Physical (Thorax)

Anterior & Lateral Thorax

Physical examination (Physician assessment)

 

 

Self-scoring is possible with some items, but examinations of the thorax are best accomplished by a healthcare professional.

 

Score

Normal expectations

Recommended action steps

Chest/breast asymmetry

[yes (score 1)/no (score 0)]

 

Normally symmetric

Report to physician if asymmetric

Respiration:

 

 

 

Rate

[bpm (score 0 if within 12-20 bpm, 1 otherwise)]

 

12-20 bpm

Report to physician if off norm

Depth

[Shallow (score 1)/normal (score 0)/deep (score 1)]

 

Normal breathing expected

Report to physician if off norm

Straining effort

[yes (score 1)/no (score 0)]

 

No difficulty, not labored, no dyspnea

Report to physician if off norm

Palpation for respiratory movements:

 

 

 

Areas of tenderness

[yes (score 1)/no (score 0)]

 

Expect no tenderness

Report to physician if areas of tenderness are present

Lesions

[yes (score 1)/no (score 0)]

 

Expect no lesions

Report to physician if lesions are present

Dilated vessels

[yes (score 1)/no (score 0)]

 

Expect no dilated vessels

Report to physician if dilated vessels are present

Palpation for trachea deviation

[Straight (score 0)/Left or Right Deviation (score 1)]

 

Straight trachea

Report to physician if deviated

Apical pulse assessment

[bpm (score 0 if within expectation, otherwise 1)]

 

60-100 bpm with stethoscope

Report to physician if off norm

Heaves & thrills assessment

[present (score 1)/absent (score 0)]

 

Absent

Professional assessment required

Tactile & vocal fremitus assessment

[Normal lung (score 0)/Increased fremitus (score -1)/Decreased fremitus (score 1)]

 

Normal vibration upon low frequency vocalization

Professional assessment required: Increased fremitus = pneumonia. Decreased fremitus = pleural effusion or pneumothorax

Lung percussion

[Resonant (score 0)/hyper-resonant (score 1)/ Dull (score 1)]

 

Resonant

Professional assessment required: Hyper-resonant percussions = pneumothorax. Dull percussions = consolidation (pneumonia), collapse or pleural effusion

Auscultation for breath sound

[Vesicular (score 0)/strained inspiration (score 1)/wheeze (score 1)/Coarse crackles (score 1) /Fine crackles (score 1)]

 

Vesicular

Professional assessment required: Strained inspiration = Upper airway obstruction. Wheeze = asthma or COPD. Coarse crackles = pneumonia or pulmonary edema. Fine crackles = pulmonary fibrosis

Auscultation for vocal resonance

[Normal (score 0)/Increased (score 1)/decreased (score 1)]

 

Vesicular, soft low-pitched sound heard primarily during inspiration

Professional assessment required: Increased resonance = consolidation, lobar collapse, or tumor. Decreased resonance = pleural effusion

Auscultation for heart sound

For the next 3 items: [yes (score 1)/no (score 0)]

 

 

 

S3

 

 

Absent

S3: potential sign of heart failure or less frequently diastolic murmur because of mitral or tricuspid regurgitation

S4

 

Absent

S4: hypertension or aortic stenosis or hypertrophic cardiomyopathy or ischemic cardiomyopathy

Murmurs

 

Absent

Murmurs: could be caused by pregnancy, fever, high blood pressure, anemia, overactive thyroid, or more seriously, heart valves defects, aortic sclerosis, or stenosis, atrial or ventricular septal defects

Overall score

 

 

 

 

Reminder: Accumulated score of zero requires no further action. The user is encouraged to discuss with a healthcare provider any line items scored as 1 and proceed with remedial actions as appropriate. Save or print the table. All forms will reset to blank state once the user exits the website.

 

"Prevention is better than cure" Desiderius Erasmus

 

Posterior Thorax

Physical examination (Physician assessment)

 

 

Self-scoring is possible with some items, but examinations of the thorax are best accomplished by a healthcare professional.

 

Score

Normal expectations

Recommended action steps

Palpation for respiratory movements:

For the next 3 items: [yes (score 1)/no (score 0)]

 

 

 

Areas of tenderness

 

Expect no tenderness

Report to physician if areas of tenderness are present

Lesions

 

Expect no lesions

Report to physician if lesions are present

Dilated vessels

 

Expect no dilated vessels

Report to physician if dilated vessels are present

Tactile & vocal fremitus assessment [Normal lung (score 0)/Increased fremitus (score1)/Decreased fremitus (score 1)]

 

Normal vibration upon low frequency vocalization

Increased fremitus = pneumonia. Decreased fremitus = pleural effusion or pneumothorax

Lung percussion

[Dull (score 1)/Resonant (score 0)/Hyper-resonant (score 1)]

 

Resonant

Hyper-resonant percussions = pneumothorax. Dull percussions = consolidation (pneumonia), collapse or pleural effusion

Auscultation for breath sound

[Vesicular (score 0) /strained inspiration (score 1)/wheeze (score 1) /Coarse crackles (score 1) /Fine crackles (score 1)]

 

Vesicular

Strained inspiration = Upper airway obstruction. Wheeze = asthma or COPD. Coarse crackles = pneumonia or pulmonary edema. Fine crackles = pulmonary fibrosis

Auscultation for vocal resonance

[Normal (score 0)/Increased (score 1)/decreased (score 1)]

 

Vesicular, soft low-pitched sound heard primarily during inspiration

Increased resonance = consolidation, lobar collapse, or tumor. Decreased resonance = pleural effusion

Spinal deformities:

[For all 4 items below: score 1 if yes, 0 if no.]

 

 

 

Cervical lordosis (curvature)

 

no

If yes or in doubt, consultation with a healthcare provider is warranted.

Thoracic kyphosis (hunchback)

 

no

If yes or in doubt, consultation with a healthcare provider is warranted.

Lumbar lordosis (curvature)

 

no

If yes or in doubt, consultation with a healthcare provider is warranted.

Scoliosis (side twist)

 

no

If yes or in doubt, consultation with a healthcare provider is warranted.

Palpation from behind:

 

 

 

Cervical glands enlargement

[yes (score 1)/no (score 0)]

 

no

Report to physician if enlarged.

Thyroid enlargement

[yes (score 1)/no (score 0)]

 

no

Report to physician if enlarged.

Spinal processes alignment

[yes (score 0)/no (score 1)]

 

yes

Report to physician if misaligned.

Spinal processes tenderness

[yes (score 1)/no (score 0)]

 

no

Report to physician if tender.

Sacroiliac joints tenderness, edema

[yes (score 1)/no (score 0)]

 

no

Report to physician if condition exists.

Paraspinal muscles spasm or tenderness

[yes (score 1)/no (score 0)]

 

no

Report to physician if condition exists.

Overall score

 

 

 

 

Reminder: Accumulated score of zero requires no further action. The user is encouraged to discuss with a healthcare provider any line items scored as 1 and proceed with remedial actions as appropriate. Save or print the table. All forms will reset to blank state once the user exits the website.

 

"Prevention is better than cure" Desiderius Erasmus