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Physical Examination: Dr. F Sahat H Situmorang, SPPD

This document provides guidance on performing a physical examination, including inspection, palpation, percussion, and auscultation of various body systems and organs. It describes: 1) The locations of important anatomical landmarks and regions for examination of the chest, including imaginary lines and areas of dullness or tympanic sounds. 2) The characteristics of different lung sounds identified by percussion including their location, pitch, and potential pathological associations. 3) Normal breath sounds identified during auscultation of the lungs and how physical findings can help identify conditions like pneumonia, effusion, and COPD. 4) The normal heart sounds and changes in intervals that may indicate different cardiac pathologies.

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Joan Simatupang
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35 views20 pages

Physical Examination: Dr. F Sahat H Situmorang, SPPD

This document provides guidance on performing a physical examination, including inspection, palpation, percussion, and auscultation of various body systems and organs. It describes: 1) The locations of important anatomical landmarks and regions for examination of the chest, including imaginary lines and areas of dullness or tympanic sounds. 2) The characteristics of different lung sounds identified by percussion including their location, pitch, and potential pathological associations. 3) Normal breath sounds identified during auscultation of the lungs and how physical findings can help identify conditions like pneumonia, effusion, and COPD. 4) The normal heart sounds and changes in intervals that may indicate different cardiac pathologies.

Uploaded by

Joan Simatupang
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Physical Examination

Dr. F sahat H Situmorang, SpPD

PADAT

CAIR

GAS

LEBIH PADAT
a
b
GAS
c
d
Bunyi = getaran yang dapat didengar (20 - 20000 Hertz)

Volume =

V=
Tekanan

(Pascal)
P

Anterior imaginary lines and


landmarks
Suprasternal fossa

Infraclavicular fossa

Anterior midline

Supraclavicular fossa

Sternal line

Parasternal line

Midclavicular line
epigastric angle

Lateral imaginary lines

Posterior axillary line


Anterior axillary line
Midaxillary line

Posterior imaginary lines and


landmarks
Suprascapular region
Interscapular region

Infrascapular region
Scapular line

Posterior midline

s
Shifting range of
bottom of lung

6-8 cm

Garlands triangle area


(tympanitic dullness)

Damoiseaus curve

Groccos triangle area


(dullness)

Percussion:
Sounds.
Note

Intensity

Pitch

Location

Path.

Flat

Soft

High

Thigh

Pleural Effusion

Dull

Medium

Medium

Liver

Lobar Pneumonia

Resonant

Loud

Low

Lung

Normal Lung

Hyperresonant

Very Loud

Lower

None

Emphysema
Pneumothorax

Tympany

Loud

High

Gastric
Air

Large
Pneumothorax

Auscultation:
Normal Sounds.
Sounds

Intensity

Pitch

Duration

Location

Vesicular

Soft

Low

Inspir > Expir

Lungs

Broncho-vesicular

Medium

Medium

Inspir = Expir

Central airways

Bronchial

Loud

Inspir < Expir

Trachea

High

Note: Auscultation should be performed with diaphragm of stethoscope

Physical exam can identify pathology :


Condition

Trachea

Percussion Breath Sounds

Fremitus

Adventitial

Normal

Midline

Resonant

Normal

Normal

None

Pneumonia

Midline

+/- Dull

Bronchial

Increased

Crackles

Effusion

Shifted

Dull

Decreased

Decreased

None

Pneumothorax

Shifted

Hyper

Decreased

Decreased

None

COPD

Midline

Hyper

Decreased

Decreased

Wheezes

CHF

Midline

Resonant

Normal

Normal

Crackles

Jantung

Sistolik
Miokard Kontraksi
Mitral/Tricuspidal tertutup
Aortal/Pulmonal terbuka
Aliran darah (blowing)
hembus
Bunyi Jantung sistolik
Bunyi Jantung 1 BJ1

Bunyi

Diastolik
-Miokard Dilatasi
Mitral/Tricuspidal terbuka
Aortal/Pulmonal tertutup
Aliran darah (rumbling)
sedot

Bunyi Jantung diastolik


Bunyi Jantung 2

BJ2

Bunyi

A1 < A2

P1 < P2
A2 < P2
A2 = P2
A2 > P2
A2 = P2
A2 < P2

M1 > M2

HEART SOUNDS
Acute rheumatic fever Loud first sound
Mitral stenosis Accentuated first sound
Mitral stenosis Opening snap
Mitral stenosis Short, mid-diastolic murmur
Mitral stenosis Presystolic murmur
Mitral regurgitation Systolic murmur
Mitral regurgitation Systolic murmur,high pitched and blowing type
Mitral regurgiation Systolic murmur, crescendo type
Mitral regurgiation Late systolic murmur, crescendo type
Mitral regurgiation Mid systolic click and late systolic murmur
Mitral regurgiation Holosystolic murmur
Mitral regurgiation Third heart sound
Mit reg+Mit stenAll sound features of mitral stenosis and mitral regurgitation

HEART SOUNDS
Aortic insufficiency Loud systolic ejection murmur, third sound
Aortic stenosis Opening snap of aortic valve, early systolic ejection sound
Pulmonary stenosis Harsh systolic ejection murmur
Tricuspid regurgitation Holosystolic murmur, high pitched,
lower during expiration and louder during inspiration
Ventricular sepatal defect Continuous murmur
Atrial septal defect Abnormal splitting of second sound during expiration
Patent ductus arteriosus Continuous "machinery" murmur
Coarctation of aortaSystolic murmur
Right bundle branch block of first sound
Complet heart block Slow heart rate,varying first sound
Systemic hypertension Accentuated second sound

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