today there was a class, 3 short cases with proff
you know the boy with CRF and lung collapse?
elder child sitting comfortable, not in respiratory distress even not atleast with miminal exertion
,(off shirt), not cyanosed. He speaks with normal voice in sentences. Hands are mildly pale, no clubbing. No visible venoue pulsations on neck, The Rt chest and shoulder is depressed, pigeon shaped chest with Harrison sulcus. (groove above the costal margin) may be due to depression itsepf or osteodystrophy etc... The upper sternum is prominent with Lt upper costal marigins.Scoliosis is present. Can sniff well (Diaphragm OK), His RR is 20/m, regular, expansion markedly reduced on Rt side.SpO2???
No obviouse welling, non tender chest wall, trachea markedly shifted Rt, apex not displacedb/c it is a pull, TVF increased so it is not collapse due to bronchial block, pleural effusion, pneumo thorax, thickpleura nor emphysema but rather cavity , consolidation or atelactasis, Rt side all over, ant,lat,post.
percussion dull on Rt without pain (thinner muscles below scapular andclavicle make them more resonant area)
he has vesicular breathing, reduced in Rt did u hear a diver breathing? thats bronchial breathing, ask my Bro increased VF not to level of bronchophony lobar pnemonia nor whispering pectoriloquy large cavity ) no aegophony nasal voice
remember Apex as part of examination,
in consolidation alveoli are not collapsed, it is atelectasis that cause it,
breath sounds are produced in large airways, so what u hear depends on how the lung filters and tranmits them
case II CVS
11 yr boy with a high volume collapsing tachycardic pulse with no RF delay
apex beat is not visible by definition it is pulpable, so visible pulsations not apexbeat
apex? character?sustained/tapping? size
there is an early diastolic murmur best heard at left upper sternal border. it is soft
Aortic n Mitral wave murmurs radiate but Pulm n tricuspid r localized
cASE 111
SPINA BIFIDA, LEVEL of lesion
iii 1 yea
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