Write-Up for Thorax and Lungs

Write-Up for Thorax and Lungs

The thorax and the lungs are part of the respiratory system. This paper documents physical examination findings for the thorax and the lungs of a 28-year-old Asian Filipino. An informed consent was obtained from the patient before the initiation of the assessment. The patient further consented to the assessment process being recorded and uploaded on YouTube for educational purposes.

Thorax and the Lungs

The objective of the process is to detail a step-by-step physical assessment of the respiratory system, highlighting potential areas and findings that may be suggestive of an underlying pathology. The process will elaborate on the role of inspection, palpation, percussion, and auscultation when assessing the respiratory system.

Inspection

The patient’s chest appears symmetrical with the trachea midline. His breathing seems rhythmic and effortless. There is no evidence of thoracoabdominal or thoracic breathing. There was also no evidence of the use of accessory musculature in breathing. The use of accessory musculature in breathing is often indicative of labored breathing and points toward pathological conditions that reduce ventilation efficiency (Sarkar et al., 2019). The patient was in a supine position with no evidence of tripod positioning or distress. Patients with pulmonary dysfunction tend to sit upright or assume the tripod position. There were no signs of pectus excavatum or pectus carinatum. Pectus excavatum is defined as a condition in which the sternum is sunk into the chest cavity, while in Pectus carinatum, the sternum protrudes from the chest cavity. There was also no sign of a barrel chest, retraction of the chest, or any other thoracic abnormalities such as kyphosis or scoliosis. The chest movements were symmetrical, with regular and rhythmic chest expansion. There was also no sign of cyanosis, nicotine staining, or finger clubbing.

Palpation

The patient’s chest is accessible and exposed. There are no signs of cutaneous or subcutaneous swelling, nodules, or tenderness of light palpation. There are also no painful points or tender areas on the chest. His chest expansion is normal. Assessing chest expansion during palpation can help determine the quality and depth of the chest movement. In this activity, the hands are positioned on the lower hemithorax, with each hand extending from the axilla to the midline. The patient then inhales and exhales gently as the movement symmetry of the hemothorax is assessed and the chest expansion is felt.

The tactile fremitus is assessed during palpation to help detect areas of abnormal lung tissue density. It is based on the principle that solid media is a better conductor of sound vibrations. In this respect, areas with abnormal lung tissue density will conduct sound vibrations better. Tactile fremitus is assessed posteriorly and anteriorly. In assessing tactile fremitus, both hands are placed on the patient’s back, positioned medially to the shoulders, with the bony edges of the palm, and the patient is asked to utter a phrase. A fremitus will be felt as the patient utters the words. An increase in vibratory transmission is highly suggestive of increased intraparenchymal density. A decrease in the tactile fremitus points towards the presence of a pleural process. Sugibayashi et al. (2023) note that significant changes in tactile fremitus signify a disease process in the lungs. A decrease in fremitus is suggestive of lung pathologies that separate the pleura from the lung parenchyma, such as pneumothorax.

No costochondral tenderness, pain, or discomfort was reported on light palpation. Light palpation of the chest may reveal unexpected tenderness. The chest is palpated anteriorly, posteriorly, and laterally. In this maneuver, the examiner moves their hands gently over the chest region. Suspected and unsuspected tender spots and localized injuries such as rib fractures. Palpation of apparent inflammation of the costochondral junction. Inflammation of the costochondral junction can result in sharp pain on inspiration.

The trachea was midline, with signs of tracheal deviation to the side. Tracheal deviation is often suggestive of the trachea being pulled to the side. This is the case in conditions that result in lung volume loss, such as pneumothorax and atelectasis. It may also mean that the trachea is being pushed away. This may be the case in the presence of an inflammatory mass or a tumor.

Percussion

The chest is percussed in all areas. This includes the posterior and anterior sides and the upper and lower lung fields. The diaphragmatic excursion was 4 cm between complete inspiration and expiration. The normal diaphragmatic excursion is between 3-5 cm. However, values lower or higher than the normal range can be suggestive of atelectasis, hyperinflation, diaphragmatic paralysis, the presence of a pleural effusion, or an intraabdominal pathology.

Percussion of the lungs revealed a resonated, low-pitched, high-amplitude tone. A high-amplitude resonance tone is indicative of a normal gas-filled lung. There was no sign of a hyper resonant or dull sound on percussion. A hyperresonate tone is highly suggestive of hyperinflated lungs. This is the case for patients with COPD. Dullness on percussion revealed an immobile diaphragm and a restrictive ventilatory defect (Kim et al., 2021). Flatness to percussion may be suggestive of the presence of fluid or solid material in the pleural space.

Auscultation

The lung is divided into basilar, apical, and middle regions. There was no wheezing sound or respiratory crackles heard on auscultation. There was also no pleural rub or stridor on auscultating all the regions of the lungs. Wheezing sounds are a highlight suggestive of airway obstruction and are a common manifestation in COPD and asthmatic cases. A crackling sound is generated when air passes through secretion-packed medium-sized and large airways. Crackles are common manifestations of pneumonia and COPD. Stridor is a high-pitched sound that results from the obstruction of the upper airway tracts. When heard on inspiration, it is suggestive of supraglottic lesions. Stridors on expiration are associated with intrathoracic tracheobronchial lesions.

Other Maneuvers

Egophony: This occurs when the “Ee” intonation sounds like “A.” This often suggests pleural effusion consolidation.

References

Kim, Y., Hyon, Y., Jung, S. S., Lee, S., Yoo, G., Chung, C., & Ha, T. (2021). Respiratory sound classification for crackles, wheezes, and rhonchi in the clinical field using deep learning. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-96724-7

Sarkar, M., Bhardwaz, R., Madabhavi, I., & Modi, M. (2019). Physical signs in patients with chronic obstructive pulmonary disease. Lung India, 36(1), 38. https://doi.org/10.4103/lungindia.lungindia_145_18

Sugibayashi, T., Walston, S. L., Matsumoto, T., Mitsuyama, Y., Miki, Y., & Ueda, D. (2023). Deep Learning for Pneumothorax Diagnosis: A systematic review and meta-analysis. European Respiratory Review, 32(168), 220259. https://doi.org/10.1183/16000617.0259-2022

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Document your findings as you would for a comprehensive system exam (only document the physical findings)
Submit a separate write-up and separate video in the assignment tab for each system this week
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Write-Up for Thorax and Lungs

Create a Write-Up Documentation for Thorax and Lungs…The findings should all be normal. Some details you might use

28 years old Asian /Filipino male
ID – ADM
Just create a write-up where all findings are normal

I attached a sample documentation, which must be close to zero to turn it in
I also attached the rubric.