prof mohammad salah abduljabbar. after completion of this session the students should be able to: ...
TRANSCRIPT
![Page 1: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/1.jpg)
Prof Mohammad Salah Abduljabbar
![Page 2: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/2.jpg)
After completion of this session the students should be able to:
Revise knowledge of anatomy and physiology
Obtain health history about respiratory system
Demonstrate physical examination Differentiate between normal and
abnormal findings
![Page 3: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/3.jpg)
anatomy and physiology of respiratory system
Assessment of respiratory system 1 Position/Lighting/Draping 2 Inspection
◦ Chest wall deformities ◦ Signs of respiratory distress
3 Palpation 4 Percussion 5 Auscultation
◦ Vocal fremitus (not usually done)
![Page 4: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/4.jpg)
The respiratory tract extends from the nose to the alveoli and includes not only the air-conducting passages also but the blood supply
The primary purpose of the respiratory system is gas exchange, which involves the transfer of oxygen and carbon dioxide between the atmosphere and the blood.
The respiratory system is divided into two parts: the upper respiratory tract and the
lower respiratory tract.
![Page 5: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/5.jpg)
The nose pharynx adenoids tonsils epiglottis larynx, and trachea.
The upper respiratory tract includes
![Page 6: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/6.jpg)
the bronchi Bronchioles alveolar ducts and alveoli With the exception of the right and left
main-stem bronchi, all lower airway structures are contained within the lungs.
![Page 7: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/7.jpg)
The right lung is divided into three lobes (upper, middle, and lower)
the left lung into two lobes (upper and lower)
The structures of the chest wall (ribs, pleura, muscles of respiration) are
also essential
![Page 8: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/8.jpg)
![Page 9: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/9.jpg)
![Page 10: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/10.jpg)
Ventilation. Ventilation involves inspiration (movement of
air into the lungs) and expiration (movement of air out of the
lungs). Air moves in and out of the lungs because intrathoracic
pressure changes in relation to pressure at the airway opening.
Contraction of the diaphragm and intercostal and scalene muscles
increases chest dimensions, thereby decreasing intrathoracic
pressure. Gas flows from an area of higher pressure (atmospheric)
to one of lower pressure (intrathoracic)
![Page 11: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/11.jpg)
A Stethoscope A Peak Flow Meter
![Page 12: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/12.jpg)
Surface markings of the lobes of the lung:(a) anterior, (b) posterior, (c) right lateral and (d) left lateral.(UL, upper lobe; ML, middle lobe; LL, lower lobe).
Ulml
a
b ll
ul
ll
ul
llml
![Page 13: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/13.jpg)
![Page 14: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/14.jpg)
![Page 15: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/15.jpg)
( Symptoms )
cough Sputum Hemoptysis Dyspnea Chest pain (chest tightness) Wheezing
![Page 16: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/16.jpg)
Coughing: character (bovine cough…) Sputum: Abnormal sound: stridor (croaking noise, loudest on
inspiration 2° to larynx, trachea or large airways obstruction), or wheezing.
Abnormal voice: hoarseness Surroundings: like containers of sputum, O2 mask,
IV lines or medications respiratory aids or machines..
![Page 17: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/17.jpg)
Type ◦ dry, moist, wet, productive, hoarse, hacking, barking, whooping
Onset Duration Pattern
◦ activities, time of day, weather Severity
◦ effect on ADLs Wheezing Associated symptoms Treatment and effectiveness
![Page 18: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/18.jpg)
amount color presence of blood (hemoptysis) odor consistency pattern of production
![Page 19: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/19.jpg)
Any risk factors for respiratory disease smoking
◦ pack years ppd X # years ◦ exposure to smoke ◦ history of attempts to quit, methods, results
sedentary lifestyle, immobilization age environmental exposure
◦ Dust, chemicals, asbestos, air pollution obesity family history
![Page 20: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/20.jpg)
Respiratory infections or diseases (URI) Trauma Surgery Chronic conditions of other systems
Family Health History
Tuberculosis Emphysema Lung Cancer Allergies Asthma
Past Health History
![Page 21: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/21.jpg)
Position – patient should sit upright on the examination
table. The patient's hands should remain at their
sides. When the back is examined the patient is
usually asked to move their arms forward (hug themselves position
Lighting - adjusted so that it is ideal.
