PHBS lissssss
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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