ANTERIOR – POSTERIOR CHEST EXAMINATION

©2014 New York Institute of Technology College of Osteopathic Medicine Reviewed by Patricia Happel, D.O. 06/30/14

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1 Observe respiratory rate Examiner should not

announce this exam, e.g. “I’m checking your respiratory rate.”

Examiner must report

results and interpretation, e.g. “Your respiration rate is 12, and that’s normal.”

2 Inspect anterior / posterior chest Gown must be lowered

to fully reveal both anterior and posterior chest.

Examiner must inspect

both the anterior and posterior chest.

Examiner must make it

clear he / she is inspecting, e.g. Saying “I’m

inspecting your chest” OR

Noting, e.g. scars, moles, etc. OR

Lowering the gown completely, front and back

ANTERIOR – POSTERIOR CHEST EXAMINATION

©2014 New York Institute of Technology College of Osteopathic Medicine Reviewed by Patricia Happel, D.O. 06/30/14

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3 Palpation of anterior and posterior chest walls Anterior chest wall: Palpate on skin. Palpate bilaterally

below the clavicle on the rib and intercostal spaces.

AND Posterior chest wall: Palpate on skin. Palpate bilaterally over

posterior lung fields.

ANTERIOR – POSTERIOR CHEST EXAMINATION

©2014 New York Institute of Technology College of Osteopathic Medicine Reviewed by Patricia Happel, D.O. 06/30/14

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4 Percuss anterior and posterior lung fields Percuss on skin, patient sitting or supine. Percuss side to side (vs. up and down), at

least 4 of 6 locations bilaterally.

○= Locations

ANTERIOR – POSTERIOR CHEST EXAMINATION

©2014 New York Institute of Technology College of Osteopathic Medicine Reviewed by Patricia Happel, D.O. 06/30/14

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5 Auscultate anterior and posterior lung fields Standing to the right of the patient, auscultate the

anterior and posterior lung fields on skin. The patient can be in any position.

Examiner asks patient to “Open your mouth and

take deep breaths in and out.” Listen to lung fields with stethoscope (diaphragm). Starting at apex, alternate side-to-side auscultation

bilaterally (vs. up and down), at least 4 of 6 locations.

○= Locations

ANTERIOR – POSTERIOR CHEST EXAMINATION

©2014 New York Institute of Technology College of Osteopathic Medicine Reviewed by Patricia Happel, D.O. 06/30/14

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6 Palpation of chest wall motion Posterior palpation done in

seated position, on skin. The examiner evaluates how

the rib cage expands by placing hands flatly on the patient’s back at bottom of rib cage (i.e. hands must be wrapped around contour of ribs), then asking patient to “inhale deeply.”

AND

Anterior palpation done in

supine position, on skin. Thumbs (both hands) at

xiphoid process, fingers fanned out laterally while feeling for symmetry / asymmetry of chest wall motion, then asking the patient to “inhale deeply.”

ANTERIOR – POSTERIOR CHEST EXAMINATION

©2014 New York Institute of Technology College of Osteopathic Medicine Reviewed by Patricia Happel, D.O. 06/30/14

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Special Tests ST 1 Evaluate tactile fremitus

Evaluate on skin, patient in

seated position.

Perform anterior and posterior exams

Must use ulnar or balls of

hands, not palms or finger pads, bilateral simultaneously.

Press firmly, ask patient to

repeat “99, 99." Side to side, at least 2 of 4

levels. Findings If increased fremitus,

suggestive of consolidation, e.g. pneumonia or abscess.

If decreased or absence of

fremitus, suggestive of pneumothorax, pleural effusion.

Anterior Exam - Options

Balls of hand simultaneously

Ulnar simultaneously

Locations for feeling fremitus

(anterior) Continued

ANTERIOR – POSTERIOR CHEST EXAMINATION

©2014 New York Institute of Technology College of Osteopathic Medicine Reviewed by Patricia Happel, D.O. 06/30/14

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ST 1 Evaluate tactile fremitus Evaluate on skin, patient in

seated position.

Perform anterior and posterior exams

Must use ulnar or balls of

hands, not palms or finger pads, bilateral simultaneously.

Press firmly, ask patient to

repeat “99, 99." Side to side, at least 2 of 4

levels. Findings If increased fremitus,

suggestive of consolidation, e.g. pneumonia or abscess.

If decreased or absence of

fremitus, suggestive of pneumothorax, pleural effusion.

Posterior Exam - Options

Balls of hand simultaneously

Ulnar simultaneously

Locations for feeling fremitus

(posterior)

ANTERIOR – POSTERIOR CHEST EXAMINATION

©2014 New York Institute of Technology College of Osteopathic Medicine Reviewed by Patricia Happel, D.O. 06/30/14

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Special Tests

ST 2 Evaluate egophony Patient in seated position. Place stethoscope

(diaphragm) over posterior lung fields.

Auscultate on skin

Ask patient to say “Eeee.” Evaluate side to side, at

least 2 of 4 levels. Findings • If heard as “Aaaa” while

listening, suggestion of consolidation.

ST 3 Evaluate whispered pectoriloquy Patient in seated position. Place stethoscope

(diaphragm) over posterior lung fields.

Auscultate on skin

While auscultating, ask

patient to whisper “1-2-3, 1-2-3.” Or “99, 99.”

Evaluate side to side, at least 2 of 4 levels.

Findings If whisper is heard louder

and clearer, suggestive of consolidation.

ANTERIOR – POSTERIOR CHEST EXAMINATION

©2014 New York Institute of Technology College of Osteopathic Medicine Reviewed by Patricia Happel, D.O. 06/30/14

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ST 4 Evaluate bronchophony Patient in seated position. Place stethoscope

(diaphragm) over posterior lung fields.

While auscultating, ask

patient to say (not whispered) “1-2-3, 1-2-3.” Or “99, 99.”

Evaluate side to side, at

least 2 of 4 levels. Findings If sounds are heard louder and clearer, suggestive of consolidation.