MindMap Gallery Chest examination
Chest examination can be performed by visual inspection, palpation, percussion, and auscultation. Each method has its own advantages. This picture introduces the common examination knowledge for each diagnosis and treatment method.
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This is a mind map about bacteria, and its main contents include: overview, morphology, types, structure, reproduction, distribution, application, and expansion. The summary is comprehensive and meticulous, suitable as review materials.
This is a mind map about plant asexual reproduction, and its main contents include: concept, spore reproduction, vegetative reproduction, tissue culture, and buds. The summary is comprehensive and meticulous, suitable as review materials.
This is a mind map about the reproductive development of animals, and its main contents include: insects, frogs, birds, sexual reproduction, and asexual reproduction. The summary is comprehensive and meticulous, suitable as review materials.
Chest examination
Inspection
thorax
normal
The anteroposterior and transverse diameters of adults are approximately 1:1.5
In children and the elderly, the anteroposterior diameter is slightly smaller than or equal to the transverse diameter.
abnormal
barrel chest
Seen during chronic obstructive emphysema and bronchial asthma attacks
flat chest
Seen in people with a lanky body type, or tuberculosis, etc.
Rickets chest
Chicken breast, common in children, seen in congenital heart disease
pectus excavatum
Seen in patients with rickets and mitral valve prolapse
One side or localized deformation
Thoracic distension
one side
Seen in large amounts of pleural effusion on one side, pneumothorax, etc.
limitation
Seen in cardiac hypertrophy, massive pericardial effusion, aortic aneurysm, etc.
Thoracic depression
Seen in atelectasis, pulmonary fibrosis, etc.
Caused by spinal deformity
chest wall
chest wall veins
No obvious veins are visible on the normal chest wall
When the superior and inferior vena cava return is blocked and collateral circulation is established, the chest wall veins may become filled or varicose.
intercostal space
retract
Airway obstruction. The "three concavities sign" is seen in stenosis or obstruction of the larynx, trachea, and large bronchi.
bulging
Seen in massive pleural effusion, tension pneumothorax or severe emphysema.
lungs and pleura
Breathing type
chest breathing
Normal adult female. It can be seen in abdominal diseases such as peritonitis and ascites and in late pregnancy.
abdominal breathing
Children and adult males. It can be seen in chest diseases such as pneumonia and severe tuberculosis.
Breathing rate depth and rhythm
Respiratory rate
Tachypnea (>20 times/min)
Seen in strenuous physical activity, fever, hyperthyroidism, etc.
Bradypnea (<12 breaths/min)
Seen in deep sleep, intracranial hypertension, barbiturate poisoning, etc.
Breathing depth
Breathe deeply and quickly
Kusmore's breathing, seen in uremia, diabetic ketoacidosis, etc.
Breathing shallowly and quickly
Seen in pneumonia, pleurisy, pneumothorax, etc.
breathing rhythm
tidal breathing
Chen-Shi breathing is seen in hypoxia or CO₂ retention.
pause in breathing
Biot's breathing is seen in intracranial hypertension caused by central nervous system diseases.
irregular breathing
Seen in severe central nervous system disease and shock.
Sobbing breathing
Seen in intracranial hypertension and pre-herniation lesions.
Sighing breathing
Seen in people with neurasthenia, nervousness or depression
respiratory movements
weaken or disappear
limitation
Seen in lobar pneumonia, tuberculosis, lung abscess, etc.
one side
Seen in large amounts of pleural effusion, pneumothorax, atelectasis of one lung, etc.
both sides
Seen in bilateral pulmonary fibrosis, pneumothorax, etc.
Enhance
palpation
chest wall
subcutaneous emphysema
Seen in lung trauma or disease, local infection with Aerobacillus aerogenes, etc.
chest wall tenderness
The chest compression test is an important sign in the diagnosis of traumatic rib fractures. It can also be seen in patients with leukemia who have abnormal bone marrow hyperplasia.
lungs and pleura
Thoracic expansion
Restricted expansion is seen in pleural effusion, pneumothorax, pleural thickening, and atelectasis.
tactile tremor
Enhance
Seen in pulmonary consolidation, large cavities in the lungs, lobar pneumonia, etc.
weaken
Seen in excessive air content in the alveoli, bronchial obstruction, pleural effusion, pneumatosis, etc.
Pleural friction sensation
It is most easily felt in the 5th to 7th intercostal spaces of the midaxillary line.
percussion
Percussion of lung boundary
upper boundary of lung
Voicing or narrowing of voiceless sounds: tuberculosis, pulmonary fibrosis
Clear or widen: emphysema, pneumothorax
anterior border of lung (absolute heart dullness area)
Narrow down: emphysema
Enlargement: cardiomegaly, pericardial effusion, pleurisy
lower boundary of lung
position
Midclavicular line-6, mid-axillary line-8, scapular line-10
move down
Seen in emphysema, abdominal visceroptosis, etc.
