The document provides guidance on assessing various body systems including the thorax, lungs, neurologic system, musculoskeletal system, and cranial nerves. It describes how to evaluate the chest for lesions, symmetry of lung expansion, percussion findings over the lungs, auscultation findings like rales and wheezes. It also covers assessing cranial nerve function including smell, vision, eye movements, facial expression, hearing, taste, and gag reflex. Hygiene, mental status, and level of consciousness are mentioned as important evaluation areas.

1. Assessing the Thorax and Lungs

2. • Assess the front, back, and sides of the chest for any scars, wounds,
or lesions
• Lesion =a region in an organ or tissue which has suffered damage
through injury or disease, such as a wound, ulcer, abscess, or tumor.
• Primary skin lesions are abnormal skin conditions present at birth or
acquired over a person's lifetime. Secondary skin lesions are the
result of irritated or manipulated primary skin lesions.

4. • Common adult spinal deformities are scoliosis, kyphosis, and
lordosis. Kyphosis involves the upper back curving forward. The
condition can create the form of a hump. Lordosis is also known as
swayback.

5. Symmetry of expansion
• correct or pleasing proportion of the parts
• Asymmetric expansion suggests pneumonia, a large pleural effusion, rib
fracture, or pneumothorax.
• Pneumonia is an infection that inflames your lungs' air sacs (alveoli). The
air sacs may fill up with fluid or pus
• Pleural effusion, sometimes referred to as “water on the lungs,” is
the build-up of excess fluid between the layers of the pleura outside the
lungs
• A pneumothorax (noo-moe-THOR-aks) is a collapsed lung. A
pneumothorax occurs when air leaks into the space between your lung and
chest wall

7. Antero posterior Diameter

8. COPD patients exhibit increased thoracic cage dimensions, especially
anteroposterior (AP) diameter, leading to a circular, “barrel-chest” appearance due
to increased lung volume and hyperinflation

9. Assess for tactile fremitus
• Tactile fremitus, also known as tactile vocal fremitus, refers to the
vibration of the chest wall that results from sound vibrations
created by speech or other vocal sounds. ... In individuals with
healthy lung tissue, tactile fremitus can be felt symmetrically along
both sides of the chest.
• Tactile fremitus is normally found over the mainstem bronchi near
the clavicles in the front or between the scapulae in the back. As you
move your hands downward and outward, fremitus should decrease.
Decreased fremitus in areas where fremitus is normally expected
indicates obstruction, pnemothorax, or emphysema.

10. Tactile fremitus increases with pneumonia or pulmonary
edema and decreases in pleural effusion or lung hyperinflation

11. What causes lung expansion?
• Hyperinflated lungs occur when air gets trapped in the lungs and
causes them to overinflate. Hyperinflated lungs can be caused by
blockages in the air passages or by air sacs that are less elastic, which
interferes with the expulsion of air from the lungs.

12. Parts of the Spine

13. Percuss over the posterior and lateral lung
fields
• Since lungs are mostly filled with air that we breathe in, percussion
performed over most of the lung area produces a resonant sound,
which is a low pitched, hollow sound.
• The purpose of percussion is to determine if the area under the
percussed finger is air filled (sounding resonant like a drum), fluid
filled (a dull sound) or solid (a flat sound).

14. Hyperresonant sounds may also be heard when percussing lungs hyperinflated
with air, such as may occur in patients with COPD, or patients having an acute
asthmatic attack. An area of hyperresonance on one side of the chest may indicate
a pneumothorax. Tympanic sounds are hollow, high, drumlike sounds.
• Tympanitic, drum-like sounds heard over air filled structures during the
abdominal examination.[4]
• Hyperresonant (pneumothorax) said to sound similar to percussion of puffed up
cheeks.
• Normal resonance/ Resonant the sound produced by percussing a normal chest.
• Impaired resonance (mass, consolidation) lower than normal percussion sounds.
• Dull (consolidation) similar to percussion of a mass such as a liver.
• Stony dull the sounds produced on percussion from the pleximeter with no
contribution from the underlying area.

