In the small group session run for Residents and Senior medical students I go through the following exercises. If you already know these concepts well, you need not proceed with this lesson. If you have problems and are still interested, proceed further with the lesson.
1. How sensitive is physical exam in detecting abnormalities. Between cardiac, neurology, and pulmonary exam in which system physical diagnosis is more precise?
2. How secure are you after the physical exam of lungs that you have identified all of the abnormalities?
3. How can you get the most out of physical exam?
4. Why not rely only on chest x-ray? Why bother doing physical exam?
5. What components of respiratory system do you evaluate?
Recruit a volunteer for the following exercises.
6. Draw trachea in front and back.
7. Identify the manubrium angle. why is it an important landmark.
8. How do you describe localizing abnormalities by exam?
9. Identify all of the spaces nomenclature used in describing the site of abnormality.
10. Similarly draw the lines we use in describing location of abnormalities on the thorax of the volunteer.
11. Draw the outline of right lung.
12. Draw the outline of left lung.
13. Draw the right oblique fissure.
14. Draw the transverse fissure.
15. Draw left oblique fissure.
16. Identify lobes of lung.
17. Draw the surface anatomical outline of mediastinum in front and back
18. Identify costal angle. What is the normal costal angle?
19. Identify 7th cervical spinous process.
20. Describe tidal breathing in physiologic terms.
21. Identify all accessory inspiratory muscles.
22. Identify expiratory muscles.
23. How do you assess pleural negative pressure by physical exam.
24. What is the extent of the involvement of the diaphragm for tidal breathing in erect and supine position?
25. What is the optimal position for use of accessory inspiratory muscles?
26. What is the optimal position for use of expiratory muscles?
27. In which position are the lungs smallest? Position the volunteer to produce the smallest right lung for him or her.
28. Why is an asthmatic orthopneic?
29. In the lateral decubitus position, are the breath sounds harsher at the bottom or top of the lung and why?
30. In normal males for tidal breathing, which component is dominant, abdomen or thorax?
31. Describe physical findings of hypoxemia. How do you clinically distinguish between central and peripheral cyanosis.
32. Describe physical findings of CO2 retention.
33. Describe physical findings of respiratory acidosis.
34. How will you count respiratory rate?
35. Describe a few patterns of breathing.
36. What is the percentage of the FRC in relationship to TLC at resting position?
37. What factors determine the size of thorax and hemithorax?
38. Describe dynamic changes of the trachea with inspiration and expiration.
39. What is the significance of increased AP diameter of the thorax?
40. How do you measure chest expansion in women?
41. What is the significance of overall decreased chest expansion?
42. What is the significance of asymmetric chest expansion? How do you decide which side abnormal.
43. How do you measure forced expiration time?
44. What is normal forced expiration time?
45. How do you assess expiratory force?
46. What happens to the thorax and lungs with aging?
47. Describe the pathology of lungs in consolidation?
48. What are the types of atelectasis?
49. What is the significance of the mediastinal position?
50. How do you assess the position of the mediastinum?
51. List the conditions that push the mediastinum.
52. List the conditions that pull the mediastinum.
53. Demonstrate how you examine for symmetry of chest expansion.
54. Demonstrate the method of eliciting lung resonance.
55. What is the significance of increased or decreased lung resonance?
56. Can you distinguish pleural effusion from consolidation by physical exam?
57. What are normal breath sounds and describe them?
58. Why is expiration short in vesicular breathing?
59. List conditions where bronchial breathing can be heard.
60. What are the types of bronchial breathing?
61. Describe pleural rub.
62. What does rhonchus mean?
63. How do you categorize fine, medium, and coarse crackles?
64. What is the difference between wheeze, rhonchus, and stridor?
65. What is bronchophony, whispering pectoriloquy, and egophony?
66. How do you examine for clubbing?
67. In what group of pulmonary diseases do we encounter clubbing?
68. In what conditions do you see foul breath?
69. In what conditions do the patient have bovine cough?
70. How do you evaluate massively obese patients?