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Physical examination of pediatric - Coggle Diagram
Physical examination
of pediatric
Chest
1-Inespection
Symmetrical
Any abnormal
•ricketic rosary
(knoblike prominence)
•Harrison sulcus
(deep groove in lower ribs)
Observe respiration
•Rate(number)
•Rhythm(regular)
•Depth(deep)
•Quality(effortless)
⬆️ rate=tachypnea
⬆️depth=hyperpnea
⬆️rate+depth=hyperventilation
Observe position of nipples
•slightly lateral mid clavicular line
between 4th-5th ribs.
Shape
Abnormal
•Barrel chest=round
(COPD)برميل
•Pigeon chest=protrudes outward
(rickets)صدر الحمامه
•Funnel chest=sternum depressed
(congenital anomalies)
Respiratory movement
•children under 7years=abdominal thorax
•children over 7years=thorax
2-Palpaton
General
Palpate thorax+breast tissue+axilla
(shape+contour+tenderness+masses)
Specific
Respiratory excursions
•Anterior
Thumb (along costal margin)
below xiphoid process
handa(rest lateral rib cage)
•posterior
at the level of 10th ribs
Tactical fremitus
Put Palomar of the hand
(suprasternal notch-thorax)
3-Percussion
•Principal
1-intercostal space
2-hyperextantion for fingers
3-midle on midle
4-distal farangial joint
5-two knock
6-zegzag motion
•Position
Anterior
(Upright)
Posterior
(Sitting)
•Normal sounds
-resonance sound
-dullness:
✓2nd_4th intercostal space
children under 7 years
✓3rd-5th intercostal space
children over 7 years
✓span of liver Rt.thorax
from 5th intercostal space
to mid clavicular line
4-Auscultation
Breathing sounds
•Bronchial breath
(hearh only suprasternal notch)
In<Ex
•Broncho-vesicular breath
(heard upper intra scapular)
In=Ex
•Vesicular breath
(heard upper extrascpular)
In>Ex
Abnormal sound
•cracklesصوت كركره الشيشه
(passage air through fluid)
•wheezes صوت تزيق الباب
(Passage air through narrowed
passageway)
•pleural friction rub
صوت مشي علي الثلج
(walking on fresh snow (
movement of inflamed results
pleural effusion -pleuritis
Heart
1-inspection
•cyanosis.
•edema
•clapping finger
•epical pulse
(premature -thin)
•distended neck veins
2-Palpatation
•peripheral pulse
•capillary filling<2 abnormal
•edema
•heart disease
(Coarctation of aorta)
✓point maximum impulse:
best place heard pulse
✓point maximum intensity:
best place palpate pulse
3-Auscultatio
•S1=closure tricuspid & mitral valves
•S2=closure pulmonic & aortic valves
•S3=normal:
infant till 3 years
athletic till 30 years
•S4=coronary heart disease
occurs before S1
Abdomen
الترتيب مهم هنا
1- Inspection
•movement of abdomen
•umbilicus size(hernias)
•scaphoid abdomen
البطن بتكون غائرة لجوه مش مدورة
2-Auscultation
(is first to keep regularity
of bowel sound)
best plase for heard
(ileocecal valve)
2-6 sound /min each 10-30 sec
3-Percussion
•Tympanic sounds
(hollow organ)
•Dull sound
(liver-spleen)
4-palpatation
Deep
1-2 cm
Superficial
lightly place hand against skin
and feel each quadrant