This document provides information on performing a local examination of the chest. It describes the key components of inspection, palpation, percussion, and auscultation. Inspection involves examining the shape of the chest and spine for any deformities. Palpation is used to confirm respiratory movements and feel for pulsations, adventitious sounds, and tracheal position. Percussion determines the lung borders and areas of dullness or resonance. Auscultation identifies breath sounds and adventitious sounds such as rhonchi or pleural rubs. Performing a thorough local chest exam provides important clinical information.
Brief Presentation on clinical examination of Respiratory System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
R Alagappan - Manual of Practical Medicine, 4th Edition
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
Brief Presentation on clinical examination of Respiratory System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
R Alagappan - Manual of Practical Medicine, 4th Edition
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
The lungs, essential for respiration, are a pair of spongy, air-filled organs located on either side of the chest. Their main functions include facilitating the exchange of oxygen and carbon dioxide during the breathing process.
The key components of the lungs include the bronchi, bronchioles, alveoli, and pleura. The bronchi and bronchioles act as airways, transporting air to and from the lungs, while the alveoli are small air sacs where gas exchange occurs. The pleura is a thin membrane covering the outside of each lung and lining the inside of the chest cavity.
Through inhalation and exhalation, the lungs enable the intake of oxygen, which is then transferred to the bloodstream, and the removal of carbon dioxide from the body. Understanding the structure and function of the lungs is essential for comprehending respiratory health and the potential impact of various lung-related conditions.
From Dr Ng Kian Seng:"Please send this out to all those coming, it is just a revision of the fundamentals. I dont intend to go through this at the workshop.
I will go straight to the Systematic Reading of the Chest Radiographs. It will take only 10 minutes to run through this powerpoint, so please run through it before coming."
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Introduction:
RNA interference (RNAi) or Post-Transcriptional Gene Silencing (PTGS) is an important biological process for modulating eukaryotic gene expression.
It is highly conserved process of posttranscriptional gene silencing by which double stranded RNA (dsRNA) causes sequence-specific degradation of mRNA sequences.
dsRNA-induced gene silencing (RNAi) is reported in a wide range of eukaryotes ranging from worms, insects, mammals and plants.
This process mediates resistance to both endogenous parasitic and exogenous pathogenic nucleic acids, and regulates the expression of protein-coding genes.
What are small ncRNAs?
micro RNA (miRNA)
short interfering RNA (siRNA)
Properties of small non-coding RNA:
Involved in silencing mRNA transcripts.
Called “small” because they are usually only about 21-24 nucleotides long.
Synthesized by first cutting up longer precursor sequences (like the 61nt one that Lee discovered).
Silence an mRNA by base pairing with some sequence on the mRNA.
Discovery of siRNA?
The first small RNA:
In 1993 Rosalind Lee (Victor Ambros lab) was studying a non- coding gene in C. elegans, lin-4, that was involved in silencing of another gene, lin-14, at the appropriate time in the
development of the worm C. elegans.
Two small transcripts of lin-4 (22nt and 61nt) were found to be complementary to a sequence in the 3' UTR of lin-14.
Because lin-4 encoded no protein, she deduced that it must be these transcripts that are causing the silencing by RNA-RNA interactions.
Types of RNAi ( non coding RNA)
MiRNA
Length (23-25 nt)
Trans acting
Binds with target MRNA in mismatch
Translation inhibition
Si RNA
Length 21 nt.
Cis acting
Bind with target Mrna in perfect complementary sequence
Piwi-RNA
Length ; 25 to 36 nt.
Expressed in Germ Cells
Regulates trnasposomes activity
MECHANISM OF RNAI:
First the double-stranded RNA teams up with a protein complex named Dicer, which cuts the long RNA into short pieces.
Then another protein complex called RISC (RNA-induced silencing complex) discards one of the two RNA strands.
The RISC-docked, single-stranded RNA then pairs with the homologous mRNA and destroys it.
