Introduction: Introduce yourself and explain to the patient what you will be doing.

1) Vitals: Ask for the vitals before you proceed.

2) General:

• Comment if the patient is comfortable with no apparent distress (no tachypnea or accessory muscle)

• Eyes: Look for Jaundice & pallor

• Mouth: Look for Central cyanosis & dental hygiene

• Face & Neck: Look for Horner syndrome or plethora, Left supraclavicular node (Virchow node for Troiser sign)

• Hands: Check the Temperature, peripheral cyanosis, clubbing, nicotine and hypertrophic pulmonary osteoarthropathy, radial pulse & cap refill

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Note: Comment if the patient is speaking in full sentences, which suggests open airways and spontaneous breathing. There is no pursing of the lips, no nasal flaring, no audible wheezes, and no use of accessory muscles. The patient is not tripoding

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3) Inspection (chest): Drape the patient appropriately

• Look for Scars, masses and symmetry with respirations & visible tracheal deviation

• Kyphosis & scoliosis & Signs of pectus excavatum or carinatum

• Increased AP diameter (barrel chest)

4) Palpation:

• Tracheal deviation (trachea is midline)

• Chest expansion (Your thumbs touching – 5cm & symmetrical)

• General palpation for tenderness

• Tactile fremitus (Ant & Post: Ask the patient to say "99")

5) Percussion:

• All lungs fields starting at clavicle for hyper-resonance or dullness (Ant & Post)

• Diaphragmatic excursion (only if suspecting COPD): Normal is between 4- 5cm

6) Ausculation: Ant & Post

• All lung fields for good air entry bilaterally (vesicular & symmetrical), No wheezes & crackles

• Egophony: Ask the patient to say “EEE” and auscultate for transmission of “AAA” sound

• Whisper pectoriloquy: Ask the patient to whisper “1,2,3" and auscultate over the suspected area of consolidation for sound transmission

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7) Complete your exam by performing: H&N LN + lower limb & sacral edema + cardiovascular exam

8) Thank the patient!