15. Ascultation in thorax
• Rales. Small clicking, bubbling, or rattling sounds in the lungs. They
are heard when a person breathes in (inhales). ...
• Rhonchi. Sounds that resemble snoring. ...
• Stridor. Wheeze-like sound heard when a person breathes. ...
• Wheezing. High-pitched sounds produced by narrowed airways.

16. Breast
• Is it normal for discharge to come out of your breast?
• Both abnormal and normal nipple discharge can be clear, yellow,
white, or green in color. Normal nipple discharge more commonly
occurs in both nipples and is often released when the nipples are
compressed or squeezed. Some women who are concerned about
breast secretions may actually cause it to worsen

17. •
Nipple discharge (ND) can be the earliest presenting symptom of
breast cancer. We hereby present two cases of breast cancer with no
palpable mass manifesting as isolated ND, which was whitish in color

19. Assessing neurologic,muscoskeletal and
peripheral vascular system
• The neurologic examination is typically divided into eight
components: mental status; skull, spine and meninges; cranial
nerves; motor examination; sensory examination; coordination;
reflexes; and gait and station.
• Muscoskeletal examining the symmetry of the joints, muscles, and
bones and checking for swelling, redness, and ease of movement.
Then you palpate over the joints, noting any areas of warmth or
tenderness.
• Assess the capillary refill time of the upper limbs. Palpate the radial
pulse. Assess for radio-radial delay. Palpate the brachial pulse. Offer
to measure the patient's blood pressure

20. Hygeine of patient
• Assessing patient hygiene and personal care is important to ascertain
how well patients care for themselves or a caregiver cares for them.
Hygiene is necessary for health, comfort, well-being, and safety. You
can assess hygiene by examining a patient's clothing, skin, mouth,
hair, and nails.

21. Mental status
• The mental status examination is an assessment of current mental
capacity through evaluation of general appearance, behavior, any
unusual or bizarre beliefs and perceptions (eg, delusions,
hallucinations), mood, and all aspects of cognition (eg, attention,
orientation, memory).

22. Level of consciousness
• Level of consciousness is a term used to describe a person's
awareness and understanding of what is happening in his or her
surroundings.
• GCS (GLASGOW COMA SCALE) objectively describe the extent of
impaired consciousness in all types of acute medical and trauma
patients

24. Cranial Nerve Function
• The cranial nerve exam is a type of neurological examination. It is
used to identify problems with the cranial nerves by physical
examination. It has nine components. Each test is designed to assess
the status of one or more of the twelve cranial nerves.

25. • The human sense of smell depends on the functioning of not only
cranial nerve I (olfactory nerve) but also portions of cranial nerve V
(trigeminal nerve).
• Cranial Nerve II (Optic Nerve). Visual acquity
• You are now familiar with the 6 cardinal directions of gaze (right/up;
right; right/down; left/up; left; left/down), as well as the remainder
of the yoked eye movements (straight up; straight down;
convergence).

26. • a nerve that's large enough to be visible to the naked eye, called the
seventh cranial nerve, carries the signal in front of the ear to the
more central part of the face, where it reaches the smile muscle
• HEARING=Cranial nerve VIII brings sound and information about
one's position and movement in space into the brain.
• GAGREFLEX =The afferent limb of the reflex is supplied by
the glossopharyngeal nerve (cranial nerve IX), which inputs to the
nucleus solitarius and the spinal trigeminal nucleus

27. • Visual acuity refers to your ability to discern the shapes and details
of the things you see.
• The physiology behind a "normal" pupillary constriction is a balance
between the sympathetic and parasympathetic nervous systems
• Normally, when the parasympathetic nerve is activated, it causes
pupils to constrict, or narrow. When the sympathetic nerve is
stimulated, pupils dilate