correct way to do heart and lung exam

[group_theory]

We've all learned how to do a good heart/lung exam while in school. Unfortunately, i've picked up some bad habbits while on clinical rotation.

So my question is, for the standardized patient portion of Step 2 (COMLEX-2 PE or USMLE CS), how will you do your heart/lung exam with the limited time given per patient?

I find that if I do it according to Bates, it takes too much time. Any advice, tips, tricks, are appreciated.

Thanks

---

Members don't see this ad.

 

[fistulitis]

If you're doing a lung/heart exam "just to do it" (it's probably a good idea to do it on everyone), then I would just listen briefly in 6 posterior lung fields and in the 4 cardiac places.

If you're actually looking for lung pathology, I would listen for a longer time in each field, listen at the axillae, listen anteriorly, do egophany, do whispered pectoriloquy; maybe even percuss the lungs and the diaphragms.

Similarly, when the cardiac exam is relevant, you could inspect the precordium (if it's a male; I probably wouldn't risk doing this on a female with all the draping issues); feel for the PMI, listen for a longer time x4 with the diaphragm AND the bell. You could also try various maneuvers to elicit murmurs, like having pt in left decubitus or exhale leaning forward. etc.