Pemeriksaan Fisik Paru Sistem Respirasi | Keterampilan Klinis | FK Unand

Summary

In a medical role-play at Universitas Andalas, Dr. Taufiq, a pulmonary specialist, examines a 22-year-old patient named Hidayat from Azizi. The patient reports intermittent shortness of breath, especially in cold weather, with no food or dust triggers. A family history of similar symptoms is noted, and the patient has been using inhaler medication since childhood. A comprehensive physical examination is conducted, including inspection, palpation, percussion, and auscultation, to diagnose the respiratory condition.

Takeaways

• 👨‍⚕️ The patient, Mr. Hidayat, is a 22-year-old unmarried male experiencing intermittent shortness of breath, particularly when it's cold.
• 🏠 Mr. Hidayat resides in Azizi and has not been hospitalized for his condition, only visiting a clinic doctor.
• 🏥 He last visited a doctor six months prior to the current consultation and has a family history of similar symptoms, specifically with his mother.
• 💊 Mr. Hidayat has been using inhaler medication since elementary school to manage his symptoms.
• 🎓 Currently, he is a college student financially supported by his parents.
• 👔 The examination by Dr. Taufiq, a pulmonary specialist, includes a general physical check focusing on respiratory disorders and associated organ abnormalities.
• 🔍 The inspection phase of the examination assesses chest shape, symmetry, and any deformities or abnormalities on the chest wall.
• 🤲 Palpation is used to confirm observations from inspection, checking for tracheal deviation, chest wall issues, and fremitus.
• 🥁 Percussion helps identify areas of dullness that should normally resonate, aiding in determining the borders of the heart and lungs.
• 👂 Auscultation involves listening to breath sounds and additional sounds that may indicate pathological processes in the respiratory system.
• 🔁 The examination process is comprehensive, including both the front and back of the patient, with a focus on symmetry and abnormal findings.

Q & A

What is the patient's name and age?

The patient's name is Hidayat, and he is 22 years old.

What is the specialty of the doctor examining the patient?

The doctor is Dr. Taufiq, a pulmonary specialist.

What is the patient's main complaint?

The patient experiences shortness of breath, particularly when it is cold.

Is the patient's shortness of breath influenced by food or dust exposure?

No, the patient's shortness of breath is not influenced by food or dust exposure.

Has the patient's condition recurred before?

Yes, the patient's condition has recurred.

How often has the patient sought medical attention for this condition?

The patient has only seen a clinic doctor and it has been six months since the last visit.

Has the patient been hospitalized for this condition?

No, the patient has not been hospitalized for this condition.

Is there a family history of the same disease?

Yes, the patient's mother has the same symptom of shortness of breath.

What type of medication has the patient been using for their condition?

The patient has been using an inhaler medicine since elementary school.

What is the patient's current occupation?

The patient is currently a college student.

What does the general physical examination related to respiratory disorders aim to identify?

The examination aims to identify any abnormalities in other organs related to the respiratory system, such as edema, cyanosis, lymph node enlargement, and clubbing fingers.

Outlines

00:00

👨‍⚕️ Patient Consultation and Preliminary Examination

This paragraph introduces a clinical skills session at the Faculty of Medicine, Universitas Andalas, where a pulmonary specialist, Dr. Taufiq, begins a consultation with a patient named Hidayat. The dialogue covers the patient's personal information, including his age, residence, marital status, and the reason for his visit, which is shortness of breath that occurs when it's cold. The doctor inquires about the frequency of the symptoms, any influence of food or dust, and whether the patient has a history of hospitalization or regular doctor visits. The patient reveals that the illness is not frequent and that his mother also experiences similar symptoms. The consultation concludes with the doctor preparing to conduct a physical examination, starting with an examination of the patient's shirtless upper body to check for abnormalities related to the respiratory system.

05:03

🔍 General Physical Examination for Respiratory Disorders

The second paragraph delves into the general physical examination related to respiratory disorders. It begins with an inspection of the patient's chest, focusing on the shape, symmetry, and the presence of any deformities or abnormalities such as a pigeon chest or barrel chest. The examination also includes looking for signs of edema, cyanosis, and palpating the neck for lymph nodes. The doctor then moves on to inspect the patient dynamically, observing the frequency of breathing and any abnormal breathing patterns. The palpation examination follows, assessing the trachea for deviation, the chest wall for crepitus or tenderness, and the development of the chest wall. The tactile fremitus examination is performed by asking the patient to say 'seventy-seven' to assess vibrations in the chest wall. Lastly, percussion is introduced as a method to identify areas of dullness that should normally resonate.

