Laboratory Work No. ____

SURFACE ANATOMY

Objectives: To be able to be familiar with the surface anatomy of the Chest, Upper Back

and Abdomen; To be able to perform the basic skills in physical examination of a normal

patient.

General Considerations:

1. The patient must be properly undressed and gowned for this examination.

2. Ideally the patient should be sitting on the end of an exam table.

3. The examination room must be quiet to perform adequate percussion and

auscultation.

4. Try to visualize the underlying anatomy as you examine the patient.

I. Inspection: Chest

1. Observe the rate, rhythm, depth, and effort of breathing. ___________

breaths/min

2. Listen for obvious abnormal sounds with breathing such as wheezes.

3. Observe for retractions and use of accessory muscles (sternomastoids,

abdominals).

4. Observe the chest for asymmetry, deformity, or increased anterior-posterior (AP)

diameter. Measure the AP diameter in cms. _______________.

5. Confirm that the trachea is near the midline

6. Take note of the following on your patient: sternal angle, point of maximum

impulse (PMI), sternal notch, costal margin, scapular area. Identify where the

triangle of auscultation is located.

Inspection: Abdomen

1. The patient should have an empty bladder. Make the patient comfortable in a

supine position. Have the patient keep arms at the sides or folded across the chest.

Observe the contour of the abdomen (is it flat? Rounded? Protuberant?

Symmetric?)

2. Note the quadrants of the abdomen. Label with markers.

3. Measure the abdominal girth in cms. __________________________.

II. Palpation: Chest

1. Identify any areas of tenderness or deformity by palpating the ribs and sternum.

2. Assess expansion and symmetry of the chest by placing your hands on the

patient's back, thumbs together at the midline, and ask them to breath deeply.

3. Check for tactile fremitus. Ask the patient to say "ninety-nine" several times in a

normal voice. Palpate using the ball of your hand. You should feel the vibrations

transmitted through the airways to the lung. What does increased tactile fremitus

indicate? ________________________________________________________

________________________________________________________________

Palpation: Abdomen

1. Usually, after inspection of the abdomen, auscultation is done afterwards, then

followed by percussion and then palpation. Palpating the abdomen is the last

procedure when examining this area.

2. When palpating the abdomen, keep your hand and forearm on a horizontal

plane, with fingers together and flat on the abdominal surface. Palpate the

abdomen with a light, gentle and dipping motion. Feel on all four quadrants.

3. Describe findings for each quadrant.

4. What is voluntary guarding? How will you differentiate if the resistance

that you are feeling while palpating the abdomen is voluntary guarding or

involuntary muscle spasms?

III. Percussion: Chest

Proper Technique

1. Hyperextend the middle finger of one hand and place the distal interphalangeal

joint firmly against the patient's chest.

2. With the end (not the pad) of the opposite middle finger, use a quick flick of the

wrist to strike first finger.

3. Categorize what you hear as normal, dull, or hyperresonant.

4. Practice your technique until you can consistantly produce a "normal" percussion

note on your (presumably normal) partner.

5. Draw an anterior chest and posterior chest and plot out which of the areas are dull

or resonant.

Percussion: Abdomen

1. Percussion of the abdomen follows directly after auscultation of the abdomen.

2. Percuss the abdomen lightly in all four quadrants to assess distribution of

tympany and dullness. Draw the abdomen and label the areas of tympany and

dullness.

3. Briefly percuss the lower anterior chest between the lungs above and costal

margin below, on both left and right sides. Compare your findings.

IV. Auscultation – will not be performed during this particular laboratory work. Your

laboratory professor will however discuss the parts of the stethoscope in preparation for

your upcoming laboratory work.

Detail all of your findings for each step of the physical examination. Submit your results

via email. If you have taken pictures, attach them and properly label.