PHBS lissssss

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  • Physical Examination Dr. F sahat H Situmorang, SpPD

  • PADATCAIRGAS

  • GASLEBIH PADATabcdBunyi = getaran yang dapat didengar (20 - 20000 Hertz)

  • 1 1Volume = V = (Pascal) Tekanan P

  • Anterior imaginary lines and landmarks

  • Lateral imaginary lines

  • Posterior imaginary lines and landmarks

  • s6-8 cm

  • Percussion:DullHyperresonantResonantTympanyMediumLoudLoudVery LoudMediumLowHighLowerHighThighLiverLungNoneGastric AirLobar PneumoniaNormal LungEmphysemaPneumothoraxLarge Pneumothorax

    NoteIntensityPitchLocationPath.FlatSoftPleural Effusion

  • Broncho-vesicularBronchialMediumLoudMediumLowHighAuscultation:Inspir = ExpirInspir < ExpirCentral airwaysTracheaNote: Auscultation should be performed with diaphragm of stethoscope

    SoundsIntensityPitchDurationLocationVesicularSoftInspir > ExpirLungs

  • Physical exam can identify pathology :NormalPneumoniaEffusionPneumothoraxCOPDConditionTracheaPercussionBreath SoundsFremitusAdventitialMidlineMidlineMidlineShiftedShiftedResonant+/- DullDullHyperHyperNormalDecreasedBronchialDecreasedDecreasedNormalIncreasedDecreasedDecreasedDecreasedNoneCracklesNoneNoneWheezesMidlineResonantNormalNormalCracklesCHF

  • J a n t u n g

  • Miokard KontraksiBunyi Jantung sistolikBunyiAliran darah (blowing) hembusAortal/Pulmonal terbuka Mitral/Tricuspidal tertutup Bunyi Jantung 1 BJ1S i s t o l i k

  • Miokard DilatasiBunyi Jantung diastolikBunyiMitral/Tricuspidal terbuka Aortal/Pulmonal tertutup Aliran darah (rumbling) sedot Bunyi Jantung 2 BJ2D i a s t o l i k

  • MPAM1 > M2P1 < P2A1 < A2A2 < P2A2 = P2A2 > P2A2 = P2A2 < 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

  • ****