Chest Examination

Yes, it is unusual for a surgeon to be evaluated on how he can examine the chest, but it is very important for you as a surgeon to know how to evaluate the chest specially in trauma and critically ill patients.

Here is a simplified plan on how you can assess the chest.

Chest and respiratory system

Inspection

  • Skin (Dilated veins – Scars – Ulcers – Pigmentation)
  • Chest wall (Shape – Symmetry – Localized deformity – Expansion – Respiratory rate – Respiratory rhythm – Respiratory type – Over action)
  • Pulsation (Apical – Epigastric)
  • Breast
  • Axilla

Palpation

  • Tenderness over (Costochondral joint – Sternoclavicular joint – Sternum – Intrcostal muscular pain)
  • TVF
  • Position of mediastinum (Trachea – Apical pulsation)
  • Palpable adventitious sound
  • Confirm pulsations
  • Confirm expansion
  • Subcostal angle
  • Swelling

Percussion

Tidal percussion – MCL – MAL – SL – PVL – Kronig’s area – Bare area – Traub’s area

Auscultation

Breath sounds Type (Vesicular – Bronchial)

Intensity

Added sounds Wheezes – Crackles – Pleural rub
Vocal resonance Bronchophony – Whispering pectoriloquy – aegophony