Advanced Physical Diagnosis
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• Accuracy in Diagnosis of Pneumonia
• Accuracy in Diagnosis of COPD
• Accuracy in Diagnosis of Pneumonia
Teaching Tips
[Skill Modules >> Pulmonary Examination >> Teaching Tips ]

Teaching Tips: Pulmonary

General Points

  • As with any physical sign, it is helpful to have the learner commit to an assessment before utilizing technology, such as radiography, ECG, or invasive monitoring.
  • Talk aloud to describe the maneuver as it is being performed.
  • To keep all participants interested, pose questions that learners can be thinking about (see case example) until it is their turn to examine patients.
  • Ask the patient's permission before reviewing the sign as a group. Summarize to the patient when the exam is completed.
  • There are different way to approach the exam depending upon the level of the learner:
    • A finding may be simply demonstrated, or A brief patient history may be given and the learner asked to demonstrate appropriate exam maneuvers, or
    • Demonstrate various maneuvers to detect an abnormality (e.g., ascites), and ask learners about the value (sensitivity and specificity) of each exam maneuver.
  • Historical points are fun and enhance interest in the exam.

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QuickTime format Interview with patient with COPD (7.17MB)
Observe how he describes exercise limitations; his labored breathing, and use of accessory muscles to breathe.
QuickTime format Demonstration of percussion technique (2.8MB)
QuickTime format Teaching technique to elicit wheezes (3MB)
All movies are in QuickTime® format. If you do not have the plugin, please download it here.

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Friction Rubs

The traditional descriptions of friction rub used correlations such as "leather rubbing together" (examples such as a saddle and leather pants). Now these are irrelevant since most of us don't even know what leather sounds like!

Better examples to convey the sound are:

  • The crunching sound of walking on new snow with an icy top crust.
  • Ask the learner to rub his/her thumb and index finger together right next to the ear
    • this reproduces a similar sound
  • Cover ear with hand and with fingernail of opposite hand, scratch along dorsal surface of hand that is covering the ear

Question: Why is a pleural friction rub loudest over the lower chest wall on the side of inflammation?

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