295
5254147819011156112
1.1205596012870106
Presence13465960128149196259313376445508570
of1951596012898145
irregularities,2131596012867113160223292362401464510548588626689742778
roughness2944596012875145215285355425487542596
on3576596012897168
the3779596012866136199
surface4013596012883152199246309370432
of4480596012899145
the4660596012868137200
pericardial4895596012899161206245308370417486525588627
sheets:851839012855125188249288342382
pericarditis,12678390128137200246285347409455526564603642696732
tuberculosis,20328390128106177246309356417487526595650689744779
leukemic28468390128105167237307369477514576
infiltration,34588390128105176223262301340387449488526597666702
hemorrhage41958390128135198306374421468538601671734
into49648390128105176214284
the52838390128106176238
thickness8511080012839110148211280351412467521
of14081080012870116
the15601080012838108170
pericardial17651080012870133178217280341388458497560599
sheets,23991080012853124186248286341377
uremia28101080012870117179288325388
–32331080012872
"funeral33411080012857103173243305352414453
bell38291080012870133171210
of40731080012870117
uremia."42251080012871117179287324386421479
2.12051321012870106
Increased134613210128118188251298360422476539608
dryness199013210128130177247315378433488
of251413210128129175
the27251321012899170233
pericardial299313210128130192239277340402449518557619657
sheets368613210128115185248310348403
–412413210128134
dehydration429413210128131193263334402449511550589659729
due505813210128131201264
to53571321012899169
persistent8511563012870133180233273327366428498537
vomiting,14231563012870140249286325365435505541
diarrhea.19971563012870109171218265334397459494
Signs:12051805012878117188257311351
1.12052046012870106
Heard134620460128173235297344414
over17952046012871140203250
the20802046012837107170
area22852046012862109171234
of25522046012870117
absolute27042046012862132187257295366404467
cardiac32062046012862125170240279342404
dullness.36442046012870141179217288351404458494
2.12052288012870106
Heard134622880128173235297344414
in17952288012840109
both19382288012870141179250
systole22232288012853124177216287325388
and26452288012862132203
diastole.28822288012870110171226265335374436472
3.12052529012870106
Does134625290128173242305360
not17402529012870141179
conduct19552529012862131201271341404443
to24332529012838107
other25762529012870109179241288
areas;28992529012863109171233288326
it3261252901283977
is3373252901284195
heard35022529012870133195242311
only38492529012870140179250
at41322529012862101
the42682529012839109172
site4475252901285493131194
of47042529012870117
formation.48562529012847116163272332371411481551587
4.12052771012870106
Intensifies134627710128118188228290360414453500539601655
with203627710128122160199269
pressure23412771012889136198252306377424485
with286127710128121160199269
a31662771012882
stethoscope32832771012873113176213283354408471540610672
and39902771012883153222
when424827710128121191254323
tilting4606277101285998136176214285354
the49952771012859129192
torso52222771012858129175230299
forward8513012012847117164266327374443
or13303012012870117
in14823012012838108
the16263012012837107170
knee-elbow18313012012870139202263311374413482553655
position.25193012012870141195233273311382451487
Pleuropericardial12053254012878117180249296366436499545583646708754824863926963
Noise:220432540128182252292346408446
It268632540128128167
represents288832540128128190260307369423485554594648
the357032540128121191254
noise385932540128152221260315378
of427232540128150197
pleura450432540128151190253322369431
rubbing,497032540128128199268338377447517552
synchronous8513495012855125194256327374443514583653708
with160634950128101140178249
systole18903495012865136190230299339400
and23253495012874145214
diastole.25753495012882120183236276348388449484
It3094349501285998
occurs32273495012881144206275322377
with365134950128101138178247
left-sided39343495012850113160198248301341410473542
pleurisy45123495012881120183253299338392463
localized50083495012850121184246285324386448517
in8513737012839110
the9963737012841111174
area12053737012865112173236
of14763737012872119
the16303737012842112175
heart.18403737012872135196242281316
When219437370128133201264334
the25643737012841111173
heart27723737012873135198244282
contracts,30903737012866135204244291352414453508543
reducing36683737012850112181251313353422492
its4195373701284181135
volume,43653737012874143183253362422457
the48573737012842113176
lungs50683737012841111181251306
in54093737012841111
contact8513979012862133202242304366405
with130039790128102140179249
it1585397901284786
expand,17073979012871140210273342411447
resulting21893979012856118173242282320359429499
in27233979012849118
friction28773979012856102140203242280350420
of33323979012880127
the34943979012847118180
pleural37093979012879118180250297359398
sheets.41423979012863133195257297351386
It4563397901285695
is46933979012848103
heard48313979012879141203250319
to51863979012848118
the53393979012848118181
left8514220012839102149186
