rs physical examination
DESCRIPTION
RS Physical Examination . Hadeel Khadawardi , teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al- Qura University. Introduction . Coughing/ Sputum Strider/ Wheezing . General Approach . Vital Signs . Position . 45 sitting over the edge of bed or - PowerPoint PPT PresentationTRANSCRIPT
RS Physical
Examination Hadeel Khadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-
Qura University
General Approach Vital Signs Position
45 sitting over the edge of bed
or on chair
Introduction Coughing/
Sputum Strider/
Wheezing
Peripheral Exam Chest Exam
Hand Wrist Face Neck ?
Inspection Palpation Percussion Auscultation
RS Exam
Nail Clubbing / HPO
Peripheral Cyanosis
What are the causes of clubbing?
Hand
What is the chronic respiratory disease that dose not cause clubbing?
Chest Exam
Expose the chest properly to the waist including the axilla.
Exam the anterior and posterior chest.
Inspection, Palpation, Percussion, Auscultation
Always compare the right and left sides.
Ant. Chest Inspection (5S) Symmetrical chest
movement (decrease)
Shape of the chest
Scar
Prominent veins in SVC obstruction
Subcutaneous emphysema
Ant. Chest What is Paradoxical breathing?
What are the causes of bilateral decrease chest movement?
What are the causes of unilateral decrease chest movement?
Ant. Chest Palpation Trachea
Centralized OR displaced. Normally, trachea is
slightly displaced to the right side.
What is Tracheal Tug?
What are the causes of trachea displacement away from the side of lung lesion?
What are the causes of trachea displacement toward the side of lung lesion?
Ant. Chest Palpation Chest Expansion
Apical Supra
mammary Infra
mammary Inspiration
Thumbs move symmetrically
apart for 3-4 cm
Ant. Chest Palpation Apex beat Site
Size Character
What are the causes of apex beat displacement away from the side of lung lesion?
What are the causes of apex beat displacement toward the side of lung lesion?
What is the lung disease causes of impalpable apex beat ?
Ant. Chest Palpation Tactile Vocal
Fremitus Use ulnar side of the hand. Ask the patient to say 99 in Eng.
Or 44 in Arab. Move in zigzag and compare
both sides. Comment as: equal, decrease,
or increase TVF. Sites Supra clavicle Infra clavicle Supra mammary Infra mammary Upper axillary Lower axillary
What are the causes of decrease TVF?What are the causes of increase TVF?
Ant. Chest Palpation Tactile Vocal
Fremitus
Ant. Chest Percussion Sites Supra clavicle clavicle Infra clavicle Supra mammary Infra mammary Upper axillary Lower axillary
Move in zigzag and compare both sides
Ant. Chest Percussion Comment as:
Resonant ………….. Hyper resonant …….. Dullness …………..... Stony Dullness ……...
Normal Pneumothorax Pneumonia Pleural effusion
Ant. Chest Auscultation Sites Supra clavicle =
Apical Infra clavicle Supra mammary Infra mammary Upper axillary Lower axillary
Move in zigzag and compare both sides
Ant. Chest Auscultation Comment on:
Breath sounds, equal, decrease, or absent
Quality of breath sounds, vesicular vs. bronchial
Added sounds, wheezing, crackles
Vocal resonance, equal, decrease, or increase
Ask the patient to say 99 in Eng. Or 44 in Arab
Ant. Chest Auscultation
Vesicular breathing …Normal
Bronchial breathing …Consolidation
No gap Insp > Exp
Gap Insp = Exp
Quality of breath sounds
Ant. Chest Auscultation Added breath sounds
Wheezing…
Crackles… Fine……… Medium… Coarse……
Asthma
Lung fibrosisLVF, pneumonia Bronchiectasis
Ant. Chest Auscultation Vocal Resonance
What are the causes of decrease vocal resonance?
What are the causes of increase vocal resonance?
What is Aegophony?
What is Whispering Pectoriloquy?
Ant. Chest Auscultation
What is the indication of silent chest in asthmatic patient?
Post. Chest Ask the patient to sit at the edge of the bed and you face his/her back. Ask the patient to make cross his/her arms on front chest to rotate the scapula anteriorly.
Post. Chest Palpation Tactile Vocal
Fremitus Sites Supra scapular Intra scapular Infra scapular basal Upper axillary Lower axillary
Move in zigzag and compare both sides
Post. Chest Percussion Sites
Supra scapular Intra scapular Infra scapular basal Upper axillary Lower axillary
Move in zigzag and compare both sides
Post. Chest Percussion Comment as:
Resonant ………….. Hyper resonant …….. Dullness …………..... Stony Dullness ……...
Normal Pneumothorax Pneumonia Pleural effusion
Post. Chest Auscultation Sites Supra scapular Intra scapular Infra scapular basal Upper axillary Lower axillary
Move in zigzag and compare both sides
Post. Chest Auscultation Comment on:
Breath sounds, equal, decrease, or absent
Quality of breath sounds, vesicular vs. bronchial
Added sounds, wheezing, crackles
Vocal resonance, equal, decrease, or increase
Ask the patient to say 99 in Eng. Or 44 in Arab