The physical exam usually starts with taking your vital signs. These include your blood pressure, pulse rate, respiratory rate and temperature. Many lung doctors consider a spirometry test and an oximetry test to be part of the vital signs info. A spirometry test is a simple breathing test. An oximetry test measures the oxygen level in your blood. Some doctors may do a complete physical exam, checking you from head-to-toe with many stops in between. Or they may decide to do a limited exam, focusing on only the parts of your body related to your current problem. For lung disease patients, a limited exam might include: the skin, ears, nose, throat, neck, lungs, heart and extremities.
The Lung Exam
Have you ever wondered what health care providers are doing when they tap on your chest and move the stethoscope around? Doctors observe, feel, bang on the chest and listen with a stethoscope to evaluate the lungs.
By observing the chest during breathing, a doctor can make sure the chest is moving as it should. When an individual has chronic breathing problems caused by a blockage to the airflow, they may have a flattened diaphragm (the area below your rib cage). When this happens, the body starts to recruit additional muscles such as the muscles of the neck to help with breathing. A doctor can observe the use of these muscles during an exam.
In addition, a patient’s chest may be larger around and barrelchested. And the lower part of the chest may move in instead of out, when breathing in. This condition is usually caused by a severe flattening of the diaphragm.
By placing his/her hands on the chest during breathing, a doctor can know if the chest is expanding evenly. A doctor can also sometimes feel air moving through blocked airways. He/she may be able to feel abnormal movements of the heart.
Most people have an image of the old doctor tapping on the chest with his fingers. This is called “percussion.” It is usually done by placing one hand on the chest and hitting a finger of
that hand with the tip of a finger of the other. It is very much like tapping the side of a barrel to see how much liquid is in it. The chest sounds differently depending on how much air is in it.
People with emphysema often have a chest that sounds like an empty barrel instead of a full one. With pleurisy, there is fluid surrounding the lungs. A doctor can hear the change in sound as he/she taps the chest at the top of the fluid level.
Listening to a chest with a stethoscope is known as “auscultation.” The stethoscope is designed to amplify the breath and heart sounds and highlight the frequency of sound. The classic stethoscope has two sides. There is a flat side for listening to sounds with a high pitch. The domed side is for listening to lower-pitched sounds. Many doctors are now using electronic stethoscopes. With these, lung and heart sounds are transmitted electronically to the ear pieces.
A doctor can determine how much and how well air is moving during breathing. They can listen for wheezing and other sounds which may suggest there is a blockage to the airflow. They can also listen for sounds that indicate there is fluid in the lungs or sounds that suggest the changes of pneumonia. In a COPD patient, a doctor will usually hear air movement sounds that are softer than normal. This means there is decreased breath. They may also hear prolonged breathing out, wheezing and “rhonchi” which is the sound of air moving past mucus.
The Heart Exam
When physicians listen to the heart, they usually listen to four main areas. These areas are the places where the sound of the various heart valves opening and closing can be heard. In these places, the sounds of abnormal blood flow may also be heard. The doctor may listen to other areas if there are unusual sounds noted, or if he/she is listening for certain heart abnormalities. They may ask you to change position or hold your breath. Sounds caused by abnormal blood flow through the valves of the heart are called “murmurs.” Not all murmurs mean the heart is abnormal. The heart and lungs depend on one another to fill the blood with oxygen and pump it through the body. So, some changes in heart sounds can
actually mean there is lung disease.
Examining the Abdomen and Extremities
The doctor may observe your abdomen or stomach. They may listen to it, push on it and explore it with both hands and percuss it. The size of the liver and spleen, in the right and left
upper abdomen, are of particular interest in examining for liver disease.
An exam of the arms, hands, legs and feet can sometimes reveal signs of fluid build-up called “edema.” This can mean there are lung, liver or heart problems. Lung problems which cause low oxygen in the blood can sometimes lead to a blueness of the lips or fingers called “cyanosis.” Certain lung diseases can lead to abnormally shaped nails and fingertips, called “clubbing.”