10:04

👂 Auscultation and Percussion Examination Techniques

The third paragraph describes the auscultation and percussion examination techniques used to assess the patient's respiratory system. Auscultation involves listening to the breath sounds with a stethoscope, starting with tracheal breath sounds in the tracheal region, followed by bronchial, bronchovesicular, and vesicular breath sounds across different areas of the chest. The doctor listens for any additional sounds that might indicate a pathological process. Percussion is then performed to compare the resonance between the left and right lungs and to determine the borders of the heart and lungs. The doctor also checks for any asymmetry in chest wall movement during respiration.

15:06

🔊 Back Examination and Lung Sounds Auscultation

The final paragraph focuses on the examination of the patient's back, including inspection for deformities and palpation for fremitus while the patient says 'seventy-seven'. The percussion examination is conducted to determine the diaphragm-lung border and the incline limit of the diaphragm. The auscultation of the back is performed to identify bronchovesicular sounds in the interscapular region and vesicular sounds throughout the pulmonary field. This comprehensive examination helps the doctor to assess the patient's respiratory health and identify any potential issues.

Keywords

💡Pulmonary specialist

A pulmonary specialist is a medical doctor who has specialized training in the diagnosis and treatment of diseases and conditions affecting the respiratory system. In the script, Dr. Taufiq introduces himself as a pulmonary specialist, indicating that he is the expert who will examine Mr. Hidayat for his respiratory issues.

💡Shortness of breath

Shortness of breath, also known as dyspnea, is a sensation of not being able to get enough air or difficulty breathing. It is a common symptom in respiratory disorders. In the script, Mr. Hidayat mentions experiencing shortness of breath, particularly when he feels cold, which is a key symptom that leads to his consultation with the pulmonary specialist.

💡Inhaler medicine

An inhaler is a device used to deliver medication into the lungs. It is commonly used to treat respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Mr. Hidayat mentions using an inhaler since he was in elementary school, which suggests a long-term management of his respiratory condition.

💡Clubbing fingers

Clubbing is a medical condition where the fingertips become enlarged and the nail beds curve around the fingertips. It can be a sign of certain lung diseases or heart conditions. The script mentions examining for clubbing fingers as part of the physical examination related to respiratory disorders.

💡Cyanosis

Cyanosis is a bluish discoloration of the skin and mucous membranes due to a lack of oxygen in the blood. It is a sign of respiratory or circulatory problems. In the script, the doctor looks for cyanosis in the lips and skin as part of the examination for respiratory abnormalities.

💡Respiratory muscles

Respiratory muscles are the muscles involved in the process of breathing, including the diaphragm and intercostal muscles. The script mentions assessing whether respiratory muscles are working properly during the dynamic state of the inspection, which is crucial for determining the function of the respiratory system.

💡Palpation

Palpation is a medical examination technique where a doctor uses their hands to feel and assess various parts of the body. In the script, palpation is used to confirm findings from the inspection, such as the presence of crepitus, tenderness, or tumor, and to assess the symmetry of chest wall development.

💡Percussion

Percussion is a diagnostic method that involves tapping on the body with a finger to produce sounds that can help determine the size, position, and consistency of internal organs. The script describes using percussion to determine the borders of the lungs and the diaphragm, which can indicate the presence of fluid or other abnormalities.

💡Auscultation

Auscultation is the act of listening to sounds within the body, typically using a stethoscope, to assess the function of internal organs. In the script, auscultation is used to listen to various breath sounds, which can indicate normal or abnormal respiratory function, such as tracheal, bronchial, bronchovesicular, and vesicular sounds.

💡Pathological process

A pathological process refers to the mechanisms by which disease occurs in the body, involving structural and functional changes. In the script, the mention of additional breath sounds like rhonchi, wheezes, and stridor suggests the possibility of pathological processes or abnormalities in the respiratory system.

💡Diaphragm

The diaphragm is a dome-shaped muscle that separates the thoracic cavity from the abdominal cavity and plays a crucial role in breathing. The script discusses determining the position of the diaphragm during the percussion examination, which helps assess the presence of any abnormalities that could affect breathing.

