胸部查體英文(全)

1、 Physical Examination-ChestSection1 Landmarks of the chest wallSection2 Chest wall,Thorax and BreastSection3 Lungs and pleuraThe main contentSection1 Landmarks of the chest wallSection2 Chest wall,Thorax and BreastSection3 Lungs and pleuraThe main contentThe chest is the area below the neck, above t

2、he abdomenThere are some landmarks on the surface of our chest wallThey are important to us to find out body surface localization of viceral organsPart 1. BONY LANDMARKSSuprastenal notchManubrium sterniSternal angle Xiphiod process Superabdominal anglePart 1. BONY LANDMARKSRib Intercostal space Scap

3、ulaSpinous process costolspinal angle It is located at the top of the sternum and can be felt as a depression at the base of the neck1.Suprastenal notchSuprastenal notchIt is the upper portion of the sternum with a hexagonal shape.Its upper part connects bilaterally to the sternal end of each clavic

4、le,and lower part connects to the body of the sternum2.Manubrium sterniThe junction of the manubrium and thebody of the sternumproduces a slightangle protruding anteriorly,the angle of Louis3.Sternal angle /Louis角Sternal angleManubrium sterniBody of the sternumSternal angle /Louis角It marks?the secon

5、d costal cartilage indicates the tracheal bifurcation the upper level of the atria inferior border of the fourth thoracic vertebra由7-10肋軟骨與胸骨下端構(gòu)成4.Suprabdominal angle1. approximaterly 70-110in normal condiction2. It can be narrower in slender and wider in dumpy persons3.Its top is the xiphoid proces

6、s12 pairs of ribs1th-10th fixed sternum and spine11th/12th ribs are called free ribs,they are attached to the vertebrae only.The space between tow ribs is intercostal space.It is numbered by the rib above it.5.Rib AND Intecostal space1.overlying the rib 2-8.2.marks to the level of the eighth thoraci

7、c3.the seventh intercostal space6.ScapulaSubscapular angle When you head down,the seventh cervical spinous process is the most prominent one,we use it to count the thoracic vertebra. 7.Spinous processanterior chest walllateral chest wallposterior chest wall Part 2. IMAGINARY LINESAnterior midlinenam

8、ely midsternal linea vertical line drawn through the middle of the sternumAnterior chest wallAnterior midlineSternal line(L,R)running along the vert edges of the sternum and parallel to the anterior midlineAnterior chest wallSternal lineParasternal line(L,R)the middle of sternal line and midclavicul

9、ar lineAnterior chest wallParasternal lineMidclavicular line(L,R)drawn through the minddle points of the clavcles and parallel to the anterior midlineAnterior chest wallMidclavicular lineAnterior axillary line(L,R)drawn along the anterior axillary folds and parrallel to the anterior mindlineLateral

10、chest wallAnterior axillary linePosterior axillary line(L,R)parrallel the anterior mindlinealong the posterior axillary foldsLateral chest wallPosterior axillary lineMidaxillary line(L,R)drawn from the vertex of the axilla and parallel to the anterior mindlineLateral chest wallMidaxillary linePoster

11、ior midlinenamely midspinal linepassing through the posterior spinous processes of vertebraePosterior chest wallPosterior midlineScapular line(L,R)parallel to the posterior midline and passing through the inferior angle of the scapularThe thoracic punture is typically located on this linePosterior c

12、hest wallScapular linePart 3. NATURAL FOSSA AND ANATOMIC REGIONPart 4. TOPOGRAPHY OF LUNGS AND PLEURAlungs apexsuperior boundary of the lunglateral boundary of the lungmedial boundary of the lunginferior boundary of the lungpleuraLung apex It is blunt superior end of the lung ascending 2-4cm above t

13、he inner third of the clavicleLUNGS AND PLEURALung apexSuperior boundary of the lung Its projection on the anterior chest wall forms an upward arcLUNGS AND PLEURASuperior boundary of the lungLateral boundray of the lung It extends from the superior boundary of the lung,and approaches the inner surfa

14、ce of the lateral chest wallLUNGS AND PLEURALateral boundray of the lungMedial boundray of the lungthe two sides nearly meet each other at the sternal angle,then runs down along the anterior midlineLUNGS AND PLEURAMedial boundray of the lungInferior boundray of the lungextend to the sixth interspace

15、 at the midclavicular lineextend to the eighth interspace at the midaxillary lineextend to the theth interspace at the scapuar lineLUNGS AND PLEURAInferior boundray of the lungPLEURAeach lung is enclosed in a serous pleural sac that consists of two continuous membranesVisceral pleuraParietal pleuraL

16、UNGS AND PLEURAVisceral pleuraParietal pleuraVisceral pleuracovers the surface of the lungs Parietal pleuralines the pulmornar cavtitiesadhering to the thoacic wall the mediastinum an diaphragmLUNGS AND PLEURAVisceral pleuraParietal pleuraSection1 Landmarks of the chest wallSection2 Chest wall,Thora

