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Fundamentals of Physical Examination

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Presentation on theme: "Fundamentals of Physical Examination"— Presentation transcript:

1 Fundamentals of Physical Examination
Chapter 5

2 Physical Examination Inspection Palpation Percussion Auscultation

3 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

4 Head Facial expression Nasal flaring Cyanosis Pursed lip breathing

5 Eyes Pupillary reflexes – PERRLA Mydriasis Miosis Ptosis Diplopia
Nystagmus

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

7 Lung Topography Anterior Chest Posterior Chest

8 Lung Topography Lateral Chest

9 Thoracic Cage Landmarks
Anterior Chest Posterior Chest

10 Lung Fissures

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

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

16

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

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

19 Figure 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.)

20 Wheezing vs Crackles

21 Voice Sounds Brochophony Egophony Whispering pectoriloquy

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

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

24 Abdomen Hepatomegaly Ascites

25 Extremities Clubbing Cyanosis Pedal edema Capillary refill
Peripheral skin temperature


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