Physical Examination of Chest

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 6 min read
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The physical examination of the chest is composed of inspection, palpation, percussion, and auscultation. Although it is not unheard of for clinicians to skip the first three steps of the chest auscultation important information can be derived from a complete lung examination. A respiratory examination, or lung...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

এই তথ্য শিক্ষা ও সচেতনতার জন্য। এটি ডাক্তারি পরীক্ষা, রোগ নির্ণয় বা প্রেসক্রিপশনের বিকল্প নয়।

Article Summary

The physical examination of the chest is composed of inspection, palpation, percussion, and auscultation. Although it is not unheard of for clinicians to skip the first three steps of the chest auscultation important information can be derived from a complete lung examination. A respiratory examination, or lung examination, is performed as part of a physical examination, in response to respiratory symptoms such as shortness of breath, cough, or chest pain, and is...

Key Takeaways

  • This article explains Inspection in simple medical language.
  • This article explains Palpation in simple medical language.
  • This article explains Percussion in simple medical language.
  • This article explains Auscultation in simple medical language.
Educational health guideWritten for patient understanding and clinical awareness.
Reviewed content workflowUse writer and reviewer profiles for stronger trust.
Emergency safety firstUrgent warning signs are highlighted below.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

  • Chest pain, severe shortness of breath, fainting, or sudden severe weakness.
  • Sudden face drooping, arm weakness, speech trouble, confusion, or vision change.
  • A rapidly worsening condition or symptoms that feel life-threatening.
1

Emergency now

Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

2

See a doctor

Book a professional medical evaluation if symptoms persist, worsen, recur often, affect daily activities, or occur in a high-risk patient.

3

Learn safely

Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

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Start here Choose the right pathway for symptoms, reports, medicines, or urgent warning signs. Disease article roadmap Read this topic step by step: meaning, symptoms, warning signs, diagnosis, treatment, prevention, and follow-up. Treatment planner Prepare questions about treatment choices, benefits, risks, side effects, and follow-up. Family & caregiver guide Organize symptoms, reports, medicines, questions, and follow-up safely. Nutrition & diet guide Prepare food, hydration, supplement, and medicine-timing questions safely. Prevention guide Organize risk factors, protective habits, screening, and warning signs. Recovery guide Prepare a safe plan for activity, rehabilitation, warning signs, and follow-up.
Definition

The physical examination of the chest is composed of inspection, palpation, percussion, and auscultation. Although it is not unheard of for clinicians to skip the first three steps of the chest auscultation important information can be derived from a complete lung examination.

A respiratory examination, or lung examination, is performed as part of a physical examination, in response to respiratory symptoms such as shortness of breath, cough, or chest pain, and is often carried out with a cardiac examination. The four steps of the respiratory exam are inspection, palpation, percussion, and auscultation of respiratory sounds, normally first carried out from the back of the chest.

Inspection

The examiner then estimates the patient’s respiratory rate by observing how many times the patient breathes in and out within the span of one minute. This is typically conducted under the pretext of some other exam, so that the patient does not subconsciously change their baseline respiratory rate, as they might do if they were aware of the examiner observing their breathing. Adults normally breathe about 14 to 20 times per minute, while infants may breathe up to 44 times per minute.[rx]

  • Skin
    • Color: allergy, infection, or inflammation. সহজ বাংলা: চামড়া লাল হয়ে যাওয়া।" data-rx-term="erythema" data-rx-definition="Erythema means skin redness, often from irritation, allergy, infection, or inflammation. সহজ বাংলা: চামড়া লাল হয়ে যাওয়া।">erythema, ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
    • Abrasions, deformities
  • Muscle tone: atrophy, hypertrophy
  • Deformity: asymmetry, rotation, amputation
  • Respiratory status
    • Rate: tachypneic, bradypneic or eupneic?
    • Ventilation: hyperpnea, hypopnea?
    • Accessory muscle use?
    • Position of the patient: upright, tripod position
    • Speaks in complete sentences
    • Symmetric chest rise
    • Trachea is midline
    • Color: cyanotic or acyanotic
  • Chest
    • Pectus excavatum or carinatum

