Physical Examination

Dr. F sahat H Situmorang, SpPD

PADAT

CAIR

GAS

GAS

LEBIH PADATab

cd

Bunyi = getaran yang dapat didengar (20 - 20000 Hertz)

1 1Volume = V = (Pascal) Tekanan P

Anterior imaginary lines and landmarks

epigastric angle

Infraclavicular fossa

Anterior midline

Suprasternal fossa Supraclavicular fossa

Sternal line

Parasternal line

Midclavicular line

Lateral imaginary lines

Anterior axillary line

Midaxillary line

Posterior axillary line

Posterior imaginary lines and landmarks

Scapular line

Posterior midline

Infrascapular region

Interscapular region

Suprascapular region

s

Shifting range of bottom of lung

6-8 cm

Damoiseau’s curve

Garland’s triangle area(tympanitic dullness)

Grocco’s triangle area(dullness)

Percussion:Percussion:

Note Intensity Pitch Location Path.

Flat Soft Pleural Effusion

DullDull

HyperresonantHyperresonant

ResonantResonant

TympanyTympany

MediumMedium

LoudLoud

LoudLoud

Very LoudVery Loud

MediumMedium

LowLow

HighHigh

LowerLower

HighHigh

ThighThigh

LiverLiver

LungLung

NoneNone

Gastric Gastric AirAir

Lobar PneumoniaLobar Pneumonia

Normal LungNormal Lung

EmphysemaEmphysemaPneumothoraxPneumothorax

Large Large PneumothoraxPneumothorax

Sounds. Sounds.

Sounds Intensity Pitch Duration Location

Vesicular Soft Inspir > Expir Lungs

Broncho-vesicularBroncho-vesicular

BronchialBronchial

MediumMedium

LoudLoud

MediumMedium

LowLow

HighHigh

Normal Sounds. Normal Sounds.

Auscultation:Auscultation:

Inspir = ExpirInspir = Expir

Inspir < ExpirInspir < Expir

Central airwaysCentral airways

TracheaTrachea

Note: Auscultation should be performed with diaphragm of stethoscopeNote: Auscultation should be performed with diaphragm of stethoscope

Physical exam can identify pathology :Physical exam can identify pathology :

NormalNormal

PneumoniaPneumonia

EffusionEffusion

PneumothoraxPneumothorax

COPDCOPD

ConditionCondition Trachea Percussion Breath SoundsBreath Sounds Fremitus Adventitial

MidlineMidline

MidlineMidline

MidlineMidline

ShiftedShifted

ShiftedShifted

ResonantResonant

+/- Dull+/- Dull

DullDull

HyperHyper

HyperHyper

NormalNormal

DecreasedDecreased

BronchialBronchial

DecreasedDecreased

DecreasedDecreased

NormalNormal

IncreasedIncreased

DecreasedDecreased

DecreasedDecreased

DecreasedDecreased

NoneNone

CracklesCrackles

NoneNone

NoneNone

WheezesWheezes

MidlineMidline ResonantResonant NormalNormal NormalNormal CracklesCracklesCHFCHF

J a n t u n g

Miokard Kontraksi

Bunyi Jantung sistolik

Bunyi

Aliran darah (blowing) hembus

Aortal/Pulmonal terbuka Mitral/Tricuspidal tertutup

Bunyi Jantung 1 ”BJ1”

S i s t o l i k

-Miokard Dilatasi

Bunyi Jantung diastolik

BunyiMitral/Tricuspidal terbuka Aortal/Pulmonal tertutup Aliran darah (rumbling) sedot

Bunyi Jantung 2 “ BJ2”

D i a s t o l i k

M

PA

M1 > M2

P1 < P2A1 < A2

A2 < P2A2 = P2A2 > P2A2 = P2

A2 < P2

HEART SOUNDS

Acute rheumatic fever Loud first sound Mitral stenosis Accentuated first sound Mitral stenosis Opening snap

Mitral stenosis Short, mid-diastolic murmur Mitral stenosis Presystolic murmur Mitral regurgitation Systolic murmur Mitral regurgitation Systolic murmur,high pitched and blowing type Mitral regurgiation Systolic murmur, crescendo type Mitral regurgiation Late systolic murmur, crescendo type Mitral regurgiation Mid systolic click and late systolic murmur Mitral regurgiation Holosystolic murmur Mitral regurgiation Third heart sound Mit reg+Mit stenAll sound features of mitral stenosis and mitral regurgitation

Aortic stenosis Opening snap of aortic valve, early systolic ejection sound

HEART SOUNDS

Aortic insufficiency Loud systolic ejection murmur, third sound

Pulmonary stenosis Harsh systolic ejection murmur

Tricuspid regurgitation Holosystolic murmur, high pitched, lower during expiration and louder during inspiration

Ventricular sepatal defect Continuous murmur

Atrial septal defect Abnormal splitting of second sound during expiration Patent ductus arteriosus Continuous "machinery" murmur Coarctation of aortaSystolic murmur

Right bundle branch block of first sound Complet heart block Slow heart rate,varying first sound Systemic hypertension Accentuated second sound