Clinical Examination of the Chest-Inspection-Palpation-Percussion-Auscultation

Clinical Examination of the Chest

As medical personnel, you will be examining the chest to detect evidence of disease. Your examination consists of inspection, palpation, percussion, and auscultation

Inspection
 shows the configuration of the chest, the range of respiratory movement, and any inequalities on the two sides. The type and rate of respiration are also noted.

Palpation
enables the physician to confirm the impressions gained by inspection, especially of the respiratory movements of the chest wall. Abnormal protuberances or recession of part of the chest wall is noted. Abnormal pulsations are felt and tender areas detected.

Percussion
 is a sharp tapping of the chest wall with the fingers. This produces vibrations that extend through the tissues of the thorax. Air-containing organs such as the lungs produce a resonant note; conversely, a more solid viscus such as the heart produces a dull note. With practice, it is possible to distinguish the lungs from the heart or liver by percussion.

Auscultation
enables the physician to listen to the breath sounds as the air enters and leaves the respiratory passages. Should the alveoli or bronchi be diseased and filled with fluid, the nature of the breath sounds will be altered. The rate and rhythm of the heart can be confirmed by auscultation, and the various sounds produced by the heart and its valves during the different phases of the cardiac cycle can be heard. It may be possible to detect friction sounds produced by the rubbing together of diseased layers of pleura or pericardium. To make these examinations, the physician must be familiar with the normal structure of the thorax and must have a mental image of the normal position of the lungs and heart in relation to identifiable surface landmarks. Furthermore, it is essential that the physician be able to relate any abnormal findings to easily identifiable bony landmarks so that he or she can accurately record and communicate them to colleagues. Since the thoracic wall actively participates in the movements of respiration, many bony landmarks change their levels with each phase of respiration. In practice, to simplify matters, the levels given are those usually found at about midway between full inspiration and full expiration.

Clinical Significance of Age on Structure

Clinical Significance of Age on Structure

The fact that the structure and function of the human body change with age may seem obvious, but it is often overlooked. A few examples of such changes are given here:

1. In the infant, the bones of the skull are more resilient than in the adult, and for this reason fractures of the skull are much more common in the adult than in the young child.

2. The liver is relatively much larger in the child than in the adult. In the infant, the lower margin of the liver extends inferiorly to a lower level than in the adult. This is an important consideration when making a diagnosis of hepatic enlargement.

3. The urinary bladder in the child cannot be accommodated entirely in the pelvis because of the small size of the pelvic cavity and thus is found in the lower part of the abdominal cavity. As the child grows, the pelvis enlarges and the bladder sinks down to become a true pelvic organ.

4. At birth, all bone marrow is of the red variety. With advancing age, the red marrow recedes up the bones of the limbs so that in the adult it is largely confined to the bones of the head, thorax, and abdomen.

5. Lymphatic tissues reach their maximum degree of development at puberty and thereafter atrophy, so the volume of lymphatic tissue in older persons is considerably reduced.