in clubbing, you'll see hypertrophy of soft tissue at end of nails and angle will be over 180 degrees.