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Physical Examination of the Chest Department of medicine Liu Yuan

Physical Examination of the Chest Department of medicine Liu Yuan. Chapter 3 Lungs and Pleura. 1. Inspection Respiratory rate and depth. Tachypnea. Normal. Bradypnea. Fast and Deep Breathing. Respiratory Rhythm. Biots Breathing. Tidal Breathing Cheyne -Stokes. Sighing Breathing.

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Physical Examination of the Chest Department of medicine Liu Yuan

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  1. Physical Examinationof the ChestDepartment of medicine Liu Yuan

  2. Chapter 3Lungs and Pleura 1. Inspection Respiratory rate and depth Tachypnea Normal Bradypnea Fast and Deep Breathing

  3. Respiratory Rhythm Biots Breathing Tidal Breathing Cheyne -Stokes SighingBreathing

  4. 2. Palpation

  5. Thoracic Expansion

  6. Vocal Fremitus

  7. 影响语音震颤2个主要因素 1、气管、支气管是否通畅 2、胸壁传导是否良好

  8. 影响语音震颤3个次要因素 1、通畅的支气管周围的传导介质的密度 固体＞液体＞气体 2、发音强、音调低＞发音弱、音调高 3、距气管、支气管距离近的区域语颤增强

  9. Pneumonia

  10. Pleural Effusion

  11. Pneumothorax

  12. Pleural Friction Fremitus

  13. 正常胸部叩诊音 3. Percussion

  14. Upper Lung Margins Normal 4～6cm

  15. Lower Lung Margins

  16. The Extent of Diaphragmatic Excursion

  17. Abnormal Percussion Sound

  18. 4. Auscultation 三种正常呼吸音 Normal Breath Sounds

  19. Bronchial Breath Sound 机理 特点 部位 喉部、胸骨上窝、背部第6、7颈椎、 第1-2胸椎

  20. Vesicular Breath Sound

  21. 机理 特点 部位 胸骨两侧第1、2肋间、肩胛间区第3、 4胸椎水平、右肺尖 Bronchovesicular Breath Sound

  22. Abnormal Vesicular Breath Sound肺泡呼吸音减弱或消失的常见原因 （1）影响肺泡呼吸音传导 （2）胸廓或肺的扩张受限 （3）通气动力不足 （4 ）通气阻力增大

  23. Abnormal Bronchial Breath Sound 1、肺组织实变 2、肺内大空洞 3、压迫性肺不张

  24. Abnormal Bronchovesicular Breath Sound1、肺实变区域较小与正常含气肺 组织混杂2、肺实变部位较深且被正常肺组 织所覆盖

  25. Rales or Added Sounds 湿性罗音 Moist rales or bubble sound 干性罗音 Dry rales or rhonchi

  26. Moist rales 机理分类Coarse ralesMedium ralesFine ralesCrepitus

  27. 特点：1、常连续多个出现2、吸气相明显3、部位较恒定 性质不易变

  28. Dry Rales or Rhonchi机理分类 Sibilant rhonchiSonorous rhonchi Diffused rhonchiLocalized rhonchi 1、 2、

  29. 特点：1、音调较高2、呼气相明显3、性质、部位易变特点：1、音调较高2、呼气相明显3、性质、部位易变

  30. 语音共振Vocal Resonance胸膜摩擦音Pleural Friction Rub机理 易听诊部位 鉴别诊断 屏气试验 闭口掩鼻试验

  31. Outline for Physical Examination of the Chest Inspection 1. Chest contour, symmetry 2. Breathing rate, rhythm, movement Palpation 1.Tracheal position 2.thoracic expansion 3.vocal fremitus 4.pleural friction fremitus

  32. Outline for Physical Examination of the Chest Percussion 1. resonance, hyperresonance, dullness, tympany, stony dullness 2.lung margins

  33. Outline for Physical Examination of the Chest Auscultation 1.breath sounds 2.added sounds or rales moist rales ,dry rales 3.vocal resonance 4.pleural friction rubs

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