CHEST

COMMENT
1. AIR entery: >> normal ?? equal on both sides??
2. ccc of breath sounds>> vesicular (normal) or bronchial
3. ccc of the phase (( inspiratory or expiratory))
4. add sounds:
- Wheez >> expiratory ( asthma) or inspiratory
Unilateral or bilateral
*Continous or interrupted.
- Crackle >> medium or coarse or fine
*Dis continiou or interrupted

Causes of wheezing (usually is expiratory)
Asthma( sibilant rhonchi) , bronchiolities , aspiration syndrome, bronchial obstruction( FB, tumor), CHF,
angioedema. Bronchitis( sonorous rhonchi)
Causes of acute stridor( usually inpiratory)
A= anaphylaxis, B= bacterial trachitis, C= croup, d= diphtheria, e= epiglottis. F= FB,
Chronic= larygiomalacia trachiomalacia
Causes of crackle( usually is inspiratory)
Fine inspiratory crackle >>>bronchpneumnia
Coarse crackle, biphasic>>> supprative lung diseas, pul. Edema, organophorus posing,
( in general: ARDS asthma bronchiectasis chronic bronchitis consolidation early CHF
interstitial lung diseas- pulmonary edema)
Fine: pulmonary fibrosis or Lt heart failure, early pneumonia
Medium: pulmonary edema
Coarse : bronchiectasis, late pneumonia

Causes of bronchial breathing
Consolidation, l.collapse, larg cavity





CVS
Auscultation of the heart
1- Normal heart sounds:
normal first and second heart sounds are audiable with normal intensity
First ( best at apex ) 2
nd
best hear at base of the hear
2- No add sounds: ( eg; 3ed ,4
th
heat sounds,opening snap and click)
3- No murmur

If there is murmur:
Comment
Location( max intensity), timing(systolic or diastolic or both), duration( eg pansystolic), intensity ( grading),
radiation, quality(e.g low or heigh pitched or harsh, rumbling)

Note:
VSD= normal hear souds with load harsh pansystolic mur at left sterna edge in the 3ed and 4
th

intercostals space radiated in a fan shape( all over) ,

ASD=wide fixed splitting of2nd sound ,/ with ejection systolic mur at pulmonary area
What is ur dd? >>> pulmonary stenosis.

PDA=normal h sounds// continuous( machinery) mur below the left clavicle radiade to the back.
AS= splitting of the 2
nd
sound//ejection systolic in aortic area radiate to the neck.

MS= Loud 1
st
hs// low pitched mid diastolic rumbling murmur at the apex proceded by opening snap.

MR= wide splitting of 2
nd
hs// with blowing pansystolic mur at the apex radiate to left axilla.