17、x and BreastSection3 Lungs and pleuraThe main contentVeinSubcutaneous EmphysemaChestWall TendernessIntercostal SpacePart 1.CHEST WALLVeinNormally the venous pattern of the chest wall is barely perceptibelSuperficial veins visible little subcutaneous fat and breastfeeding womens breastsIf the superfi

18、cial veins are distended or varicose,the direction of blood flow should be determined Part 1.CHEST WALLVaricosity of chest wallPart 1.CHEST WALL1.Exposure to the chest2.With two fingers to press on each end of the veinExamination of chest wall VaricosityPart 1.CHEST WALL3.Release one finger and obse

19、rver the venous filling rate.P3. The veins fill slowly4.Release the other finger,P4.The veins swell quickly.You can see the direction of the venous filling.Part 1.CHEST WALLSubcutaneous Emphysemacondition that occurs when air or gas gets into tissues under the skinInspection-SwellingPalpation-sensat

20、ion of grasping snowcommon causes thoracic trauma ribs fracture thracic close drainage and thoracentesisPart 1.CHEST WALLChestWall TendernessNormally there is no tenderness on chest mon causes intercostal neuritis costal chondritis soft tissue inflammation Tenderness and percussion pain of the stern

21、um are common in the patients with leukemiaPart 1.CHEST WALLExamination of chest wall tendernessPart 1.CHEST WALLIntercostal SpaceIt must be mentioned whether the intercostal space is narrow or bulging.Retraction/sunken- obstruction of respiratory tractBulging -massive pleural effusion tension pneum

22、othorax severe emphysemaPart 1.CHEST WALLThe depressions of intercostal space,suprasternal fossa and supraclavicular fossa during inspiration.suprasternal fossasupraclavicularfossaintercostal spaceThree depression signPart 1.CHEST WALLNormal thorax：bilaterally symmetrical and ellipticalPart 2.THORAX

23、anteroposterior diameter: transverse diamter=1:1.5Part 2.THORAXFlat ChestThe thorax is flat and the anteroposterior diameter is less than half of the transverse diameter.slender adultsTBPart 2.THORAXBarrel Chest significant increase in the anteroposterior diameterThis diameter is sometimes approxima

24、tely equal to or even greater than the transverse diameter.COPDAsthmaPart 2.THORAXcylindric thoraxRachitic ChestThe sternal ends of rachitic ribs bulge at their costochondral junctions like rosary,termed rachitic rosary.Part 2.THORAXRachitic ChestThe anteroposterior diameter is a little longer than

25、the transverse diameter,the sternum is bulging and the adjacent ribs are depressed.This kind of thoracic defomity is called pigeon chest.Part 2.THORAXFunnel Chest reverse of the pigeon chestmost cases are congenital.Part 2.THORAXSpine malformations Part 2.THORAXIn normal children and males,the breas

26、ts are rudimentary.The nipple is usually at the lever of the fourth intercostal space or the fifth rib. The patient takes a seat or supine position. Two steps of visual inspection and palpation.Part 3.BREAST1. InspectionSymmetry and sizeSkin of breastNippleAreolaPart 3.BREAST1. InspectionSymmetry an

27、d sizeObserve whether the breast is symmetrical on both sides.Skin of breastIs there redness in the breast skin?Skin erythema of the breast is often associated with inflammation or cancer.Inflammation is always accompanied by local sweling,fever and pain.Part 3.BREAST1. InspectionNipplesize and colo

28、r of two are similar.Recently, nipple retraction is most likely to become cancerous.The bloody discharge fom the nipples is most often seen in breast cancer.Areolainclude size,shape,symmetry,color and surface characteristics.Part 3.BREAST2. PalpationThe breast is divided into four quadrants by imagi

29、nary vertical and horizontal lines intersecting at the nipple.Part 3.BREASTUpper lateral quadrantLower lateral quadrantUpper medial quadrantLower medial quadrant2. PalpationCheck order: first check the healthy side, then check the side of the disease.Upper lateral Lower lateralUpper medial Lower med

30、ialPart 3.BREAST2. PalpationTechnique: Refers to the finger pulp light pressure, using rotary and sliding palpation.Part 3.BREAST2. PalpationContent: 1.硬度和彈性（consistency and elasticity） 2.壓痛（tenderness） 3.包塊（masses）：部位(location), 大小(size), 數(shù)量(number)，外形(contour), 硬度(consistency), 壓痛(tenderness), 活動(dòng)度

31、 (mobility).Part 3.BREASTSection1 Landmarks of the chest wallSection2 Chest wall,Thorax and BreastSection3 Lungs and pleuraThe main contentMatters needing attention1.The patient was seated or supine, exposing the chest sufficiently2.The indoor environment is comfortable and warm, and natural light i