THE RISC COMPLEX:
RISC is large(>500kD) RNA multi- protein Binding complex which triggers MRNA degradation in response to MRNA
Unwinding of double stranded Si RNA by ATP independent Helicase
Active component of RISC is Ago proteins( ENDONUCLEASE) which cleave target MRNA.
DICER: endonuclease (RNase Family III)
Argonaute: Central Component of the RNA-Induced Silencing Complex (RISC)
One strand of the dsRNA produced by Dicer is retained in the RISC complex in association with Argonaute
ARGONAUTE PROTEIN :
1.PAZ(PIWI/Argonaute/ Zwille)- Recognition of target MRNA
2.PIWI (p-element induced wimpy Testis)- breaks Phosphodiester bond of mRNA.)RNAse H activity.
MiRNA:
The Double-stranded RNAs are naturally produced in eukaryotic cells during development, and they have a key role in regulating gene expression .
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
A brief information about the SCOP protein database used in bioinformatics.
The Structural Classification of Proteins (SCOP) database is a comprehensive and authoritative resource for the structural and evolutionary relationships of proteins. It provides a detailed and curated classification of protein structures, grouping them into families, superfamilies, and folds based on their structural and sequence similarities.
Richard's entangled aventures in wonderlandRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
This pdf is about the Schizophrenia.
For more details visit on YouTube; @SELF-EXPLANATORY;
https://www.youtube.com/channel/UCAiarMZDNhe1A3Rnpr_WkzA/videos
Thanks...!
The increased availability of biomedical data, particularly in the public domain, offers the opportunity to better understand human health and to develop effective therapeutics for a wide range of unmet medical needs. However, data scientists remain stymied by the fact that data remain hard to find and to productively reuse because data and their metadata i) are wholly inaccessible, ii) are in non-standard or incompatible representations, iii) do not conform to community standards, and iv) have unclear or highly restricted terms and conditions that preclude legitimate reuse. These limitations require a rethink on data can be made machine and AI-ready - the key motivation behind the FAIR Guiding Principles. Concurrently, while recent efforts have explored the use of deep learning to fuse disparate data into predictive models for a wide range of biomedical applications, these models often fail even when the correct answer is already known, and fail to explain individual predictions in terms that data scientists can appreciate. These limitations suggest that new methods to produce practical artificial intelligence are still needed.
In this talk, I will discuss our work in (1) building an integrative knowledge infrastructure to prepare FAIR and "AI-ready" data and services along with (2) neurosymbolic AI methods to improve the quality of predictions and to generate plausible explanations. Attention is given to standards, platforms, and methods to wrangle knowledge into simple, but effective semantic and latent representations, and to make these available into standards-compliant and discoverable interfaces that can be used in model building, validation, and explanation. Our work, and those of others in the field, creates a baseline for building trustworthy and easy to deploy AI models in biomedicine.
Bio
Dr. Michel Dumontier is the Distinguished Professor of Data Science at Maastricht University, founder and executive director of the Institute of Data Science, and co-founder of the FAIR (Findable, Accessible, Interoperable and Reusable) data principles. His research explores socio-technological approaches for responsible discovery science, which includes collaborative multi-modal knowledge graphs, privacy-preserving distributed data mining, and AI methods for drug discovery and personalized medicine. His work is supported through the Dutch National Research Agenda, the Netherlands Organisation for Scientific Research, Horizon Europe, the European Open Science Cloud, the US National Institutes of Health, and a Marie-Curie Innovative Training Network. He is the editor-in-chief for the journal Data Science and is internationally recognized for his contributions in bioinformatics, biomedical informatics, and semantic technologies including ontologies and linked data.
