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Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

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Книга_3067_Библиотеки_им_академика_М_И_Перельмана

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Core pulmonary exam

• Posterior: 6 places on skin

• Anterior: 2 places on skin

• Inspection

• Palpation: 6 areas anteriorly (3 each

side)

• Chest expansion

• Normal: >2 cm

• Tactile fremitus (“99”)

• Percussion: 12 areas (6 each side)

• Auscultation: 12 areas (6 on each side)

Demonstrate: “Breathe

deeply through mouth”

Full inspiration and expiration

https://t.me/med1917

13 Abdomen

Abdomen

• Inspect

• Auscultate

• Bowel sounds

• Bruits

• Aorta (A)

• Renal (R) arteries

• Iliac (I) arteries

• Femoral (F) arteries

• Percussion (4 quadrants)

• Palpation

• 4 quadrants + epigastric,

periumbilical, and suprapubic

• Light palpation: <1 cm

• Deep palpation: >1 cm

Right upper

quadrant

(RUQ)

Left upper

quadrant

(LUQ)

Epigastric region

Periumbilical region

Suprapubic region

Right lower

quadrant

(RLQ)

Left lower

quadrant

(LLQ)

Core Abdomen Exam

• Auscultate 1 area

• Palpate 6 areas

• 4 Quadrants

• Epigastric

• Suprapubic

• Abdomen

Auscultation before palpation

One area to auscultate for

bowel sounds sufﬁcient

Peritoneal Signs

• Guarding

• Rebound

• Rigidity

https://t.me/med1917

Palpate Aorta: Use 2 ﬁngers

of the right hand on either side

of the aorta

Palpate while patient is

exhaling

Liver

• Percussion

• Along midclavicular line

• Measure size

• Palpation

Aorta

• Palpate

• Slightly to the left of the midline

• Abnormal: >3 cm

Kidney

• Costovertebral angle tenderness

Spleen Palpation

1. Place

left hand

posterior

2. Right hand

pushes up

https://t.me/med1917

Anterior axillary line (AAL):

8-9th intercostal space

Traube Space Boundaries

• Left AAL

• 6th rib

• Costal margin

Castell Method

• Percuss in the lowest left

intercostal space

• AAL

Murphy Sign: Ask patient to

“breathe in deeply”

AAL

Traube

Castell

14 Advanced Abdomen

Splenic Enlargement

• Percussion of Traube space

• Normal = resonant

• Positive = dullness

• Percussion by Castell method

• Normal = resonant during inspiration

• Positive = dullness

Gallbladder Inﬂammation

• Murphy sign

• Firmly place hand at the costal margin

in the right upper quadrant (RUQ)

• Positive = pain on inspiration

https://t.me/med1917

McBurney point: 2/3 of the

distance from the umbilicus to

the right anterior superior iliac

spine (ASIS)

Psoas sign alternative:

Patient lies on his/her left

side. Hyperextend right thigh.

Positive test if results in

abdominal pain.

Appendicitis Signs

• McBurney sign

• Palpate McBurney point

• Positive = tenderness in right lower

quadrant (RLQ)

• Rovsing sign

• Palpate left lower quadrant (LLQ)

• Positive = pain in RLQ

• Psoas sign

• Raise right knee against your

resistance

• Positive = abdominal pain

• Obturator sign

• Internally rotate the hip

• Positive = abdominal pain

Figure 4 position

2. Push down knee

https://t.me/med1917

15 Spine

Cervical Spine

• Inspect

• Cervical concavity

• Palpate

• Spinous processes

• Range of motion (ROM) (4)

• Flexion, extension, lateral bending,

rotation

Thoracic and Lumbar Spine

Trapezius muscle

Deltoid muscle

Infraspinatus

muscle

Teres

major muscle

Latissimus

dorsi muscle

Erector spinae

muscles

Posterior superior

iliac spine

Spinou

process

of T12

vertebra

https://t.me/med1917

Normal Kyphosis

Lordosis Scoliosis

• Inspect

• Thoracic and lumbar concavity

• ROM (4)

• Flexion, extension, rotation, lateral

bending

Anchor patient’s hips while

performing lumbar spine ROM

Adam’s Forward Bend Test for Scoliosis

Bend forward with palms facing each other.

