This document provides an introduction to examining the chest, lungs, heart, and cardiovascular system during a clinical skills examination. It covers evaluating the chest externally including landmarks, muscles, and surface anatomy. Techniques for examining the lungs are described, including inspection, palpation, percussion, and auscultation. The heart and cardiovascular system are also discussed, such as heart sounds, murmurs, arterial pulses, blood pressure, and jugular vein pressure. The document provides guidance on recording clinical findings.

1. Introduction to Clinical Skills Thorax, Lungs and CVC system Universidad Iberoamericana UNIBE

2. Introduction to Clinical Skills Teaching Staff Dra Elizabeth Peralta Dr Marcos Núñez Dra Cristina Páez C Dr Juan Carlos Mariñez Dra Wayna Greo Dra Yun Pey Lee

3. Introduction to Clinical Skills Chest Exam: anterior and posterior Landmarks Muscle skeletal Mediastinum Lungs Heart

4. Introduction to Clinical Skills Chest Exam: anterior and posterior Landmarks C7 Louis angle Tip of scapula

5. Introduction to Clinical Skills Chest Exam: anterior and posterior Landmarks

6. Introduction to Clinical Skills Chest Exam: anterior and posterior Muscle skeletal Exam Pectoralis major…………….. Trapezius ……………….. M0 to M5

7. Introduction to Clinical Skills Chest Exam: anterior and posterior Surface Anatomy

8. Introduction to Clinical Skills Chest Exam: anterior and posterior Surface anatomy

9. Introduction to Clinical Skills Chest Exam: anterior and posterior Mediastinum Heart and great vessels

10. Introduction to Clinical Skills Chest Exam: anterior and posterior The Lungs The Trachea and major bronchi The Pleurae Lungs , Fissures and Lobes Breathing

11. Introduction to Clinical Skills Chest Exam: anterior and posterior The Health History Chest pain Myocardium, Pericardium, Aorta Trachea and large bronchi, Pleura (parietal) Chest wall Esophagus Extrathoracic : Gallbladder, Stomach Shortness of breath (dyspnea) Wheezing Cough Blood-streaked sputum (hemoptysis)

12. Introduction to Clinical Skills Chest Exam: anterior and posterior Health Promotion and Counseling Tobacco cessation CAD, Stroke, PVD COPD Cancer Immunizations Influenza Neumococcus

13. Introduction to Clinical Skills Chest Exam: anterior and posterior Techniques of Examination Assess patient Color Observe and Listen patient´s breathing Rate, Rythm, Depth and Effort of breathing Inspect the neck Observe shape of the Chest

14. Introduction to Clinical Skills Chest Exam: anterior and posterior Techniques of Examination Inspection Palpation Percussion Auscultation

15. Introduction to Clinical Skills Chest Exam: anterior and posterior Techniques of Examination: Inspection

16. Introduction to Clinical Skills Chest Exam: anterior and posterior Techniques of Examination: Palpation Diaphragm mobility Tactile fremitus

17. Introduction to Clinical Skills Chest Exam: anterior and posterior Techniques of Examination: Percussion Resonance

18. Introduction to Clinical Skills Chest Exam: anterior and posterior Techniques of Examination: Percussion Dullness

19. Introduction to Clinical Skills Chest Exam: anterior and posterior Techniques of Examination: Percussion

20. Introduction to Clinical Skills Chest Exam: anterior and posterior Techniques of Examination: Auscultation

21. Introduction to Clinical Skills Chest Exam: anterior and posterior The Thorax and Lungs. Recording findings “ Thorax is symmetric with good expansion. Lungs resonant. Breath sounds vesicular, no rales, wheezes, or rhonchi. Diaphragms descend 4 cm bilaterally”.

22. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Surface projections of Heart and Great vessels Cardiac chambers, valves and circulation Events in the Cardiac Cycle Splitting of Heart Sounds Heart murmurs Auscultatory findings to the chest wall The conduction system Arterial pulses and Blood Pressure Jugular venous pressure

23. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Surface projections of Heart and Great vessels

24. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Cardiac chambers, valves and circulation

25. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Events in the Cardiac Cycle

26. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Events in the Cardiac Cycle

27. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Splitting of Heart Sounds

28. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Turbulence = Heart murmurs (physiologic) http://www.wilkes.med.ucla.edu/intro.html

29. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Auscultatory findings to the chest wall

30. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System The conduction system

31. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Arterial pulses and Blood Pressure

32. Introduction to Clinical Skills Chest Exam: anterior and posterior Factors Influencing Arterial Pressure Left Ventricular stroke volume Distensibility of the aorta and the large arteries Peripheral vascular resistance, particularly at the arteriolar level Volume of blood in the arterial system

33. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Jugular venous pressure

34. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Jugular venous pressure

35. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Jugular venous pulsations

36. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System The Health History Chest pain Palpitations Shortness of breath Dyspnea Orthopnea Paroxysmal dyspnea Swelling or edema

37. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Health Promotion and Counseling Screening for hypertension Screening for coronary heart disease and stroke Screening for dyslipidemias Promoting lifestyle modification and risk - factor reduction

38. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination Jugular Venous Pressure and Pulsations The Carotid Pulse The Heart Functional Murmurs

39. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: JVP and pulsations

40. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: The Carotid pulse

41. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination : The Heart

42. Introduction to Clinical Skills Chest Exam: anterior and posterior

43. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: The Heart

44. Heart and Cardiovascular System Techniques of Examination: The Heart

46. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination Functional Murmurs

47. Introduction to Clinical Skills Chest Exam: anterior and posterior Heart and Cardiovascular System Recording your Findings “ The Jugular venous pulse is 3 cm above the sternal angle with the head of the bed elevated to 30°. Carotid upstrokes are brisk, without bruits. The point of maximal impulse is tapping, 7 cms lateral to the midsternal line in the 5th intercostal space. Crisp S1 and S2. At the base S2 is greater than S1 and physiologically split, with A2 > P2. At the apex S1 is greater than S2 and constant. No murmurs or extrasounds.”