Draping - the chest should be fully exposed. Exposure time should be minimized.
![Page 22: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/22.jpg)
* General appearance* General system* Chest examination
General appearance
Respiratory distress:count RR, normal 14-20 tachypnea = ↑ rate of breathing Hyperapnea = ↑ level of ventilation look to the accessory muscles (sternomastoids,
scalene, platysma & strap muscles of neck & abdominal muscles) if they are in use?
![Page 23: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/23.jpg)
Hands:1. Clubbing (check respiratory causes)2. Tar staining 3. Weakness of hand’s small muscles (abduction) Wrist:1. Pulse: rate & character2. Flapping tremors (asterixis)
![Page 24: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/24.jpg)
Neck: 1.JVP: ↑ in corpulmonale & SVC obstruction but not pulsatile.2.LN: enlargement in CA bronchus or metastesis
Face:1.Eye: Horner’s syndrome in CA bronchus2.Tongue: central cyanosis 3.SVC obstruction: plethoric & cyanosed, periorbital edema, injected conjunctivae.
![Page 25: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/25.jpg)
Inspection Palpation Percussion Auscultation
![Page 26: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/26.jpg)
Tracheal deviation (seen in tension pneumothorax)
Chest wall deformities. Kyphosis - curvature of the spine - anterior-posterior Scoliosis - curvature of the spine - lateral Barrel chest - chest wall increased anterior-posterior diameter (normal in children) typical of hyperinflation and seen in COPD Pectus excavatum Pectus carinatum
![Page 27: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/27.jpg)
![Page 28: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/28.jpg)
:1.Shape: AP diameter compared to transverse (barrel-chest), pectus excavatum, pectus carinatum, kyphoscoliosis,…. others 2.Symmetry: assessment of upper & lower lobes should be done posteriorly looking for ↓ or delayed chest movement during moderate respiration 3.Scars: from previous operation or chest drains or cautery marks or radiotherapy markings. 4.Prominent veins: in case of SVC obstruction
![Page 29: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/29.jpg)
KyphosisThoracoplastywith secondarychanges in the
spine.Pectus exacavatum
![Page 30: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/30.jpg)
Cyanosis - person turns blue Pursed-lip breathing - seen in COPD. Accessory muscle use( Scalene muscle)
Diaphragmatic paradox -the diaphragm moves opposite of the normal direction on inspiration; suspect flail segment in trauma
Intercostal indrawing
![Page 31: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/31.jpg)
‘pink puffer’. Note thepursed-lip
breathing .
‘blue bloater’showing ascitesfrom marked cor
pulmonale.
![Page 32: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/32.jpg)
![Page 33: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/33.jpg)
1. Trachea: normally central, slight right displacement could be normal. Check for gross displacement. Tracheal tug means the normal distance between sternal notch & cricoid cartilage is < 3-4 finger breadths & occurs in chest overexpansion as COPD
2. Apex beat & mediastinum: Check for displacement.3. Chest expansion: Normal expansion ≥ 5cm4. Tactile vocal fremitus (TVF): can be done with the
palm of one hand.
![Page 34: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/34.jpg)
Tactile fremitus is vibration felt by palpation. Place your open palms
against the upper portion of the anterior chest, making sure that the fingers do not touch the chest. Ask the patient to repeat the phrase “ninety-nine” or another resonant phrase while you systematically move your palms over the chest from the central airways to each lung’s periphery.You should feel vibration of equally intensity on both sides of the chest. Examine the posterior thorax in a similar manner. The fremitus should be felt more strongly in the upper chest with little or no fremitus being felt in the lower chest
![Page 35: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/35.jpg)
Ask the patient to say "ninety-nine" several times in a normal voice.
Palpate using the palm of your hand. You should feel the vibrations transmitted
through the airways to the lung. Increased tactile fremitus suggests
consolidation of the underlying lung tissues
![Page 36: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/36.jpg)
![Page 37: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/37.jpg)
Assessing chest expansion in expiration (left) and inspiration (right).
Direct percussion of the clavicles for disease in the lung apices
Percussion over the anterior chest.
![Page 38: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/38.jpg)
Should be done symmetrically (Lt compared with the Rt), posteriorly (the back), anteriorly (the front) & laterally (the sides).