32、s good3.Pay attention to the contrast of the corresponding parts on the left and right sidesLUNGS AND PLEURAMatters needing attention4.Order: up to down front to back contrast left and rightInspectionPalpationPercussionAuscultationLUNGS AND PLEURAPart1.INSPECTIONBreathing MovementRespiratory Frequen

33、cyRespiratory DepthRespiratory Rhythm and RangeNormal breatStable, rhythmic, bilateral symmetryAbdominal breathing-Men and childrenThoracic breathing-FemalePart1.INSPECTIONBreathing MovementThe respiratory rate in the newborn is about 44 cycles per minuteThe normal rate in adults is between 12 and 2

34、0,and the ratio of respiration to pulse is 1:4.Part1.INSPECTIONRespiratory FrequencyTachypneaIt is defined as incrased respiratory rate over 24 cycles per minute.feverpainhypoxiaanemiaheart failurePart1.INSPECTIONRespiratory FrequencyBradypneaIt is defined as decrased respiratory rate less than 12 c

35、ycles per minute.narcotic or sedative overdoseincreased intracranial pressurePart1.INSPECTIONRespiratory FrequencyShallow breathingDeep breathingPart1.INSPECTIONRespiratory Depthnormal respiration are regular and smoothabnormalTidal breathingBiot breathingSighing breathPart1.INSPECTIONRespiratory Rh

36、ythm and RangeTidal breathing(Cheyne-Stokes)Part1.INSPECTIONRespiratory Rhythm and RangeShallow and slow Deep and fast ApneaShallow and slow Each cycle of tidal breathing lasts 30s to 2min,and the apneic period lasts 5 to 30 secondsBiot breathingPart1.INSPECTIONRespiratory Rhythm and RangeBreath Apn

37、eaApneaBreathPeriods of apnea alternate irregularly with series of equal depth that terminate abruptlySighing breathThe normal respiratoryrhythm arest is occasionally interruptedby a long,deep,sigh.It seen inpanasthenia or depressionPart1.INSPECTIONRespiratory Rhythm and RangePart2.PALPATIONThoracic

38、 ExpansionVocal FremitusPleural Friction FremitusPlace your palms flat on the symmetrical side of your chest and ask the patient to take a deep breath. Compare the breathing movements on both sidesPart2.PALPATIONThoracic ExpansionPlace your hands on the chest with the extended thumbs lying along the

39、 inferior edges of the costal margins Part2.PALPATIONThoracic ExpansionPlace your thumbs at the level of the tenth rib,press the tissues and pull your hands medially until your thumbs meet spines Part2.PALPATIONThoracic ExpansionPart2.PALPATIONThoracic ExpansionUnilateral increase in thoracic Expans

40、ionoccurs when the contralateral lung expansionpulmonary atelectasisrib fracturesPart2.PALPATIONThoracic ExpansionUnilateral decrease in thoracic Expansionoccurs unilateral decrease of lung elasticity or air contentuilateral pleural thickening or rib and soft tissue lessionsPart2.PALPATIONThoracic E

41、xpansionBilateral increase in thoracic Expansionasciteshepatosplenomegalygiant abdominal tumoracute peritonitisPart2.PALPATIONThoracic ExpansionBilateral decrease in thoracic Expansioncentral nervous system diseasesperipheral neuropathyrespiratory muscle weaknessextensive lung lesionsPart2.PALPATION

42、Thoracic ExpansionDuring speech,the patients vocal cords set up vibrations in the bronchial,and conduct to the chest wall.They may be perceived by vibratory palpation.Different lung disease respond Vocal fremitus differently Part2.PALPATIONVocal FremitusTechnique:Place your palms or thenar sides of

43、your hands on the patients chest wall symmetrically and ask him/she to repeat the test words“yi” ,using the same pitch and inensity of voice each time.Feel the vibrations and compare symmetrical parts of the chest.Part2.PALPATIONVocal FremitusPart2.PALPATIONVocal FremitusPart2.PALPATIONVocal Fremitu

44、sDecrease or absenta.alveoli contain too much gas -emmpysemab.bronchial obstruction-bronchial carcinomac.massive pleural effusion or pneumothoraxPart2.PALPATIONVocal FremitusDecrease or absentd.severe pleural thickening and adhesione.subcutaneous emphysema or edema of the chest wallPart2.PALPATIONVo

45、cal FremitusIncrease a.lung consolidation-lobar pneumoniab.large cavity in the lung,especially when the cavity is close to the chest wall-cavitary pulmonary tuberculosispression atelectasisPart2.PALPATIONVocal FremitusNormally-on pleural friction fremitusInflamtion-The sensation is like two pieces o