Move up
Seen in obstructive atelectasis, lung atrophy, pleural effusion, pneumothorax, etc.
mobility of lower lung boundary
Normal 6-8cm, weakened <4cm, will not increase
weaken
Loss of elasticity of lung tissue: emphysema Collapse of lung tissue: pulmonary fibrosis, atelectasis Local pleural adhesions: pleurisy, lung tissue inflammation after chest surgery, edema
Hard to knock out
Massive pleural effusion, pneumothorax, and extensive pleural hypertrophy
Normal chest percussion sounds
unvoiced
Normal lungs, back from the suprascapular area to the lower edge of the 9th-11th rib, except for the spine
voiced sound
The overlapping area where the lungs meet the liver or heart
solid sound
The heart or liver not covered by the lungs, also known as the absolute dullness area of the heart or liver
Drum sound
The lower left side of the chest is the gastric tympanic sound area.
Physiological variation
The percussion sound in the upper part of the chest is relatively dull compared to the lower part. The percussion sound in the upper part of the right lung is slightly duller than that in the upper part of the left lung. The percussion sound on the back is slightly duller than that on the front chest The right armpit is slightly turbid
Abnormal chest percussion sounds
Voiced or solid sound
Seen in pulmonary effusion, lung tumors, pleural effusion, etc.
drum sound
Seen in cavitary tuberculosis, liquefied and ruptured lung abscess or lung tumor, pneumothorax, etc.
Too unvoiced
Seen during emphysema and bronchial asthma attacks
empty urn sound
Seen in large cavities, superficial locations and smooth cavity walls, or tension pneumothorax, etc.
Broken pot sound
Seen in large cavities and pneumothorax in tuberculosis
Voiced tympanic sound
Seen in atelectasis, congestion or dissipation phase of pneumonia, pulmonary edema, etc.
auscultation
normal breath sounds
tracheal breath sounds
Rough, loud and high-pitched, does not indicate lung disease.
bronchial breath sounds
Location: larynx, suprasternal fossa, 6th and 7th cervical vertebrae, 1st and 2nd thoracic vertebrae
Features: "Ha——" sound, short inhalation and long exhalation
Alveolar breath sounds
Site: normal lung tissue
Characteristics: "Husband——" sound, long inhalation and short exhalation
bronchoalveolar breath sounds
Location: Near the sternal angle, 3rd and 4th thoracic vertebrae
Characteristics: Inhalation is alveolar, expiration is bronchial.
Pathological breath sounds
pathological alveolar breath sounds
weaken or disappear
Seen in respiratory movement disorders, respiratory obstruction, intrathoracic masses, pleural diseases, chest wall thickening, etc.
Enhance
Seen in exercise, fever, respiratory center excitement, hyperthyroidism, etc.
extend
Seen in bronchial asthma, wheezing bronchitis, chronic obstructive emphysema, etc.
intermittent breath sounds
Seen in pneumonia, tuberculosis, bronchial lung cancer, etc.
rough breath sounds
Seen in the early stages of bronchitis or pneumonia
Pitch-modified breath sounds
Seen due to movement of foreign bodies within relaxed bronchial tubes
Pathological bronchial breath sounds
Consolidation of lung tissue
Seen in the consolidation stage of lobar pneumonia, pulmonary tuberculosis, lung abscess, lung tumors, etc.
Large cavity in lung
Seen when tuberculosis, lung abscess, and lung cancer form cavities.
Compressive atelectasis
Seen above a moderate amount of pleural effusion, in the left subscapular area when there is a large amount of pericardial effusion, and around the lung mass
Pathological bronchoalveolar breath sounds
Pulmonary consolidation is small and the location of consolidation is deep
Seen in early stages of bronchopneumonia, tuberculosis, and lobar pneumonia
rales
Dry rales
Features: high adjustment, long duration, obvious exhalation, changeable position
Category: snoring sound - low tone, large airway Whistle tone - high pitch, small airway
Clinical significance: bilateral → asthma localization→tumor
rales
Characteristics: intermittent and short, obvious inhalation, constant location, unchangeable nature, can be relieved or disappeared after coughing
Classification
According to bronchial caliber: thick, medium and fine crackles
According to the loudness level: loud crackles and non-loud crackles
Clinical significance: unilateral → pneumonia Bilateral→pulmonary stasis
Crepitus
Seen in the elderly, those who sleep deeply or are bedridden for a long time; pneumonia or early stage of tuberculosis, pulmonary blood stasis, etc.
auditory speech
weaken
Seen in excessive weakness, bronchial obstruction, chronic obstructive emphysema, etc.
Enhance
Seen in pulmonary consolidation, pulmonary cavities, and compressive atelectasis
"The sound of sheep"
pleural friction rub
Location: Anterior and inferior chest wall
Cause: Major pleural inflammation makes the pleural surface rough
Clinical significance: seen in dry pleurisy, pulmonary infarction, uremia, etc.