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Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal...

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Physical Examination of the Chest Collegio A. Volta 20 Gennaio 2017
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Page 1: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Physical Examination of the Chest

Collegio A. Volta

20 Gennaio 2017

Page 2: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Chest Topography: Anterior Chest

Page 3: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Chest Topography: Lateral Chest

Page 4: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Chest Topography: Posterior Chest

Page 5: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Fissures:

Page 6: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Location of Lobes

Page 7: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Physical Exam Techniques

•  Observation •  Palpation •  Percussion •  Auscultation

Page 8: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Observation

•  Patient ‘s surroundings, ie: the view from the door – Equipment present – Posted signs –  SPUTUM!

Page 9: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Observation: Breathing Patterns

•  Eupnea •  Tachypnea/Bradypnea •  Biot’s •  Cheynes-Stokes •  Kussmaul

Page 10: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Observation: Thoracic Contour

Page 11: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Observation: Thoracic Contour (cont.)

•  Pectus Excavatum •  Pectus Carinatum •  Kyphosis •  Scoliosis •  Kyphoscoliosis •  Symmetry of chest movement

Page 12: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Observation: Clubbing

Page 13: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Palpation: Tracheal Alignment

Page 14: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Tracheal Alignment Abnormalities

•  Pneumothorax – shifts to unaffected side •  Pleural Effusion – shifts to unaffected side •  Fibrosis or Atelectasis – shifts towards

affected side •  Pulmonary consolidation – no shift

Page 15: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Palpation : Chest Excursion

Page 16: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Palpation: Vocal Fremitus

•  BILATERAL comparison of vocal vibrations

•  Increased with alveolar consolidation

•  Decreased with increased distance between lung and chest wall –  Pneumothorax, Pleural

effusion

Page 17: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Percussion

•  Assess density of underlying tissue

Page 18: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Percussion Notes

•  Resonance – normal •  Dullness – increased density

– Atelectasis, alveolar filling/consolidation, pleural effusion, fibrosis

•  Hyperresonance – decreased density – Hyperinflation (COPD), Pneumothorax

Page 19: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Case Study

A patient is recently diagnosed with RLL bronchogenic CA. As you enter the room, you see that the patient is on 4 LPM nasal cannula. He appears short of breath with tachypnea and shallow respirations. Chest

excursion appears normal except in the RLL. Vocal fremitus is also absent in the RLL. Percussion reveals dullness in the RLL.

Page 20: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

Auscultation

Page 21: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase
Page 22: Physical Examination of the Chest -  · Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increasedCase

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