Physical Examination of the Chest

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Physical Examination of the Chest
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r?Doctor director ?Neurologist
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Chapter 3Lungs and Pleura

• 1. Inspection
• Respiratory rate and depth

Tachypnea
Normal
Bradypnea
Fast and Deep Breathing
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Respiratory Rhythm

• Tidal Breathing Cheyne -Stokes

Biots Breathing
Sighing Breathing
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• 2. Palpation

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Thoracic Expansion
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• Vocal Fremitus

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• 1???????????
• 2?????????

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• 1?????????????????
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• 2????????gt???????
• 3??????????????????

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• Pneumonia

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• Pleural Effusion

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• Pneumothorax

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Pleural Friction Fremitus
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• 3. Percussion

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• Upper Lung Margins
• Normal 46cm

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Lower Lung Margins
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The Extent of Diaphragmatic Excursion
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Abnormal Percussion Sound
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• 4. Auscultation
• ???????
• Normal Breath Sounds

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Bronchial Breath Sound

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• ??
• ?? ???????????6?7???
• ?1-2??

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• Vesicular Breath Sound

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• Bronchovesicular Breath Sound

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4????????
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Abnormal Vesicular Breath Sound???????????????

• (1)?????????
• (2)?????????
• (3)??????
• (4 )??????

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Abnormal Bronchial Breath Sound

• 1??????
• 2??????
• 3???????

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Abnormal Bronchovesicular Breath
Sound1?????????????? ????2??????????????
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Rales or Added Sounds

• ????
• Moist rales or bubble sound
• ????
• Dry rales or rhonchi

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Moist rales ????Coarse
ralesMedium ralesFine ralesCrepitus
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??1???????? 2??????
3?????? ?????
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Dry Rales or Rhonchi????

Diffused rhonchiLocalized rhonchi
Sibilant rhonchiSonorous rhonchi
2?
1?
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3????????
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????Vocal Resonance?????Pleural Friction Rub
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Outline for Physical Examination of the Chest

• Inspection
• 1. Chest contour, symmetry
• 2. Breathing rate, rhythm, movement
• Palpation
• 1.Tracheal position
• 2.thoracic expansion
• 3.vocal fremitus
• 4.pleural friction fremitus

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Outline for Physical Examination of the Chest

• Percussion
• 1. resonance, hyperresonance,
• dullness, tympany, stony
• dullness
• 2.lung margins

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Outline for Physical Examination of the Chest

• Auscultation
• 1.breath sounds
• 2.added sounds or rales
• moist rales ,dry rales
• 3.vocal resonance
• 4.pleural friction rubs