1. Local ExaminationLocal Examination
Of The ChestOf The Chest
Iman GalalIman Galal
Assistant Professor Pulmonary MedicineAssistant Professor Pulmonary Medicine
Ain Shams UniversityAin Shams University
E-mail: dr.imangalal@gmail.comE-mail: dr.imangalal@gmail.com
3. Page 3
Local Examination of the ChestLocal Examination of the Chest
1- Shape of the chest & Spine Deformity1- Shape of the chest & Spine Deformity
2-MovementMovement
3-Symmetry3-Symmetry
4-Pulsations4-Pulsations
5-Respiratory movements5-Respiratory movements
6-Skin6-Skin
7-Subcostal angel7-Subcostal angel
8-Special signs8-Special signs
Inspection:Inspection:
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Normal ShapeNormal Shape
Barrel shaped chestBarrel shaped chest
Pigeon chestPigeon chest
Rachitic chestRachitic chest
Funnel-shaped chest (Pectus Excavatum)Funnel-shaped chest (Pectus Excavatum)
Shape of the Chest:Shape of the Chest:
Local Examination of the ChestLocal Examination of the Chest
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Shape:Shape: ↑↑ AP diameterAP diameter
Local Examination of the ChestLocal Examination of the Chest
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Shape: Pectus ExcavatumShape: Pectus Excavatum
Local Examination of the ChestLocal Examination of the Chest
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Spine Deformity: KyphosisSpine Deformity: Kyphosis
Local Examination of the ChestLocal Examination of the Chest
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Spine Deformity: ScoliosisSpine Deformity: Scoliosis
Local Examination of the ChestLocal Examination of the Chest
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Both sides of normal chest areBoth sides of normal chest are
symmetrical in shape and mobility.symmetrical in shape and mobility.
The diseased side or part is less mobileThe diseased side or part is less mobile
than the healthy one.than the healthy one.
Movement & Symmetry :
Local Examination of the ChestLocal Examination of the Chest
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Shape: Pigeon ChestShape: Pigeon Chest
Local Examination of the ChestLocal Examination of the Chest
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Significance ofSignificance of ↓↓ respiratory movements:respiratory movements:
UnilateralUnilateral ↓↓ of chest wall movements:of chest wall movements:
•Pleural effusionPleural effusion
•EmpyemaEmpyema
•PneumothoraxPneumothorax
•Pulmonary consolidationPulmonary consolidation
•Pulmonary collapsePulmonary collapse
•Pleural or parenchymatous pulmonary fibrosisPleural or parenchymatous pulmonary fibrosis
BilateralBilateral ↓↓ of chest wall movements:of chest wall movements:
•Bronchial asthmaBronchial asthma
•EmphysemaEmphysema
•Diffuse pulmonary fibrosisDiffuse pulmonary fibrosis
Local Examination of the ChestLocal Examination of the Chest
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BulgingBulging RetractionRetraction
Pleural effusionPleural effusion
PneumothoraxPneumothorax
HydropneumothoraxHydropneumothorax
EmpyemaEmpyema
Precordial bulgePrecordial bulge
Chest wall causesChest wall causes
Pulmonary collapsePulmonary collapse
Pulm. FibrosisPulm. Fibrosis
Pleural fibrosisPleural fibrosis
Local Examination of the ChestLocal Examination of the Chest
Movement & Symmetry :
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Respiratory rate
Type of respiration
Regularity of respiration
Pulse Rate: Respiratory Rate Ratio
Respiratory Movements:Respiratory Movements:
Local Examination of the ChestLocal Examination of the Chest
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Skin eruptionSkin eruption e.g HZe.g HZ
NodulesNodules (inflammatory,metastatic,lipoma, neurofibroma…)(inflammatory,metastatic,lipoma, neurofibroma…)
Subcutaneous emphysemaSubcutaneous emphysema
Purpuric spots,Vascular spiders, BruisesPurpuric spots,Vascular spiders, Bruises
Dilated prominent blood vesselsDilated prominent blood vessels (SVC obstruction)(SVC obstruction)
ScarsScars (previous operation,trauma, intercostal tube…)(previous operation,trauma, intercostal tube…)
Discharging sinusesDischarging sinuses
Lesions of the breastsLesions of the breasts
Skin:Skin:
Local Examination of the ChestLocal Examination of the Chest
