Internal disease- chest examination

Finally learning sumthing i like in med school...
Internal disease class..!! Seems to be much more look like a doct..!!hahaha...
Lets do some recap...
First of all... The first of that they teach about the importance of taking medical history of pt..
Their age,job,what they've ate,family medical history,symptoms n evrything...
various diagnostic procedures (inspection, measuring temperature, percus sion, auscultation, palpation, laboratory tests, X-ray examination, etc

Then i jz realise the important of medical history towards a diagnosis(dx)..
So,then we learn about, how to do physical examination(P.E)..
Okie..theres few types..

A.) Percussion
-An assessment method in which the surface of the body is struck with the fingertips to obtain sounds that can be heard or vibrations that can be felt. It can determine the position, size, and consistency of an internal organ. It is done over the chest to determine the presence of normal air content in the lungs, and over the abdomen to evaluate air in the loops of the intestine.
Compare percussion notes on both lung fields at same intercostal levels. 

Normal percussion note is resonant. 
Dullness on percussion is caused by consolidation (as in pneumonia), fluid (as in pleural effusion). 
Hyperresonance heard in case of a pneumothorax.

B.) auscultation- to hear

• Auscultate the anterior chest wall (both right and left), especially the apex of both lungs. TB commonly affects this area.
• Auscultate the posterior chest in right and left lung fields, especially at the base of the lungs, for breath sounds and adventitious sounds (rales, ronchi, wheezes).
• The normal breathing pattern heard all over the lung is referred to as vesicular breathing. The inspiration limb is longer than the expiration limb.
• Bronchial breath sounds (see figure below), where the expiratory sound is higher pitched and louder than in vesicular breath sounds, the expiratory component is equal to or greater than the inspiratory component. These bronchial sounds are normal over the trachea and the large bronchi. It is abnormal if heard in the peripheral parts of the lungs.
• Auscultation of the right and left lung must be done at the same intercostal level for comparison of auscultatory findings

• Wheezes:
  • Wheezes are whistling sounds caused by constriction of the bronchioles, e.g., asthma.
• Rales and ronchi:
  • These are crackling sounds produced due to the presence of fluid in the lungs, e.g., bronchitis, congestive heart failure (CHF). The vesicular and bronchial breath sounds in relationship to the inspiratory and expiratory component.

C.) palpatation- To examine by feeling and pressing with the palms of the hands and the fingers. 



D.) inspection

a) The shape of the chest
b) The type of breathing
(c) The degree of expansion of the chest wall (movement of the chest wall during respiration)
d) The rate of respiration
(e) The rhythm of respiration
(f) The presence of prominent superficial veins on the chest wall, if any
g) Any growth or bulging
h) Any retraction of the chest wall e.g. in Pancot's tumor, big cavities
I.) Any winging of scapula etc

Normal shape of chest
- normostenic
- hyperstenic
- hypostenic
Pathological shape of chest
-pigeon shape
- emphysematous
- funnel shape
-paralytic chest
- foveated chest

Type of breathing
- abdominal
- chest

Sputum test

Sputum
Term	Description	Associated with
1.Fetid	Foul-smelling, typical of	Bronchiectasis, lung
	anaerobic infection	abscess, or cystic fibrosis
2.Frothy	White or pink-tinged, foamy, thin sputum	Pulmonary edema
3.Hemoptysis	Expectoration of blood or bloody sputum; amount may range from blood-streaked tomassive hemorrhage	A variety of pathologies
4.Mucoid	White or clear, not generally associated with broncho-pulmonary infection	Chronic cough (acute orchronic bronchitis, cystic fibrosis)
5.Purulent	Pus, yellow or greenish sputum, often copious and thick	Acute and chronic infection
6.Rusty	Descriptive of the color of sputum (also called prune juice)	Pneumococcal pneumonia

Charcot-Leyden crystals are microscopic crystals found in people who have allergic diseases such as asthma or parasitic infections such as parasitic pneumonia or ascariasis.

Curschmann's spirals
Coiled, basophilic plugs of mucus formed in the lower airways and found in sputum and tracheal washings; indicate chronic obstruction.

Bronchoscopy