Physical Examination Checklist: Focused Thorax/Lungs, Cardiac and Peripheral Vascular Exam

Focused Thorax/Lungs Exam Checklist

Task:

Physical Examination Checklist

Focused Thorax/Lungs, Cardiac and Peripheral Vascular Exam
patient sitting upright
Observe the rate, rhythm, depth, and effort of breathing noting color and any cyanosis
Inspect for accessory muscle use noting retraction of interspaces during inspiration
Inspect shape of the chest (AP diameter to lateral chest diameter) noting symmetry and deformities
Palpate the chest wall noting tenderness and fremitus
Palpate the chest for lung expansion/excursion
Percuss the chest noting any abnormalities, note diaphragmatic excursion of the posterior chest
Auscultate the lungs noting pitch, intensity, and duration of inspiratory and expiratory sounds; identify any adventitious sounds
Special Techniques
Assess voice transmission with egophony (change from “ee” to “ay”)
Assess voice transmission with bronchophony (change with stated word such as “baseball” or “Scooby Doo”)
Assess for voice transmission with whispered pectoriloquy (clearer whispered voice)
patient is supine with 30-degree elevation of the head unless otherwise stated
Inspect for jugular venous pressure and carotid pulsations
Auscultate the carotid pulse for presence of bruits
Palpate the carotid pulse noting amplitude and presence of any thrills
Palpate anterior chest noting heaves, lifts, thrills, crepitus, and tenderness
Palpate the PMI noting location, amplitude and duration
Auscultate the anterior chest with both diaphragm and bell of the stethoscope in aortic, pulmonic tricuspid, Erb’s Point, and mitral areas noting location, timing, intensity, pitch, rhythm, extra sounds, and quality of murmurs if present
Note systole and diastole (S2>S1 at base and S1>S2 at apex)
Special Techniques
Auscultate for mitral stenosis with the patient in the left lateral decubitus position
Auscultate for aortic regurgitation with the patient sitting up, leaning forward, exhaling completely, and briefly holding their breath after
expiration (listening at LSB at the apex)
Peripheral Vascular System (15 points)
Palpate radial and brachial pulses