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Skin:Skin: SVC ObstructionSVC Obstruction
Local Examination of the ChestLocal Examination of the Chest
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ApicalApical
ParasternalParasternal
EpigastricEpigastric
Pulsations:Pulsations:
Local Examination of the ChestLocal Examination of the Chest
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Palpation:Palpation:
To confirm Respiratory Movements +/- ExpansionTo confirm Respiratory Movements +/- Expansion
Pulsations (see before)Pulsations (see before)
Palpable Adventitious SoundsPalpable Adventitious Sounds
TTactileactile VVocalocal FFremitus (TVF)remitus (TVF)
Position of the TracheaPosition of the Trachea
Local Examination of the ChestLocal Examination of the Chest
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Palpation of Respiratory MovementsPalpation of Respiratory Movements
1.1. Respiratory movements in the infraclavicular regionsRespiratory movements in the infraclavicular regions
2.2. Respiratory movements at the costal marginsRespiratory movements at the costal margins
3.3. Respiratory movements of the lower ribs posteriorlyRespiratory movements of the lower ribs posteriorly
Local Examination of the ChestLocal Examination of the Chest
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Symmetry & Movement:
Local Examination of the ChestLocal Examination of the Chest
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Palpation: Chest ExcursionPalpation: Chest Excursion
Local Examination of the ChestLocal Examination of the Chest
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TVFTVF
Increased TVFIncreased TVF Decreased TVFDecreased TVF
Consolidation
Cavitation
Collapse with patent main
bronchus
Thick chest wall
Pleural effusion
Pleural fibrosis
Pneumothorax
Emphysema
Collapse
Local Examination of the ChestLocal Examination of the Chest
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Palpable Adventitious SoundsPalpable Adventitious Sounds
Palpable RhonchiPalpable Rhonchi
•Diffuse
•Localized and Persistent
Palpable Pleural Rub
Local Examination of the ChestLocal Examination of the Chest
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Position of the Trachea:Position of the Trachea:
How to test for the position of the trachea?How to test for the position of the trachea?
Trill’s sign:Bulging of the sternomastoid muscle inTrill’s sign:Bulging of the sternomastoid muscle in
front of the deviated trachea.front of the deviated trachea.
To evaluate the position of theTo evaluate the position of the
Upper Mediastinum.Upper Mediastinum.
Local Examination of the ChestLocal Examination of the Chest
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Position of the Trachea:Position of the Trachea:
Local Examination of the ChestLocal Examination of the Chest
25. Page 25
Causes of deviation of the trachea
IpsilateralIpsilateral
(To pull)(To pull)
ContralateralContralateral
( To push)( To push)
CollapseCollapse
FibrosisFibrosis
Apical massApical mass
Pleural effusionPleural effusion
PneumothoraxPneumothorax
Local Examination of the ChestLocal Examination of the Chest
Position of the Trachea:Position of the Trachea:
31. Page 31
Percussion: Anterior ChestPercussion: Anterior Chest
1.1. Percuss from side to side andPercuss from side to side and
top to bottom using thetop to bottom using the
pattern shown in thepattern shown in the
illustration.illustration.
2.2. Compare one side to the otherCompare one side to the other
looking for asymmetry.looking for asymmetry.
3.3. Note the location and qualityNote the location and quality
of the percussion sounds youof the percussion sounds you
hear.hear.
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Percussion: Posterior ChestPercussion: Posterior Chest
1.1. Percuss from side to side and top toPercuss from side to side and top to
bottom using this pattern. Omit thebottom using this pattern. Omit the
areas covered by the scapulae.areas covered by the scapulae.
2.2. Compare one side to the otherCompare one side to the other
looking for asymmetry.looking for asymmetry.
3.3. Note the location and quality of theNote the location and quality of the
percussion sounds you hear.percussion sounds you hear.
