paediatrics 5th year

29 August 2012 (tomorrow) will be my end of posting examination ^_^ bismillahirrahmanirrahim... i want to do my VERY BEST in my final year, insyaallah..

http://aia.i4u.us/islam.shtml

auscultation of heart

4 areas: - aortic - pulmonary - tricuspid - mitral

http://www.stethographics.com/heart/main/sites.htm

pattern of resp muscles use

um, for the pattern of respiratory muscle use: Normally, the diaphragm does all the work of inspiration and the abdomen will move outward along with the chest wall as the diaphragm descends (Figure 35.3). Inward inspiratory motion of the abdomen is termed abdominal paradox and suggests diaphragmatic dysfunction (Figure 35.4). Inward inspiratory motion of the chest wall is suggestive of a decrease in lung compliance. Placing the palms of the hands on the chest and abdomen may help confirm the visual impression. Active use of the abdominal musculature during expiration is distinctly abnormal. Look to see if the strap muscles of the neck, the scalenes, and the sternocleidomastoids are contracting during inspiration causing an upward motion of the entire chest.

Use of accessory muscles is suggestive of increased inspiratory work of breathing. Extreme increases in inspiratory work of breathing may be reflected in accentuated swings of pleural pressure. Negative pleural pressure may be manifested by inspiratory retraction of the suprasternal or supraclavicular notches or the intercostal spaces. In the presence of notch retraction, pulsus paradoxus is frequently present and should always be measured.

http://clinicalmethods.blogspot.com/2011/08/chapter-35-overview-of-pulmonary-system.html, Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990; http://soundersleep.com/musclesOfRespiration.php

paradoxical thoracoabdominal breathing

we learnt that there will be a paradoxical thoracoabdominal breathing in a life threathening asthma (respiratory arrest eminent). this might help me a bit.

Figure 35.3Normal inspiration Descent of the diaphragm raises intra-abdominal pressure moving the abdomen outwards along with chest expansion. The sternum moves outward.

Figure 35.4Abnormal inspiratory findings In the hyperinflated patient with obstructive lung diseases the flattened diaphragm pulls in the lower ribs at end-inspiration (Hoover's sign). The sternum is pulled cephalad by the action of the strap muscles of the neck. The abdomen may be retracted by the passive transmission of intrathoracic pressure across the dysfunctional diaphragm.

http://clinicalmethods.blogspot.com/2011/08/chapter-35-overview-of-pulmonary-system.html, Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990