2. Heart sounds – 5 points across the
precordium
A. Five points across the precordium
1. Aortic area - second intercostal space,
right sternal border
2. Pulmonic area - second intercostal space,
left sternal border
3. Erb's point - third intercostal space, left
sternal border
4. Tricuspid area -fifth intercostal space, left
sternal border
5. Mitral area - fifth intercostal space, left
midclavicular line
7/3/2023
NEETHU
MOHANLAL
2
5. Point of maximum impulse - area where pulse
is felt the strongest
Heaves or thrusts - sharp lifting of chest wall
Thrills - vibration felt with palmar surface of
hand.
7/3/2023
NEETHU
MOHANLAL
5
6. • Heart murmurs are generated by
turbulent flow of blood , it occur inside or
outside the heart , may be physiological (
benign ) or pathological (abnormal)
• It is caused by stenosis- Restricting the
opening of a heart valve, resulting in
turbulence as blood flows through it.
7/3/2023
NEETHU
MOHANLAL
6
7. Pericardial friction rub
Caused by the beating of the heart
against an inflamed pericardium or lung
pleura.
• This sound is usually continuous and
heard diffusely over the chest
• If the rub completely disappears when
the patient holds his breath it is more
likely due to pleural , not pericardial ,
7/3/2023
NEETHU
MOHANLAL
7
9. Assessment of breasts
Inspection
Normal breast appears round and
essentially symmetric ,although one breast
is often slightly larger than the other, the
skin should be smooth and intact with the
areola darker in color , round and
symmetric , the nipple should be everted
7/3/2023
NEETHU
MOHANLAL
9
10. Contd…
Palpation
Palpation is done to determine if masses
or lumps are present in the breast , Palpate each
breast for tenderness, nodules or masses ,
during the palpation teach the women how to
perform breast self palpation.
7/3/2023
NEETHU
MOHANLAL
10
Heart murmurs are sounds — such as whooshing or swishing — made by rapid, choppy (turbulent) blood flow through the heart. The sounds can be heard with a device called a stethoscope
C- murphy’s point at the –intersecction of mid clvicular line used to assess liver.
G- traube’s area, a space formed by the left costal margin, 7 th rib and Aal is used to assess spleen.
E- Mc Burney’s point 3 cm medial to the antrior superior iliac spine used to asess apendix. Mc Burney’s line between anterior superior iliac spine to the umblics.
F- anterior superior iliac spine
