![]() 1, 2 Although chest physical examination findings can be confirmed with chest x-ray results, objective data on clinician accuracy and reproducibility of physical examination findings are limited. INTRODUCED NEARLY 200 years ago, auscultation and percussion of the chest are considered essential in the physical examination and are taught to every medical student. ![]() The traditional chest physical examination is not sufficiently accurate on its own to confirm or exclude the diagnosis of pneumonia. The most valuable examination maneuvers in detecting pneumonia were unilateral rales and rales in the lateral decubitus position. ![]() The 3 examiners' clinical diagnosis of pneumonia had a sensitivity of 47% to 69% and specificity of 58% to 75%.Ĭonclusions The degree of interobserver agreement was highly variable for different physical examination findings. Relatively high agreement among examiners (κ ≈ 0.5) occurred for rales in the lateral decubitus position and for wheezes. Abnormal lung sounds were common in both groups the most frequently detected were rales in the upright seated position and bronchial breath sounds. Twenty-eight patients did not have pneumonia. Results Twenty-four patients had pneumonia confirmed by chest x-ray films. Chest x-ray films were read by a radiologist. Examination findings by lung site and whether the examiner diagnosed pneumonia were recorded on a standard form. A comprehensive lung physical examination was performed sequentially by 3 physicians who were blind to clinical history, laboratory findings, and x-ray results. Methods Fifty-two male patients presenting to the emergency department of a university-affiliated Veterans Affairs medical center with symptoms of lower respiratory tract infection (cough and change in sputum) were prospectively examined. Objectives To determine the accuracy of various physical examination maneuvers in diagnosing pneumonia and to compare the interobserver reliability of the maneuvers among 3 examiners. Shared Decision Making and Communicationīackground The reliability of chest physical examination and the degree of agreement among examiners in diagnosing pneumonia based on these findings are largely unknown.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Any duplication or distribution of the information contained herein is strictly prohibited. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. Links to other sites are provided for information only – they do not constitute endorsements of those other sites. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. This site complies with the HONcode standard for trustworthy health information: verify here. Learn more about A.D.A.M.'s editorial policy editorial process and privacy policy. is among the first to achieve this important distinction for online health information and services. follows rigorous standards of quality and accountability. is accredited by URAC, for Health Content Provider (URAC's accreditation program is an independent audit to verify that A.D.A.M. Wheezing and other abnormal sounds can sometimes be heard without a stethoscope.Ī.D.A.M., Inc. They are most often heard when a person breathes out (exhales). High-pitched sounds produced by narrowed airways. Usually it is due to a blockage of airflow in the windpipe (trachea) or in the back of the throat. Wheeze-like sound heard when a person breathes. They occur when air is blocked or air flow becomes rough through the large airways. Rales can be further described as moist, dry, fine, and coarse. They are believed to occur when air opens closed air spaces. They are heard when a person breathes in (inhales). Small clicking, bubbling, or rattling sounds in the lungs. There are several types of abnormal breath sounds. Over-inflation of a part of the lungs ( emphysema can cause this).Air or fluid in or around the lungs (such as pneumonia, heart failure, and pleural effusion).Using a stethoscope, the health care provider may hear normal breathing sounds, decreased or absent breath sounds, and abnormal breath sounds. Normal lung sounds occur in all parts of the chest area, including above the collarbones and at the bottom of the rib cage. The lung sounds are best heard with a stethoscope. ![]()
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