of10734220012872118
the12264220012841111174
relative14354220012848110149211250288359421
cardiac18914220012864126173242282344406
dullness.23324220012871141180221291354407462498
It2865422001284786
intensifies29874220012839109149211280334374421459522575
with360042200128101140178248
deep38834220012872134196267
breathing,41844220012873119181243281351391460530565
accompanied47844220012864127189258368436499569608670739
by8514461012870141
the10254461012839109172
presence12324461012871117180234296366428491
of17564461012870118
pleural19094461012870108170240287350388
friction2332446101284794131194233272341412
noise27784461012870141179233296
in31094461012839108
other32524461012870109179242289
areas35764461012862109170232287
away38994461012862163225295
from4227446101284794164273
the45334461012839110173
heart.47414461012870132195241280315
Cardiopulmonary12054702012894156203273311382452521561670738809872918989
Noise:222747020128134204243298360398
This266147020128119187227281
is29774702012871126
a31394702012894
physiological326847020128104173244297336406445515585624687748787
extracardiac40914702012894164203250312374436482553591654716
noise.484147020128104173213267330365
This524147020128118188227281
noise8514945012870141179233296
is1182494501284599
associated13164945012868122177247309347410448511581
with193849450128101139177248
the22214945012844114176
fact24324945012853115177215
that26834945012844114177215
during29334945012875145193231300370
systole,33384945012861131184223293336398433
the38064945012845114177
heart40184945012875138200247285
decreases43384945012876138200247309372425488543
in49164945012844113
volume,50654945012876145184255364424459
allowing8515186012862101141210312351420490
the13775186012843114176
area15875186012868115177239
of18615186012874121
the20185186012843113175
lung22285186012844114184254
adjacent25175186012868137177239301363432472
to30235186012845115
it3173518601284482
to32905186012844114
expand,34395186012868137208270340410445
causing39195186012868129199253293362432
friction4387518601285298137199237277346417
between48395186012875137176278340402471
the53465186012843113175
alveoli8515427012862101172234304342381
as12675427012876129
air14325427012875113160
enters.16275427012874144183245292346381
It2043542701285897
resembles21765427012859122175238347415454517571
weak279554270128101163225294
vesicular31255427012882144198237300369408470517
breathing,36775427012882129192253292362401471540576
synchronous42885427012866136205267338385454525594664719
with505454270128102140179249
the53385427012852121183
work85156690128101171218288
of11755669012884130
the13405669012854123186
heart.15615669012884147209255294330
It1926566901286099
is20615669012851106
heard22035669012884146208255324
more257756690128109177224286
often28985669012884132171233304
along32375669012875114185255324
the35975669012853122185
left38175669012853121168205
border40585669012884154201270333379
of44715669012885132
relative46385669012861123162225263302372435
cardiac51085669012876138185254293356417
dullness8515911012870141179219288351405459
in13455911012839108
case14895911012862125179241
of17655911012870117
heart19165911012870133194241280
hypertrophy22315911012871141209272319357404473544613684
or29485911012870117
increased31005911012839110173218281343398461530
myocardial366559110128109178246309372418488528591629
contraction43295911012863131201240288349411450489558629
speed.49945911012853123185247318353
Vascular120561520128101163218281351389452499
Noises:174161520128101170209263326380419
After219761520128102148187249296
palpating25286152012872135173243306344382453523
the30866152012841111174
arteries,32956152012864111149211258296358412448
their37786152012841111173212259
auscultation40726152012864134188251320360398461499538608677
is4785615201284196
carried49166152012865127173219259321391
out53426152012871141179
without85163930128101140179249320389429
compressing131563930128116185295363410472527581620690760
the21106393012892163226
artery237163930128116163201263310380
wall278563930128155216255295
with311563930128155194233303
a345363930128116
stethoscope.360463930128108147210249318388443505575645707743
Normally,438263930128153223270379439478518594627
without504563930128154193232303373442481
pressing8516635012870117180233288327397467
on13536635012885155
the15436635012854124186
carotid,17646635012878140186256295333404439
subclavian,22386635012869139209272309372441481543613648
femoral29216635012862124234301349411450
arteries,34076635012877124162225271309372426461
only39036635012885155194265
the42016635012854125188
first44236635012862100147201240
heart46986635012884147210256294
sound50286635012870139209280349
is54136635012853107
heard.8516877012870133195242311347
Tones12326877012886156225288343
are16106877012863108170
not18166877012870139178
heard20296877012870133195242311
over23766877012870139202249
smaller26606877012853163223262301364411
vessels.31066877012870131185240303341395430
In12057118012847117
pathology:13587118012870131170240311349419489560597