《肺部体检》课件.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Bradypnea is seen in all of the following except:  1.Brain Tumor 2.Myxedema （粘液水肿） 3.Morphine overdose 4.Congestive heart failure Slow deep breathing is:  1.Kussmals breathing 2.Biots respiration 3.Cheyne stokes breathing 4.Sighs 5.Sleep apnea In Congestive Heart failure following can occur except:  1.Increased Respiratory rate 2.Cheyne stokes breathing 3.Platypnea 4.Orthopnea 5.Labored breathing Possible causes of unilateral diminution or delay in chest expansion include all of the following except:  1.Pleural effusion 2.Asthma 3.Pulmonary consolidation 4.Pleural pain with splinting Assessment of chest expansion with deep inspiration helps identify the side of abnormality. Patient has decreased chest expansion on the left. Which is the most likely condition the patient may have: 1.Emphysema/COPD 2.Bronchial asthma 3.Right pleural fibrosis 4.Left pneumothorax 5.Right lung mass Patient has consolidation of right lower lobe. You would expect: 1.No change in chest expansion 2.Decreased expansion of right hemithorax 3.Decreased expansion of left hemithorax 4.Increased expansion of left hemithorax Tactile fremitis is decreased in all of the following conditions except:  1.Pleural effusion 2.Pleural fibrosis 3.Pneumothorax 4.Lobar pneumonia 再 见 * * * * * * * * * * * * * * * * * * * * * * * * * 胸廓扩张度（thoracic expansion) 临床意义：一侧胸廓扩张受限见于大量胸腔积液、气胸、胸膜增厚和肺不张等 * 语音震颤（vocal fremitus）-触觉震颤（tactile fremitus) 体位：前胸部——仰卧位或坐位 背部——坐位 检查顺序：前胸部-背部 手法：检查者双手半握拳，将尺侧缘轻轻放在病人胸壁两侧的对称部位，令病人用低音调拉长声发出“一……”的声音，由上向下，左右交叉进行对比 观察内容：比较双手掌震动感 语音震颤（vocal fremitus）-触觉震颤（tactile fremitus) 检查部位（前6后8） 语音震颤（vocal fremitus）-触觉震颤（tactile fremitus) 检查部位（前6后8） 语音震颤（vocal fremitus）-触觉震颤（tactile fremitus) 影响语音震颤强度的因素：发音的强弱、音调的高低、胸壁的厚薄、支气管至胸壁距离的差异 语音震颤减弱或消失见于：肺泡内含气量过多，如肺气肿；支气管阻塞，如阻塞性肺不张；大量胸腔积液或气胸；胸膜高度增厚粘连；胸壁皮下气肿 语音震颤增强见于：肺泡内炎症浸润，如大叶性肺炎实变期、大片肺梗死等；接近胸膜的肺内巨大空腔，如空洞性肺结核、肺脓肿等 * 胸膜摩擦感（