4.4. Find the level of the diaphragmaticFind the level of the diaphragmatic
dullness on both sides.dullness on both sides.
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Traube’s area:Traube’s area:
4 points:4 points:
Left 6Left 6thth
rib in the MCL to 8rib in the MCL to 8thth
costal cartilage in thecostal cartilage in the
parasternal line ,then along the left costal margin to the 11parasternal line ,then along the left costal margin to the 11thth
rib in the MAL, then the 9rib in the MAL, then the 9thth
rib in the MAL.rib in the MAL.
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Kronig’s Isthmus :Kronig’s Isthmus :
It is a band of resonance representing lung apex.It is a band of resonance representing lung apex.
LaterallyLaterally it is marked by a line joining 2 points:it is marked by a line joining 2 points:
1.1. The junction of the medial 2/3 of the clavicle with theThe junction of the medial 2/3 of the clavicle with the
lateral 1/3.lateral 1/3.
2.2. The junction of the medial 1/3 of the scapular spine withThe junction of the medial 1/3 of the scapular spine with
the lateral 2/3.the lateral 2/3.
MediallyMedially marked by a line between the sternal end ofmarked by a line between the sternal end of
clavicle and the 7clavicle and the 7thth
cervical spine.cervical spine.
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Bare area of the heart :Bare area of the heart :
Medial border: left lateral border of the sternumMedial border: left lateral border of the sternum
Lateral border: left parasternal lineLateral border: left parasternal line
Superior border: lower border of Lt 4Superior border: lower border of Lt 4thth
rib.rib.
Inferior border: upper border of Lt 6Inferior border: upper border of Lt 6thth
ribrib
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Surface anatomy of liver:Surface anatomy of liver:
Upper border:Upper border:
It starts from the left 6It starts from the left 6thth
ribrib just inside the MCL, passing tojust inside the MCL, passing to
the Rt and slightly upwards to the 5the Rt and slightly upwards to the 5thth
rib in the MCL, thenrib in the MCL, then
the 7the 7thth
rib in anterior axillary line, to the 9rib in anterior axillary line, to the 9thth
rib in mid-axillaryrib in mid-axillary
line.line.
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1.1. Find the level of the diaphragmatic dullness on both sides.Find the level of the diaphragmatic dullness on both sides.
2.2. Ask the patient to inspire deeply.Ask the patient to inspire deeply.
3.3. The level of dullness (diaphragmatic excursion) should goThe level of dullness (diaphragmatic excursion) should go
down 3-5cmdown 3-5cm symmetricallysymmetrically..
4.4. Decreased or asymmetric diaphragmatic excursion mayDecreased or asymmetric diaphragmatic excursion may
indicate paralysis or emphysema.indicate paralysis or emphysema.
Diaphragmatic ExcursionDiaphragmatic Excursion
Local Examination of the ChestLocal Examination of the Chest
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1. It is used to differentiate supra-diaphragmatic from infra-
diaphragmatic dullness.
2. While the patient seated find the upper level of dullness
3. Ask the patient to take deep inspiration and to hold it then
percuss again.
4. If the note becomes resonant infra-diaphragmatic cause.
5. If there is no change of the note supra-diaphragmatic
cause as pleural effusion.
Tidal percussion:Tidal percussion: Local Examination of the ChestLocal Examination of the Chest
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Auscultation:Auscultation:
Intensity of breath soundsIntensity of breath sounds
Type of breath soundsType of breath sounds
Adventitious soundsAdventitious sounds
Voice sounds (vocal resonance)Voice sounds (vocal resonance)
Local Examination of the ChestLocal Examination of the Chest
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Technique of Auscultation
• While the patient relaxed and breathes normally with mouthWhile the patient relaxed and breathes normally with mouth
open, auscultate the lungs, making sure to auscultate theopen, auscultate the lungs, making sure to auscultate the
apices and middle and lower lung fields posteriorly, laterallyapices and middle and lower lung fields posteriorly, laterally
and anteriorly.and anteriorly.
