rs physical examination hadeel khadawardi, teaching assistant at internal medicine department,...
TRANSCRIPT
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
Hand
Nail Fingers Dorsum
Nail
Clubbing / HPO
Peripheral Cyanosis
What are the causes of clubbing?
Hand
What is the chronic respiratory disease that dose not cause clubbing?
Fingers
Nicotine Stain
Hand
Dorsum
Muscle Wasting
Hand
Flapping tremor (Asterixis)
Wrist
What are the causes of flapping tremor?
What is fine tremor?
Face
Eyes Nose Mouth Sinuses
Face
Eye
Pallor
Horner’s Syndrome Meiosis
Partial ptosis Loss of
sweating
Face
Nose
Deviated nasal septum
Polyps
Enlarged turbinate
Face
Mouth
Peripheral cyanosis Central cyanosis Signs of URTI Infected teeth
Face
Sinuses
Neck ?
JVP
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.
Surface Anatomy of the Lung
Ant. Chest
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 Palpation
Ribs For tenderness
Ant. Chest
Palpation
Trachea
Chest Expansion
Apex beat
Tactile Vocal Fremitus
Ribs
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
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 Inspection
Shape of the chest
Scar
Post. Chest Palpation
Chest Expansion Basal
Thumbs move symmetrically
apart for 3-4 cm
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
Palpation
Chest Expansion
Tactile Vocal Fremitus
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
Pemberton’s Sign
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