Highlights

Introduction of a clinical skills training session at the Faculty of Medicine, Universitas Andalas.

Doctor introduces himself as a pulmonary specialist preparing to examine the patient.

Patient named Hidayat, 22 years old, presents with intermittent shortness of breath.

Symptoms of shortness of breath occur specifically in cold conditions.

Patient denies any influence of food or exposure to dust on his symptoms.

Patient confirms the illness has recurred and he has seen a clinic doctor previously.

Patient's last visit to a doctor was six months ago.

No hospitalization history, only treatment for symptoms.

Family history of similar symptoms present in the patient's mother.

Patient has been using inhaler medication since elementary school.

Patient is currently a college student financially supported by parents.

Doctor explains the necessity of a physical examination to determine the patient's illness.

Description of general physical examination related to respiratory disorders.

Inspection of the patient's face for edema, lips, and skin for cyanosis.

Examination of the neck for lymph nodes and extremities for clubbing fingers.

Explanation of static and dynamic inspection of the respiratory system.

Palpation examination to confirm findings from inspection, including trachea and chest wall.

Percussion examination to identify dullness in areas where resonance should be present.

Auscultation examination using a stethoscope to listen to breath sounds.

Identification of normal and abnormal breath sounds during auscultation.

Physical examination of the back of the lungs, including inspection, palpation, percussion, and auscultation.

Transcripts

Faculty of Medicine Universitas Andalas

Clinical skills (Skills Lab)

Doctor: "Good afternoon, sir!"

Patient: "Good afternoon, doc!"

D: "What is your name, sir?" P: "My name is Hidayat, doc."

D: "I am dr. Taufiq. I am a pulmonary specialist who will examine you."

D:" Mr. Hidayat, right?"

D: "How old are you now?"

P: "I am still 22 years old." D: "22 years old? Where do you live?"

P: "In Azizi, doc." D: "Azizi?"

D: "Are you married?"

P: "Not yet, doc."

D: "What is the reason you come to the doctor now?"

P: "I experience shortness of breath, but not always."

D: "You don't always have shortness of breath, so when does that usually happen?"

P: "Shortness of breath appears when I feel..."

P: "...cold, doc." D: "When it's cold, ok"

D: "Is there any influence of food too?" P: "No, doc."

D: "When you are exposed to dust, are there any symptoms?"

P: "No, doc."

D: "Has the illness recurred?"

P: "Yes, it has, doc."

D: "Have you often seen a doctor?"

P: "Only to the clinic doctor, doc."

D: "When did you go to the doctor lately?"

P: "It's been a long time, doc."

P: "It's been six months, doc."

D: "Well, it's quite rare for the illness to recur, right?" P: "Yes, it is, doc."

D: "Have you been hospitalized before?" P: "No, I haven't, doc."

D: "So, you just go for treatment?" P: "Yes, I do, doc."

D: "Besides you, is there a family history..."

D: "...of the same disease? Father, mother, or grandparents?"

P: "My mother has the same symptom, doc."

D: "Does shortness of breath sound?" P: "Yes, it does, doc."

D: "What are the medicines that..."

D: "...are usually consumed?"

P: "The inhaler medicine, like that, doc."

D: "It has been used for a long time?" P: "Yes, doc. Since..."

P: "Since I was in elementary school, doc."

D: "What is your occupation now?" P: "Still in college, doc."

D: "Still, borne by parents?" P: "Yes, I am, doc."

D: "To complete and determine your illness, I have to check you first."

P: "Ok, doc."

D: "To be examined, you must go to the examination bed." P: "Ok, doc."

D: "And please open the shirt."

General physical examination related to respiratory disorders.

This examination is done to see some abnormalities in other organs related to the respiratory system.

Conjunctival and sclera examination.

See the face if there is edema.

Look at the lips and skin for cyanosis.

Check the lymph nodes of the neck,

supraclavicular,

and infraclavicular.

Examine the extremities to see any clubbing fingers.

Inspection.

Examination of the respiratory system

begins with an inspection,

that is an observation made on a patient.

Inspection can be done at the state of

static

and dynamic.

Inspection in a static state

begins with knowing or understanding the anatomy of the chest.

First, determine the shape of the chest.

Anterior-posterior and lateral diameters,

then pay attention to whether

the shape is symmetrical or not.

Asymmetrical chest shape

can be caused by abnormalities

in bone structure or the contents of the chest cavity.