Examine from behind sides and front. Look

for asymmetry, rib hump, or spine curve.

https://t.me/med1917

Muscle Strength Scale

0—no muscle strength

1—barely detectable ﬂicker

2—movement but not against

gravity

3—movement with gravity, no

resistance

4—movement with gravity,

some resistance

5—normal strength

16 Upper Musculoskeletal

Resting

anatomical

position

Shoulder

• Inspect

• Deformities, muscle atrophy,

sternoclavicular joint,

acromioclavicular joint, deltoid muscle

• Palpate

• Acromion, acromioclavicular joint,

greater tubercle of humerus, biceps

tendon

• Supraspinatus, infraspinatus, teres

minor, and subscapularis (SITS)

muscles

• ROM (6)

• Flexion, extension, abduction,

adduction, internal rotation, external

rotation

• Strength (3)

• Abduction, ﬂexion, external rotation

SITS Muscles

• Supraspinatus

• Infraspinatus

• Teres minor

• Subscapularis

Remember not all SITS

muscles are palpable

Resting Anatomical

Position: Note that palms

face forward. Medial and

lateral are based on this

anatomical position.

Elbow

• Inspect

• Medial epicondyle, lateral

epicondyle, olecranon

• Palpate

• Olecranon, epicondyles

• ROM (4)

• Flexion, extension, supination,

pronation

• Strength (2)

• Flexion, extension

Remember to supinate and

pronate the elbow

https://t.me/med1917

Wrist

• Inspect

• Palmar and dorsal surface

• Thenar and hypothenar eminences

• Palpate

• Radial styloid, anatomical snuffbox

• ROM (4)

• Flexion, extension, radial deviation,

ulnar deviation

• Strength (2)

• Flexion, extension

Fingers

• Inspect

• Radial and ulnar deviation, tendon

thickening or contractures

• Palpate

• Metacarpophalangeal joints (MCPs),

proximal interphalangeal joints (PIPs),

distal interphalangeal joints (DIPs)

• ROM (4)

• Flexion, extension, abduction, adduction

• Strength (4)

• Abduction, adduction, thumb ﬂexion,

hand grip

OA, Osteoarthritis

RA, Rheumatoid arthritis

DT, De Quervain’s

tenosynovitis

Heberden’s

node

Bouchard’s

node

OA, RA

https://t.me/med1917

17 Lower Musculoskeletal

Hip

• Inspect

• Gait and muscle atrophy

• Palpate

• Greater trochanter

• Landmarks: iliac crest, tubercle, and

superior iliac spine

• ROM (6)

• Flexion, extension, abduction,

adduction, internal rotation, external

rotation

• Strength (4)

• Flexion, extension, abduction,

adduction

Knee

• Inspect

• Deformities, alignment, contour,

symmetry of length/position

• Palpate

• Tibiofemoral joint, patella, tibial

plateau, tibial tuberosity, femur,

patellar tendon

• ROM (2)

• Flexion, extension

• Strength (2)

• Flexion, extension

Iliac crest

Inguinal

lig.

Vastus

medialis m.

Quadriceps

tendon

Patella

Tibial

tuberosity

Medial

malleolus

Extensor

hallucis

longus tendon

Lateral

malleolus

Tibialis

anterior m.

superior

iliac spine

Vastus

lateralis m.

Rectus

femoris m.

Iliac crest

Greater

trochanter

of femur

Iliotibial

tract

Gastroc-

nemius m.

Medial head

Lateral head

Bicep

femoris m.

Long head

Short head

Calcaneal

(Achilles)

tendon

Plantar surface

of foot

Popliteal

fossa

Calcaneal

tuberosity

https://t.me/med1917

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