• Alternate and compare both sides at each site.Alternate and compare both sides at each site.
• Listen to at least one complete respiratory cycle at each site.Listen to at least one complete respiratory cycle at each site.
• First listen with quiet respiration. If breath sounds areFirst listen with quiet respiration. If breath sounds are
inaudible, then have him take deep breaths.inaudible, then have him take deep breaths.
• First describe the breath sounds and then the adventitiousFirst describe the breath sounds and then the adventitious
sounds.sounds.
Local Examination of the ChestLocal Examination of the Chest
41. Page 41
Technique of AuscultationTechnique of Auscultation
• Note the intensity of breath sounds and make a comparisonNote the intensity of breath sounds and make a comparison
with the opposite side.with the opposite side.
• Assess length of inspiration and expiration. Listen for a pauseAssess length of inspiration and expiration. Listen for a pause
between inspiration, expiration and the quality of pitch of thebetween inspiration, expiration and the quality of pitch of the
soundsound
• Also compare the intensity of breath sounds between upperAlso compare the intensity of breath sounds between upper
and lower chest in upright position. Compare the intensity ofand lower chest in upright position. Compare the intensity of
breath sounds from dependent to top lung in the decubitusbreath sounds from dependent to top lung in the decubitus
position.position.
• Note the presence or absence of adventitious sounds.Note the presence or absence of adventitious sounds.
Local Examination of the ChestLocal Examination of the Chest
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Bronchial breathing may be heard in:Bronchial breathing may be heard in:
ConsolidationConsolidation
Collapse with patent large airwaysCollapse with patent large airways
Compressed lung by a large pl effusion or a tensionCompressed lung by a large pl effusion or a tension
pneumothoraxpneumothorax
Pulmonary fibrosisPulmonary fibrosis
CavitationCavitation
Local Examination of the ChestLocal Examination of the Chest
Auscultation:Auscultation: Bronchial BreathingBronchial Breathing
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Auscultation:Adventitious soundsAuscultation:Adventitious sounds
Crepitations: typesCrepitations: types
Rhonchi: sibilant and sonorousRhonchi: sibilant and sonorous
Pleural rubPleural rub
Local Examination of the ChestLocal Examination of the Chest
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Auscultation: Voice soundsAuscultation: Voice sounds
Voice Transmission Tests: are only used in special
situations. All these tests become abnormal in
consolidation. They include:
Bronchophony
Whispered Pectoriloquy
Egophony
Local Examination of the ChestLocal Examination of the Chest
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Auscultation: Voice sounds- BronchophonyAuscultation: Voice sounds- Bronchophony
1. Ask the patient to say "ninety-nine“ or 44 in arabic several
times in a normal voice.
2. Auscultate several symmetrical areas over each lung.
3. The sounds you hear should be muffled and indistinct.
Louder, clearer sounds are called bronchophony.bronchophony.
Local Examination of the ChestLocal Examination of the Chest
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Voice sounds: Whispered PectoriloquyVoice sounds: Whispered Pectoriloquy
1. Ask the patient to whisper "ninety-nine“ or 44 in arabic
several times.
2. Auscultate several symmetrical areas over each lung.
3. You should hear only faint sounds or nothing at all. If you
hear the sounds clearly this is referred to as whisperedwhispered
pectoriloquy.pectoriloquy.
Local Examination of the ChestLocal Examination of the Chest
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Voice sounds: EgophonyVoice sounds: Egophony
1.1. Ask the patient to say "ee" continuously.Ask the patient to say "ee" continuously.
2.2. Auscultate several symmetrical areas over each lung.Auscultate several symmetrical areas over each lung.
3.3. You should hear a muffled "ee" sound. If you hear an "ay"You should hear a muffled "ee" sound. If you hear an "ay"
sound this is referred to assound this is referred to as "E -> A" or"E -> A" or egophony.egophony.
Local Examination of the ChestLocal Examination of the Chest