semiology lecture for 5th semester medical students

semiology lecture for 5th semester medical students

1. نییبنلا متاخ هاگشناد(ص)
یملع تنواعم-یسیردت
هدکشناد :تنمتراپید یوجلاعم بط : هلخاد
نومضم :سرد ناونع یژولویمس:یسفنت متسیس یکیزف هنیاعم
داتسا :هسلج یزاین للها فیس رتکد :موس

2. میحرلا نمحرلا الله مسب

3. Objects:
Inspection of chest
palpation of chest
Percussion of chest

4. PHYSICAL EXAMINATION OF
RESPIRATORY SYSTEM

5. PHYSICAL EXAMINATION HAS 4 STEPS:
1.INSPECTION
2.PALPATION
3.PERCUSSION
4.AUSCULTATION

6. inspection of chest
 شتفت طیارش ردص:
دشاب هنهرب ناکما دح ات ضیرم یردص هسفق
دشاب هتسشن تسار دق یکوچ یلااب ضیرم تسا رتهبوش هنیاعم یتبون لکشب و هدیباوخ ، دنیشب دناوتن هک دراوم ردود
دشاب دوجوم یفاک ینشور
دشاب بسانم هنیاعم قاتا ترارح
دشاب یتوص یگدولآ نودب و مارآ قاتا یاضف

7. Topographic Anatomic lines

8. During chest inspection focus on:
1.shape of chest
2.symmetry of chest
3.chest expansion
4.types of respiration
5.location of trachea
6.supra clavicular notch
7.inter costal space
8.skin pigmentation
9.PMI and other heave or thrill

9. 1-shape of chest:
Normal chest is elyptical and has two types: ratio : 3/5
a)Asthenic type in tall and thin person
b)sthenictype in obeys person

10. Abnormal shape of chest
1-Barrel chest
•Ant –post diameter is equal to transvers.
•In emphysematous case is seen

11. 2-Pectus or pigeon chest:
•Protuberant of sternum
•Associated with Harrison sulcus
•In Rickets

12. 3-Funnel chest
•Congenital funnel chest
•Acquired funnel chest

13. 4-Malformation of vertebra

15. Chest deformity

16. Symmetry of chest
•Normal chest is symmetrical
•Two types of asymmetry:
1)Bulging( pleural effusion,tumor,pneumothorax,
cardiomegaly )
2)Retraction( collapse, fibrosis)

17. Expansion of chest
•Normally symmetrical expansion during ins and esp.
•Normally 5-8 cm deference in expand isp
•Less then 2 cm is abnormal

18. Types of respiration:
Thoraco -abdominal in female
Abdomeno -thoracic in male
In children diaphragmatic
During inspection of breathing focus on:
1.Rate ( 12 –18 / m)
2.Rhythm ( regular )
3.Depth

19. Terminology
Tachypnea: Rate > normal
Bradypnea : Rate < normal
Hyperpnea or hyperventilation ; rapid and deep respiration
Hypopnea or hypoventilation; slow and shalowrespiration
Apnea; stopping of respiration

20. Types of abnormal respiration:
•Cheyne –stoke respiration:
oPeriodic
oApnea after hyperventilation occurred
oAfter apnea respiration stared slowly , shallow and
gradual increase Rate and dept.
oIn heart failure, renal failure, sever pneumonia,ICP,
narcotic intoxication is seen.

21. Types of abnormal respiration:
•Biot respiration( ataxic breathing):
oPeriodic that is not common in hospitalized patient.
oRate and rhythm is stable but with apnea DS the rhythm
oSpecific for meningitis

22. Types of abnormal respiration:
•Kussmaul respiration:
oSpecific form of hyperventilation
oIn acidosis is seen

23. Types of abnormal respiration:
•Hippocratic respiration or fish mouthing respiration
•Hypoventilation
•Rate < 10

24. Palpation of chest:
Principle of palpation should be considered such as:
•Clean hands
•Warm hands
•All side of chest
•Up to down
•Ant then post then latside
•Compare the same side with each other.

25. Palpation of Trachea
4-5 cm of the upper trachea can be felt in the neck
between the cricoid cartilage and the sternal notch.
Pushed–pneumothorax
-pleural effusion
Pulled—fibrosis
--collapse

26. Method of Palpation of trachea
1.One finger method
2.Three finger method

28. Palpation of chest movement
Chest expansion–normal up to 5 cm
-abnormal < 2 cm

30. Palpation of lung apices:

31. Palpation of vocal fremitus:
Vocal fremitus is a palpable vibration of the thoracic wall produced by phonation.
--Ask the patient to say 99, 44
--you should feel the vibration transmitted through the airways to the lung.

32. Increased in---pneumothorax
--emphysema
Decreased---pleural effusion

33. Percussion of chest:
method of percussion:
1)Mediated percussion
2)Immediate percussion ( only on clavicle)

34. Principles of chest percussion

36. During chest percussion we should hear :
•Resonance ; in normal lung is audible
•Hyper resonance ; when lung is over filled like emphysema
•Tympanic ; when Hyper resonance is more sever , and shows free air.
Like On the stomach
•Dullness ; when the visceral is solid or filled with water.
•Stony dullness or flatness is sever form of dullness

38. The end