Supraclavicular area, then clavicles should be percussed directly to evaluate the upper lobes.
Liver dullness: of the upper edge starting at the 6th rib MCL, resonant note below this area indicates hyper-inflation (copd, severe asthma)
Cardiac dullness: may be ↓ in hyperinfated chest.
![Page 39: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/39.jpg)
Assessing chest expansion in expiration (left) and inspiration (right).
Direct percussion of the clavicles for disease in the lung apices
Percussion over the anterior chest.
![Page 40: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/40.jpg)
![Page 41: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/41.jpg)
![Page 42: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/42.jpg)
![Page 43: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/43.jpg)
![Page 44: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/44.jpg)
To assess breath sounds, ask the patient to breathe in and out slowly and deeply through the mouth.
Begin at the apex of each lung and
zigzag downward between intercostal spaces . Listen with the diaphragm portion of the stethoscope.
![Page 45: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/45.jpg)
Using the diaphragm of a stethoscope & comment on the following:
Breath sounds (BS) Intensity: N or ↓ as in (consolidation, collapse, pleural
effusion, pneumothorax, lung fibrosis) Quality: Vesicular or bronchial in consolidation Differentiation between vesicular & bronchial BS: Vesicular: louder &longer on inspiration than expiratory
phase & has no gap between the 2 phases Bronchial: louder &longer on expiratory phase & has a gap
between the 2 phases
![Page 46: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/46.jpg)
Normal breath sounds Note Pitch Intensity Quality Duration
![Page 47: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/47.jpg)
Bronchial: Heard over the trachea and mainstay bronchi (2nd-4th intercostal spaces either side of the sternum anteriorly and 3rd-6th intercostal spaces along the vertebrae posteriorly). The sounds are described as tubular and harsh. Also known as tracheal breath sounds
. Bronchovesicular: Heard over the major bronchi below the clavicles
in the upper of the chest anteriorly. Bronchovesicular sounds heard over the peripheral lung denote pathology. The sounds are described as medium-pitched and continuous throughout inspiration and expiration.
Vesicular: Heard over the peripheral lung. Described as soft and low- pitched. Best heard on inspiration.
Diminished: Heard with shallow breathing; normal in obese patients with excessive adipose tissue and during pregnancy. Can also indicate an obstructed airway, partial or total lung collapse, or chronic lung disease.
![Page 48: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/48.jpg)
Normal auscultatory sound
![Page 49: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/49.jpg)
Type: Wheezes or Crackles or friction rub Timing: inspiratory or expiratory Wheezes: are continuous musical polyphonic sound, heard
louder on expiration & can be heard on inspiration which may imply severe airway narrowing. High pitched- wheezes are found in BA due to acute/chronic airflow limitation & low pitched in COPD. Localized monophonic wheeze due to fixed airway obstruction in CA bronchus.
Crackles: interrupted non-musical inspiratory sound Crackles may be early, late or pan-inspiratory. Fine, coarse
or medium.
![Page 50: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/50.jpg)
It’s due to thickened or roughened pleural surfaces rub together as lungs expand & contract & give off a continuous or intermittent grating sound. It indicates pleurisy & may be heard in pneumonia or pulmonary infarction.
Vocal Resonance It’s the ability to transmit sounds. Ask patients to say 44 (Arabic) or 99 (English) &
listen for the transmitted sound which may be ↓ or ↑ or N (low pitched component of speech heard with booming & high pitched become attenuated).
![Page 51: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/51.jpg)
When the patient with consolidation is asked to say ‘e’ it sounds like ‘a’
Whispering pectoriloquy The whispered speech is heard very loudly over the
consolidated area.
Other signs should be looked for to complete the respiratory system examination “signs of complications”
1. Signs of pulmonary HTN or corpulmonale.2. Signs of SVC obstruction.3. Signs of CA bronchus metastasis or extension.
![Page 52: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/52.jpg)
![Page 53: Prof Mohammad Salah Abduljabbar. After completion of this session the students should be able to: Revise knowledge of anatomy and physiology Obtain](https://reader036.vdocuments.mx/reader036/viewer/2022062322/56649ea35503460f94ba703b/html5/thumbnails/53.jpg)
Posterior Chest Anterior Chest