After obtaining the patient’s respiratory rate, the examiner looks for any signs of respiratory distress, which may include:

  • Cyanosis, a bluish tinge of the extremities (peripheral cyanosis), or of the tongue (central cyanosis)
  • Pursed-lip breathing
  • Accessory muscle use, including the scalene and intercostal muscles
  • Diaphragmatic breathing, paradoxical movement of the diaphragm outwards during inspiration
  • Intercostal indrawing
  • Decreased chest–chest movement on the affected side
  • An increased jugular venous pressure, indicating possible right heart failure

The anterior and posterior chest walls are also inspected for any abnormalities, which may include:

  • Kyphosis, abnormal anterior-posterior curvature of the spine
  • Scoliosis, abnormal lateral curvature of the spine
  • Barrel chest, bulging out of the chest wall; normal in children; typical of hyperinflation seen in chronic obstructive pulmonary disease (COPD)[10]
  • Pectus excavatum, sternum sunken into the chest
  • Pectus carinatum, sternum protruding from the chest

In addition to measuring the patient’s respiratory rate, the examiner will observe the patient’s breathing pattern:

  • A patient with metabolic acidosis will often demonstrate a rapid breathing pattern, known as Kussmaul breathing. Rapid breathing helps the patient compensate for the decrease in blood pH by increasing the amount of exhaled carbon dioxide, which helps prevent further acid accumulation in the blood.
  • Cheyne–Stokes respiration is a breathing pattern consisting of alternating periods of rapid and slow breathing, which may result from a brain stem injury.[14] Cheyne-Stokes respiration may be observed in newborn babies, but this is occasionally physiological (normal).
  • Chest retractions may be observed in patients with asthma. During a chest retraction, the patient’s skin appears to sink into the chest. During supra-sternal retractions, the skin of the neck appears to sink in as the accessory breathing muscles of the neck contract to aid with inspiration. During intercostal retractions, the skin between the ribs appears to sink in as the intercostal muscles (the muscles between the ribs) aid in respiration. These are signs of respiratory distress.

The physician then typically inspects the fingers for cyanosis and clubbing.

The tracheal deviation is also examined.

Palpation

  • Palpate for
    • Effusion
    • Clicking
    • Snapping
    • Crepitus
    • pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।" data-rx-term="tenderness" data-rx-definition="Tenderness means pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।">Tenderness
    • Temperature
    • Masses
  • Areas of Emphasis
    • Tactile fremitus
    • Peripheral pulses (regular, irregular, weak, bounding)

Percussion

  • Sounds
    • Resonant: normal
    • Flat or dull: abnormal suggesting soft tissue or fluid
    • Hyperresonant: abnormal suggesting air such as pneumothorax
    • Tympanic

Auscultation

Auscultation of the lungs should be systematic and follow a stepwise approach in which the examiner surveys all the lung zones. For practical purposes, the lung can be divided into apical, middle and basilar regions during auscultation. The description of abnormal breathing sounds should be tagged with the location in which it was heard.

The movement of air generates normal breath sounds through the large and small airways. Normal breath sounds have a frequency of approximately 100 Hz. The absence of breath sounds should prompt the health care provider to consider shallow breath, abnormal anatomy or pathologic entities such as airway obstruction, bulla, hyperinflation, pneumothorax, pleural effusion or thickening, and obesity.

  • Lung sounds
    • Normal (vesicular)
    • Wheezing
    • Rales (crackles)
    • Ronchi
    • Pleural Rub
    • Stridor
    • Absent
  • Cardiac
    • S1 and S2
    • Rate (slow, fast, normal)
    • Rhythm (regular or irregular)
    • Murmur
    • Rub
    • Gallop

Tubular breath sounds are high-pitched, bronchial breath sounds, seen in the following conditions: consolidation, pleural effusion, pulmonary chronic injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।" data-rx-term="fibrosis" data-rx-definition="Fibrosis means excess scar-like tissue formation after chronic injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।">fibrosis, distal collapse, and mediastinal tumor over a large patent bronchus.