Pay attention whether the ribs

are the same between the right side and

the left side.

We also have to look for

chest deformities that can be found,

such as a pigeon chest,

funnel chest,

flat chest,

barrel chest,

unilateral flattening or

unilateral prominence.

Besides that, we also have to see abnormalities

in the chest wall, whether there is

tumor,

scar,

or venous dilation

Inspection in a dynamic state, we do

first,

calculate the frequency of the breath

in one minute.

Assess whether there are

abnormal breathing patterns, such as Kussmaul breathing

asthmatic breathing,

Cheyne stokes breathing,

or Biot breathing.

Third, assess whether there are

respiratory muscles that work.

Fourth, assess whether

the movement of the right and left chest wall

is symmetrical.

D: Inhale and release.

Palpation

The palpation examination provides confirmation of

the findings obtained at the inspection.

We will do

first, palpation in the trachea.

Palpation to assess

at the time of inspiration,

the trachea will be pulled down,

assess whether there is a deviation of the trachea.

Secondly,

general palpation of the chest wall

to assess the presence of crepitus,

tenderness,

or tumor.

Third, palpation of the chest

in a dynamic state.

To assess whether there is the development of

the chest wall, symmetrical on the left

and the right side.

Fourth, the tactile examination of

fremitus

D: "Please say 'seventy-seven'" (repeatedly)

Percussion examination

The purpose of percussion examinations is

to show the dullness

in a position where there should be

resonance.

FIrst, comparing

left and right lungs

Normally, the sound will be

resonant.

Determine the left border of the heart.

Determine the upper border of the heart.

Determine the border of the right lung

and liver.

Auscultation

Auscultation examination is carried out

indirectly

using a stethoscope.

Patients should be asked to breathe through the mouth.

At this examination, we will

listen to the main voice, that is

first, tracheal breath sounds

D: "Please breathe with the mouth, sir!"

In the tracheal region,

where the duration of inspiration

is the same as the expiration

with loud intensity

and high pitch.

Secondly, bronchial breath sounds

in the suprasternal region

where the duration of inspiration

is longer than expiration

with loud intensity and high pitch.

Third,

bronchovesicular breath sounds

can be heard in

the 1st and 2nd intercostal space area

close to the sternum,

where

the intensity and pitch are moderate.

Fourth, vesicular breath sounds

almost in the entire lung field

where the duration of the inspiring sound is longer.

The intensity is

soft with a low pitch.

Bronchial and bronchovesicular breath sounds

if found other than

in that position

will give a hint of a pathological process.

Besides that, we also listen to

additional breath sounds,

that is rhonchi,

wheezes,

stridor,

pleural friction rub,

bronchophony.

Additional breath sounds also

indicate the possibility of pathological processes

or abnormalities in the respiratory system.

Physical examination of the back of the lungs

Examination of the back of the lungs

can be done in the position of the patient

sitting back to the examiner.

The examination carried out

is the same as before, namely inspection, palpation,

percussion, and auscultation.

Inspection

Perform inspection in a static state.

pay attention to whether there are back deformities

such as gibus, scoliosis,

or kyphosis.

Compare the right and left side.

Perform a back inspection in a dynamic state.

Is there any difference

in movement between the left

and right back wall.

Do it by sticking your palms

on the back of the patient

with your thumbs close together,

then the patient is asked

to inhale.

D: "Please inhale!"

Note whether there are differences

in the movement of the examiner's left and right hands.

Palpation

Perform fremitus examination

using both palms

on the patient's back,

while asking the patient to say the word

"seventy-seven"

D: "Please say 'seventy-seven'". P: "Seventy-seven". (repeatedly)

Do it from the top of the back

along the scapular line to

the lower edge of the ribs.

P: "Seventy-seven". (repeatedly)

Compare the results of the examination

on the left and right sides.

P: "Seventy-seven". (repeatedly)

Percussion

Perform a percussion examination

starting from the top of the back,

alternating between left and right,

to the arcus costarum.

Determine the left diaphragm-lung border

and the right one, through

the scapula line from

the bottom of the scapula

to the lower edge of the ribs.

Determine the incline limit of

left and right diaphragm.

D: "Take a deep breath and hold for a while"

Auscultation

Perform an auscultation examination.

Under normal conditions,

bronchovesicular sounds

are heard in the interscapular region.

And vesicular sounds can be heard

throughout the pulmonary field.