Fundamentals of Physical Examination Chapter 5 Physical Examination

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Fundamentals of Physical Examination Chapter 5

Fundamentals of Physical Examination Chapter 5

Physical Examination • • Inspection Palpation Percussion Auscultation

Physical Examination • • Inspection Palpation Percussion Auscultation

Physical Exam • Determine the correct diagnosis • Proficiency is attained through practice •

Physical Exam • Determine the correct diagnosis • Proficiency is attained through practice • Typical format for recording the exam includes: – Initial impression – Vital signs – HEENT – Neck – Thorax – Abdomen – Extremities

Head • • Facial expression Nasal flaring Cyanosis Pursed lip breathing

Head • • Facial expression Nasal flaring Cyanosis Pursed lip breathing

Eyes • • • Pupillary reflexes – PERRLA Mydriasis Miosis Ptosis Diplopia Nystagmus

Eyes • • • Pupillary reflexes – PERRLA Mydriasis Miosis Ptosis Diplopia Nystagmus

Neck • • • JVP Accessory muscle use Tracheal position Lymph nodes Carotid pulse

Neck • • • JVP Accessory muscle use Tracheal position Lymph nodes Carotid pulse

Lung Topography Anterior Chest Posterior Chest

Lung Topography Anterior Chest Posterior Chest

Lung Topography Lateral Chest

Lung Topography Lateral Chest

Thoracic Cage Landmarks Anterior Chest Posterior Chest

Thoracic Cage Landmarks Anterior Chest Posterior Chest

Lung Fissures

Lung Fissures

Thoracic Inspection • Thoracic configuration • Breathing patterns • Central cyanosis • Breathing Effort

Thoracic Inspection • Thoracic configuration • Breathing patterns • Central cyanosis • Breathing Effort – – – Pectus carinatum Pectus excavatum Kyphosis Scoliosis Kyphoscoliosis Flail chest – – – Apnea Biots Cheyne stokes Kussmauls Apneustic Paradoxical Asthmatic Retractions/bulging Abdominal paradox Respiratory alterans Hoover’s sign

Thoracic Palpation • • Vocal fremitus Tactile fremitus Thoracic expansion Skin and subcutaneous tissues

Thoracic Palpation • • Vocal fremitus Tactile fremitus Thoracic expansion Skin and subcutaneous tissues

Thoracic Percussion • Indirect percussion • Lung fields – Normal resonance – Increased resonance

Thoracic Percussion • Indirect percussion • Lung fields – Normal resonance – Increased resonance – Decreased resonance • Diaphragmatic Excursion

Lung Auscultation • • • Tracheal breath sound Bronchovesicular Vesicular Bronchial Adventitious – Wheeze

Lung Auscultation • • • Tracheal breath sound Bronchovesicular Vesicular Bronchial Adventitious – Wheeze – Crackles – Rhonchi – Stridor – Pleural friction rub

Figure 05 -19 Location on chest wall where normal bronchovesicular and vesicular breath sounds

Figure 05 -19 Location on chest wall where normal bronchovesicular and vesicular breath sounds are heard. A, Anterior bronchovesicular. B, Posterior bronchovesicular. C, Anterior vesicular. D, Posterior vesicular. (From Wilkins RL, Hodgkin JE, Lopez B: Fundamentals of lung and heart sounds, ed 3, St Louis, 2004, Mosby. )

Wheezing vs Crackles

Wheezing vs Crackles

Voice Sounds • Brochophony • Egophony • Whispering pectoriloquy

Voice Sounds • Brochophony • Egophony • Whispering pectoriloquy

Precordium • Heart topography • Point of maximal impulse – PMI • Heart sounds

Precordium • Heart topography • Point of maximal impulse – PMI • Heart sounds

Neurologic Exam • Suspected brain or spinal cord injury • Assessment of LOC •

Neurologic Exam • Suspected brain or spinal cord injury • Assessment of LOC • Brainstem

Abdomen • Hepatomegaly • Ascites

Abdomen • Hepatomegaly • Ascites

Extremities • • • Clubbing Cyanosis Pedal edema Capillary refill Peripheral skin temperature

Extremities • • • Clubbing Cyanosis Pedal edema Capillary refill Peripheral skin temperature

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