1. physical examinationof thechest 2. physical signsof ... · infiltration in the alveoli:...
TRANSCRIPT
1.1. PhysicalPhysical examinationexamination of of
thethe chestchest
2. 2. PhysicalPhysical signssigns of of
pulmonarypulmonary syndromessyndromes
Dr. Zsuzsa Dr. Zsuzsa NebenfNebenfüührerhrer 20122012
HistoryHistory
�� SymptomsSymptoms ((painpain, , dyspneadyspnea, , coughcough))
�� FeverFever
�� OccupationOccupation, , jobjob
�� MedicationMedication
PhysicalPhysical examinationexamination
�� InspectionInspection
�� PalpationPalpation
�� PercussionPercussion
�� AuscultationAuscultation
LinesLines onon thethe chestchest
InspectionInspection
CyanosisCyanosis
ClubbingClubbing
InspectionInspection
ChestChest
�� ShapeShape of of thethe chestchest
�� ChestChest expansionexpansion
CausesCauses of of chestchest deformitydeformity
�� DiseasesDiseases of of thethe vertebralvertebral coloumncoloumn
�� kyphosiskyphosis, , lordosislordosis, , scoliosisscoliosis
�� kyphoscoliosiskyphoscoliosis
�� NeurologicalNeurological disordersdisorders: : �� palsypalsy of of thethe m. m. serratusserratus →→ scapulascapula aleataaleata
�� ssyringomyeliayringomyelia
�� DiseasesDiseases of of thethe lunglung oror thethe pleurapleura: : �� air air oror fluid fluid inin thethe pleuralpleural cavitycavity
�� shrinkigshrinkig of of thethe ppleuraleura oror atelectasiatelectasiss
InspectionInspection
�� ShapeShape of of thethe chestchest
�� symmetricsymmetric
�� barrel barrel chestchest
�� pigeonpigeon chestchest
�� pectuspectus excavatumexcavatum
�� ChestChest expansionexpansion
ChestChest expansionexpansion decreaseddecreased
�� SymmetricalSymmetrical onon
bothboth sidessides: :
•• severesevere airwayairway
obstructionobstruction
•• pulmonarypulmonary fibrosisfibrosis
•• BechterewBechterew diseasedisease
�� UnilateralUnilateral: :
•• pleuralpleural effusioneffusion
•• ptxptx
•• pneumoniapneumonia
•• calluscallus
•• tbc tbc
PalpationPalpation of of thethe tracheatrachea
�� Normal: Normal: midlinemidline
�� DislocationDislocation: :
�� MassMass inin thethe neckneck ((goitergoiter) )
�� DislocationDislocation of of thethe mediastinummediastinum
�� TowardToward thethe healthyhealthy sideside
�� PtxPtx
�� LargeLarge pleuralpleural effusioneffusion
�� TowardToward thethe sideside of of thethe diseasedisease
�� CollapseCollapse of of thethe lunglung duedue toto centralcentral airwayairway obstructionobstruction
�� Local Local fibrosisfibrosis
PalpationPalpation
�� ChestChest excursionexcursion
�� PleuralPleural rubrub: : palpablepalpable, , audibleaudible ––
pleuritispleuritis
�� Tender Tender areasareas
�� pleuritispleuritis
�� ribrib: : fracturefracture, , periostitisperiostitis, , metastasismetastasis
�� sternumsternum: : anaemiaanaemia, , leukaemialeukaemia, , myelomamyeloma
�� TactileTactile fremitusfremitus
TactileTactile fremitusfremitus
�� Normal: Normal: symmetricsymmetric
�� DecreasedDecreased::
�� ObstructionObstruction of of thethe
airwaysairways
�� Fluid, air, Fluid, air, calluscallus inin
thethe pleurapleura
�� IncreasedIncreased: :
�� PneumoniaPneumonia, tumor, tumor
PercussionPercussion
�� TopographicTopographic
�� ComparativeComparative
BordersBorders of of thethe lunglung
�� ParavertebralParavertebral and and scapularscapular line: XI. line: XI. thoracicthoracic
vertebravertebra
�� MidaxilllaryMidaxilllary: VIII. : VIII. ribrib
�� Right Right midclavicularmidclavicular line: VI. line: VI. ribrib
�� LeftLeft midclavicularmidclavicular line : IV. line : IV. ribrib ((dullnessdullness of of thethe
heartheart))
PercussionPercussion
DislocationDislocation of of lunglung bordersborders
�� DeeperDeeper onon bothboth sidessides: : �� emphysemaemphysema
�� acuteacute bronchialbronchial asthmaasthma
�� congenitalcongenital
�� ((DeeperDeeper onon oneone sideside: : ptxptx))
�� HigherHigher onon bothboth sidessides: : �� increasedincreased abdominalabdominal pressurepressure
�� ((pleuralpleural fluid fluid onon bothboth sidessides))
�� HigherHigher onon oneone sideside::�� n. n. phrenicusphrenicus palsypalsy
�� shrinkingshrinking lunglung oror pleuralpleural diseasedisease
�� oneone sidedsided abdominalabdominal diseasedisease
�� ((pleuralpleural fluid)fluid)
�� right right lunglung bit bit higherhigher physiologicallyphysiologically
PercussionPercussion
�� TraubeTraube
�� KrKröönignig
PercussionPercussion
�� TraubeTraube
�� KrKröönignig
PercussionPercussion
�� Normal: Normal: resonanceresonance
ComparativeComparative percussionpercussion�� DullnessDullness
�� No No airair--filledfilled lunglung tissuetissue�� infiltrationinfiltration inin thethe alveolialveoli: : pneumoniapneumonia, tumor, tbc, tumor, tbc
�� no air no air inin thethe alveolialveoli = = atelectasiaatelectasia
�� SomethingSomething inin thethe pleuralpleural cavitycavity�� exsudationexsudation, , tanssudationtanssudation, , puspus = = empyemaempyema, , bloodblood = = haemothoraxhaemothorax
�� tumor, tumor, calluscallus
�� TympanicTympanic�� ptxptx
�� bigbig cavernacaverna
�� relaxationrelaxation of of lunglung tissuetissue
�� over over thethe lowerlower part of part of leftleft lunglung (+ air (+ air inin thethestomachstomach))
�� HyperresonanceHyperresonance�� emphysemaemphysema
AuscultationAuscultation
�� VesicularVesicular
�� BronchivesicularBronchivesicular
�� BronchialBronchial
�� TrachealTracheal
AdventitiousAdventitious soundsound
�� BronchialBronchial (air (air atat inin-- exspirationexspiration + +
mucus) mucus)
�� DryDry: : wheezeswheezes
�� WetWet: : cracklescrackles
�� StertorStertor
�� PleuralPleural
�� RubRub
TransmittedTransmitted voicevoice soundssounds
�� BronchophonyBronchophony
�� 9999
�� 6666