  • Vesicular breath sounds/normal breath sounds: While Laënnec considered normal lung sounds to originate from the flow of air in and out of alveoli, later investigations of the origin of respiratory sounds have not shown lung “vesicles” to participate in sound generation. Therefore, vesicular breath sounds is a misnomer for normal breath sounds.
  • Wheezes: High-pitched continuous sounds with a dominant frequency of 400 Hz or more. (ATS) Suggestive of asthma, COPD, airway obstruction, or mucus plug.
  • Ronchi: Low-pitched continuous musical sounds with a dominant frequency of about 200 Hz or less (ATS).
  • Crackles: A “popping” sound generated by the passage of air through the accumulated secretions within the large and medium-size airways, creating the bubbling sounds (brief, non-musical, “discontinuous” sounds). Seen in COPD, Pneumonia, and Heart Failure.
  • Pleural Rub: Occurs due to inflamed pleural surfaces rubbing each other during breathing. It is difficult to differentiate from fine crackles, but the sound is similar to rubbing your stethoscope against cotton.
  • Stridor: A loud, high-pitched, musical sound produced by upper respiratory tract obstruction. It indicates an extrathoracic upper airway obstruction (supraglottic lesions like laryngomalacia, vocal cord ulcer. সহজ বাংলা: শরীরের অস্বাভাবিক দাগ, ক্ষত বা ফোলা অংশ।" data-rx-term="lesion" data-rx-definition="A lesion is an abnormal area of tissue such as a spot, wound, patch, lump, or ulcer. সহজ বাংলা: শরীরের অস্বাভাবিক দাগ, ক্ষত বা ফোলা অংশ।">lesion) when heard on inspiration. It occurs in expiration if associated with intrathoracic tracheobronchial lesions (tracheomalacia, bronchomalacia, and extrinsic compression). It occurs in both phases if a lesion is fixed, for example, stenosis.

Special Maneuvers

  • Pectoriloquy – Ask the patient to whisper a word such as “one-two-three” or “ninety-nine” and listen with a stethoscope. Typically, words are heard faintly. In cases of consolidation, the whispered sounds will be heard clearly and distinctly.
  • Egophony is elicited by asking the patient to say  “Ee,” and it will sound like an “A.” Suggestive of consolidation or pleural effusion.

Chest percussion

Percussion is the act of tapping on the surface of the body in order to assess the structures that lie beneath the skin. Percussion and resonance (the quality and feeling of sound) are used to examine lung movement and possible lung conditions. Specifically, percussion is performed by first placing the middle finger of one hand over the area of interest. The middle finger of the other hand is used to strike the last joint of the placed finger. Percussion is performed in a systematic matter, from the upper chest to the lower ribs, and resonance is compared between the left and right sides of the chest. This is done from the front and back of the thorax.[rx]

Percussion over different body tissues results in five common “notes”.[rx]

  • Resonance: Loud and low-pitched
  • . Normal lung sound.[rx]
  • Dullness: Medium intensity and pitch. Experienced with fluid.[rx]
    • A dull, muffled sound may replace resonance in conditions like pneumonia or hemothorax.
  • Hyper-resonance: Very loud, very low pitch, and longer in duration. Abnormal.
    • Hyper-resonance can result from asthma or emphysema
  • Tympany: Loud and high-pitched. Common for percussion over gas-filled spaces.
    • Tympany may result in pneumothorax.
  • Flatness: Soft and high-pitched.

Special Tests

  • Egophony: ask the patient to say “Eeeee,” and it will sound like an “A.”
    • Suggestive of consolidation, pleural effusion.
  • Pectoriloquy:
Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Emergency care / cardiology / medicine doctor
Tests to discuss with doctor
  • ECG as early as possible when chest pain suggests heart risk
  • Troponin or cardiac blood tests if doctor suspects heart attack
  • Blood pressure, oxygen level, chest examination, and other tests as advised urgently
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Is this heart-related, and do I need emergency observation?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Physical Examination of Chest

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

Add references, clinical guidelines, textbooks, journal articles, or trusted medical sources here. You can edit this area from the RX Article Professional Blocks panel.

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