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نقف ناحية رجل العيان و اقولة اتوسطن فى السرير ...1
و بعدها ابوطى شوية و ابص على منطقة الprecordium..
و اشوف لو فيهbulge ولا لا؟؟
طب ال bulge da indicates eh??
ان الراجل عنده cardiomegaly since childhood..
w lw s2lny ay 7eta blt7did a2olo: right venticle
2-بعد كدة بقى اقف يمين العيان
و ابص على الapex
, و اشوف لو فيه apical pulsation wla l2...
لو ملقتش يبفى فيه كذا سبب:
a- obese
b-copd
c-apex behind rib msh fl space
d- pleural effusion
e pericardial effusion
االطبيعى انى اشوفpulsations w lw mshfthash 3la el a2al a7esha
طيب شفتها و حستها بعد كدة اعمل ايه؟ افضل احط ايدى اليمين
عليها و اطلع بالشمال لحد الangle of lewis w a3d bs ew3o ay 7ad yshel edo mn 3l apex
w yost7san kman n3d mn ne7yt el mid clavicular 3lshan el spaces awsa3
طيب حددت مكانها اعمل ايه؟
ابتدى اشوف ال
.. character bt3tha
a- hyperdynamic: forcible unsustained احس بضربة قوية تحت ايدى و مبتخدش وقت
w de asbbha volume overload zy( aortic w mitral regurge w patent ductus arteriusus)
b- heaving: forcible sustained ضربة قوية بس بتاخد وقت
w de asbbha pressure overload (aortic stenosis aw coaractaion aw htn)
w konha forcible f gmee3 el a7wal a2ol enha gaya mn el left vent..
w b3dha ashoof el pulsation de diffuse y3ny wa5da aktr mn space wla localized ??
bs mn el a5er kda kony le2etha forcible yb2a a2ool localized w gaya mn el left vent tmam??
c- slapping apex: palpable 1st sound de mfedsh feha l2ny mshofthah 2bl kda sara7a
و بعد كدة ال timing:
bm3na a7ot 2eed 3la el apical pulsation w l shmaal a7s beha el carotid pulse w asoof el drba bta3et el pulsation
mashya m3 el systole bta3 el carotid wla w2t el diastole w2t mabyfdy
lw systole yb2a da left ventricle hypertrophy
y3ny lw ana msln 3rft en el 3yan 3ndo mshkla fl left ventricle yb2a a2lf kda: apex shifted downward and lateral mn el mid clavicular line.. (site)
w forcible pulsation
w localized
w lma geet a3ml timming kan systolic bulge
el rt vent 3ksaha shifted laterally w n2ool feen mn el midclavicular line
w systolic retraction
w diffuse
a5er 7aga n3l2 3leha el thrill:
احط ايدى على الapexw ashoof sm3a murmur wla l2 lw msm3tsh mamsheesh l2
a2ool lel 3yan lw sm7t nam 3la gnbk el shmaal
w bkda 5lsna el apex..
tb el other pulsations
epigastric pulsation:
اقف على يميين العيان و اقوله اكتم نفسك:
و ابص علىepigastrium t7t el subcoastal angle kda w ashoof feeh wl l2
الطبيعى مايكونش شايفة حاجة:
بس لو شفت يبقى حاجة من 3
a- rt vent. enlargement
b- liver disease
c- from aorta
طب افرق ازاى
احط الtips of my finger mn n7yet ymeen el 3yan w lw el pulsation gatly mn fo2 yb2a ana rt ventricle
lw mn t7t sawab3y yb2a aorta
lw t7t 5als b2a liver
tb lw 7anfbrk b2a ana 3rft eno rt ventricle problem aw tricuspid regurge msln
a2ool site shifted laterally w n2ol ad eh mn mcl
a2ol feh ystolic retraction b3d makarent bl carotid pulse w edy 3l apex
w diffuse pulsation
w not forcible
w feeh epigastric pulsation gaya mn foo2
b3d kda b2a el left parasterna pulsation:
a7oot a5er 7eta mn el palm n7yet el wrist 3la blzbt 7ta mn el sternum w el 7ta ely gnbo w sawab3y msh mnymaha 3la el 3yan l2 mtyaraha fl hawa 7abeteen w ko da w ana 3la ymeen el 3ayan
w ashoof a7es pulsation wla l2
lw 7aseet yb2a 3ndo rt vent enlargement
w b3d kda el pulmonary area(el 2nd lt space) lw 7seet pulsations yb2a pulm. HTN
aortic area(rt 2nd space) lw 7aseet 7aga thrill aw pulsation
yb2a systemic HTN aw aortic stenosis msln
wl mante2teen dool brdo b7sohom bl tips of myfingers just lateral ll sternum..