46、f leather being rubbed together.most obvious in the lower part of the thoraxIt can be palpated in two stages of breathingIt disappears when the patient holds the breathPart2.PALPATIONPleural Friction FremitusDiseasesa.pleuritisb.primary or secondary pleural tumorsc.severe pleural drynessPart2.PALPAT

47、IONPleural Friction FremitusPart2.PALPATIONPleural Friction FremitusPart3.PERCUSSIONTechniques of PercussionNormal and Abnormal Percussion Notes of the ThoraxPercussion of Lung BoundaryPart3.PERCUSSIONTechniques of PercussionTechnique:Patient relax and breathe evenly in the sitting or supinePercuss

48、the chest top to down,anterior to posteriorpleximeter finger is usually placed parallel to the ribs,percussing the interscapular ,finger should parallel to the spinePart3.PERCUSSIONTechniques of PercussionTechnique: 1.The front of the second knuckle of the middle finger of the left hand is used as a

49、 percussion board, and the end of the middle finger(plexor finger) of the right hand is used as a percussion hammer. The sound is judged by percussion on the wrench finger in a vertical direction.Part3.PERCUSSIONTechniques of PercussionTechnique:2.quick flick of the strike thee pleximeter finger 2-3

50、 times,and then withdraw your striking finger quickly,called mediate percussion.3.The immediate percussion is performed by striking the thoracic wall directly with the figers or hand.Part3.PERCUSSIONTechniques of PercussionTechnique:Part3.PERCUSSIONTechniques of PercussionPart3.PERCUSSIONNormal and

51、Abnormal Percussion NotesThe normal percussion note of the lungs is resonance,but there is a little difference among various parts.Where the chest wall muscles are thicker,the percussion is a little dullPart3.PERCUSSIONNormal and Abnormal Percussion NotesWhen lung resonance is replaced by abmormal s

52、ounds suggested diseases.Abnormal Percussion Notes:Abnormal dullness or flatnessHyperresonanceTympany(Drum sound)Part3.PERCUSSIONPercussion of Lung BoundarySuperior Boundary of the lungIt the width of the apices(4-6cm)Technique:Percuss from the central part of the anterior edge of the trapezius musc

53、le to inner side and outer side respectively until dullness replaces resonance.The width of the resonant boundary is the width of apices.Part3.PERCUSSIONPercussion of Lung BoundarySuperior Boundary of the lungNarrowed-TB,pneumonia,lung tumorsWidened-emphysema,pneumothoraxPart3.PERCUSSIONPercussion o

54、f Lung BoundaryAnterior Boundary of the lungNormally,the anterior boundary of the lung is equivalent to the cardiac dullness.Part3.PERCUSSIONPercussion of Lung BoundaryInferior Boundary of the lungextend to the sixth interspace at the midclavicular lineextend to the eighth interspace at the midaxill

55、ary lineextend to the thenth interspace at the scapuar linePart3.PERCUSSIONPercussion of Lung BoundaryPart3.PERCUSSIONPercussion of Lung BoundaryMovement range of the inferior Boundary of the lungTechnique:1.Determine the level of the inferior lung boundary during quiet respiration.2.Ask the patient

56、 to take a deep breath and hold it,percuss downward until dullness replaces resonance and mark itPart3.PERCUSSIONPercussion of Lung BoundaryMovement range of the inferior Boundary of the lungTechnique:3.Ask the patient to exhale deeply and hold breath,percuss the infeior lung boundary again and mark

57、 it.4.The distance between the two marks is the movement range of the inferior lung boundaryPart3.PERCUSSIONPercussion of Lung BoundaryPart3.PERCUSSIONPercussion of Lung BoundaryPart3.PERCUSSIONPercussion of Lung BoundaryMovement range of the inferior Boundary of the lung6-8cm(at scpular line)decrea

58、sed-emphysema atelectasis pulmonary fibrosisPart4.AUSCULTATIONNormall Breath SoundsAbnormal Breath SoundsAbnormal Bronchial Breath SoundsAbnormal Bronchovesicular Breath SoundsRalesPleural Friction RubPart4.AUSCULTATIONNormall Breath SoundsBronchial breath soundsVesicular breath soundsBronchovesicul

59、ar breath soundsPart4.AUSCULTATIONNormall Breath SoundsBronchial breath soundsAir flow through the glottis,trachea or main bronchiSound is loud and high pitched.Heard in the suprasternal notch and over the sixth and seventh cervical spines.Part4.AUSCULTATIONBronchial breath sounds-mechanismPart4.AUS

60、CULTATIONBronchial breath sounds-LocationPart4.AUSCULTATIONNormall Breath SoundsBronchial breath sounds“ha-ha”Part4.AUSCULTATIONNormall Breath SoundsVesicular breath soundsAir flow through the bronchioli and alveoli.Sound is soft and low pitched.Heard almost over the entire lung surface,except the s