👀 General Appearance / Posture
- Patient positioned upright with skin exposed for inspection.
- Appears relaxed, and in no acute distress.
- Posture normal, no signs of discomfort.
- Respirations even, quiet, unlabored, and within normal rate.
- No nasal flaring, accessory muscle use, or intercostal retractions.
- No diaphoresis, cyanosis, pallor, or anxiety observed.
🫁 Thorax Inspection
- Thorax symmetric bilaterally with normal AP:transverse ratio ≈ 1:2.
- Anatomical landmarks identified: suprasternal notch, sternum, manubrium, angle of Louis, 2nd rib, intercostal spaces, C7 spinous process.
- Vertical reference lines visualized: midsternal, midclavicular, anterior/mid/posterior axillary lines, and midscapular lines.
- Trachea midline; no deviation.
- Normal rise and fall of chest with inspiration and expiration. No abnormal movements.
- No deformities (no barrel chest, scoliosis, kyphosis, or pectus abnormalities).
- Skin over thorax: color consistent with ethnicity, intact, warm, and dry.
- No lesions, scars, rashes, edema, or abnormal pigmentation.
- No masses, lumps, or abnormal lesion distribution patterns.
💅 Nails & 🧴 Skin
- Skin: normal color, temperature, texture, thickness, moisture, and hygiene.
- Normal mobility and turgor (no tenting).
- No edema present.
- Nails: clean, smooth, and firmly attached to nail beds.
- Nail beds pink, with normal contour and shape.
- No clubbing, pitting, deformities, or lesions.
- Capillary refill < 3 seconds bilaterally.
✋ Palpation
- Symmetric chest wall expansion, anteriorly and posteriorly.
- Tactile fremitus: vibrations equal bilaterally (apices → bases, anterior, posterior, lateral).
- No tenderness over ribs, sternum, or intercostal spaces.
- No subcutaneous emphysema, crepitus, or palpable masses.
- Spine midline, no step-offs or abnormal curvature detected.
🔨 Percussion
- Patient correctly positioned.
- Resonant tones throughout anterior, posterior, and lateral lung fields.
- No dullness (suggesting consolidation or effusion).
- No hyperresonance (suggesting air trapping, emphysema, or pneumothorax).
🎧 Auscultation
- Stethoscope placed correctly; patient instructed to breathe through mouth.
- Breath sounds clear and vesicular bilaterally in all lung lobes.
- Normal bronchial, bronchovesicular, and vesicular sounds heard in appropriate locations.
- Equal air entry on both sides.
- No adventitious sounds (wheezes, crackles, rhonchi, stridor).
- Auscultation of trachea. Breath sounds present and normal.
- No abnormal voice sounds (negative for bronchophony, egophony, whispered pectoriloquy).