percussion
awl 7aga el upper border bta3 el liver:
اقف على يمين العيان بردو و ابتدى اعمل percussion 3la kol space l7d mawsal lmnt2a dull lma awslaha a2olo 5od nafas w ektemo a3ml tany percussion 7ala2y el dull b2a resonant: el dull da bssb eny l2eet el upper border of liver
tb 2lb resonant leeh 3shan lma 5d nfs w ktmo e lung hyper inflated w nzlt el liver t7t
el tabe3y el upper boarder fl 5th rt space midclavicular line bs lw l2eto t7t kda yb2a 3ndo COPD WL PRECUSSION DA ESMO TIDAL PERCUSSION
WL DULL LMA NZLA LT7T 3N EL NORMAL BSBB COPD (HYPER INFLATED LUNG )ESMO ENCOARCHMENT OF LIVER DULLNESS AREA
5LSNA EL UP . BORDER OF LIVER N3ML EH TANY
LW EL LIVER CAN NORMAL FL 5TH SPACE ATL3 SPACE WA7ED FL 4TH SOACE Y3NY W AFDL A3MEL VERTICAL PERCUSSION MN LATERAL L MEDIAL L7D EL STERNUM GNMBO KDA KDA ANA BGEEB EL RT BORDER OF HEART NORMALY EL MNT2A DE MN LATERAL RESONANT L7D EL RT BORDER LMA ALA2EEH W DAH BY HEAVY PERCUSSION
PERCUSSION LL BASE OF HEART:
Y3NY 73ML PERC. LL RIGHT WL LT 2ND SPACE TMAAAM MN LATERAL L MEDIAL BBY HEAVY PERCUSSION W W DAH VERTICAL PERCUSSION EL TABE3Y ALA2Y EL MNTE2TEEN DOL RESONANT TB LW L2ETHOM DULL YB2A LW
LEFT SPACE DULL: PULMONARY HTN
PULM DILATATION
AORTIC ANEURYSM
PERICARDIAL EFFUSION
PLEURAL EFFUSION
W DE 3SHAN HYA EL PULM AREA FL ASBAB KOLHA FL PULM ARTERY AW PLEURA AW PERICARDIUM
RT 2ND SPACE:DULL: A-SYST. HTN
B- AORTIC DIATATION
W BRDO PERICARDIAL W PLEURAL EFFUSION
W HNA 3SHAN AORTIC AREA F KOL EL ASBAB AORTIC PROBLEMS
TALET PERCUSSION AROUND THE APEX PERIAPICAL PERCUSSION: W DA BYTNSY 3LA FKRA: W ISA TFTKRO W DA VERTICAL HEAVY PERCUSSION
EL TABE3Y RESONANT ELA LW FE ENLARGEMENT AW EFFUSION
W PERCUSSION 3LA EL LOWER END OF STERNUM: 3LSHAN A7ESS EL RIGHT VENTRICLE KEDA W DA HEAVY PERCUSSION W VERTICAL
AUSCULTATION :
APEX(MITRAL AREA)
PULMONARY AREA (LT 2ND SPACE)
AORTIC REA (RT 2ND SPACE)
WL ETNEEN M3 B3D ESMOHOM EL BASE OF HEART
LOWER END PF STERNUM(TRICUSPID AREA)
A- APEX:الطبيعى انى حسمع صوت سرييع مش بياخد وقت LUP DUB
لكن لو الصوت طوول شوية يبقة انا كدة MURMUR
TB 3YZA A3RF B2A DA MITRAL REGURGE WLA STENOSIS
A3ML EH??
A3ML TIMING M3 EL CAROTID
A7OT EL SAMA3A 3L APEX
WE2EDY 3L CAROTID
LW SYSTOLIC YB2A DA REGURGE
TB 3YZA A7LF A7OT EL SMA3A 3LA EL AXIILA SM3 DAWSHA BRDO DE ESMAHA EL PROPAGATION BT3TO
TAB LW STENOSIS 7LA2Y EL SOOT M3 EL DIASTOLE OF CAROTID
W 7ALA2Y ACCENTUATION LL S1 7S3O 3ALY AWY BS DA WAHMOLOGY SHEWYA
B- AORTIC AREA ELY HYA FEEN??
LW SM3T MURMUR YB2 MSHKLA FL AORTA 3YZA A7LEF A7OT EL SMA3A 3L CAROTID SM3T MURMUR YB2A AORTA VALVE STENOSIS AW REGURGE 7FR2 BNHOOM EZY?? BL TIMING LW SYSTOLIC YB2A STENOSIS LW DIASTOLIC YB2A REGURGE
C- NFS EL 7EKAYA 3LA EL PULMONARY AREA
D-LOWER END OF STERNUM EL TRICUSPID AREA: A7OT EL SMA3A SM3T MURMUR YB2A TRICUSPID PRBLEM 3
3YZA A7LF ENO TRICUSPID A2OLO 5OD NFS 7ALA2Y EL SOOT ZAD M3 EL INSPIRATIOON W DA SM3NAAH F3LN
TB 3YZA A3RF HOWA REGURGE WLA STENOSIS BL TIMING LW SYSTOLIC YB2A REGURGE
LW DIASTOLIC YB2A STENOSIS
.. و تم بحمد الله ربنا معانا يا رب
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وهم صح ... ؟
