AHA Exam 2 Flashcards
Pectus carinatum
Sternal Protrusion
Pectus excavatum
sternal cavitation
Deep rapid respirations associate with metabolic acidosis
Kussmaul respiration
Hyperpnea
deep breathing
hypopnea
shallow breathing
Feel increased vibration in chest over lung and indicates possible consolidation
Tactile fremitus
Hyperresonance of lungs indicates what condition?
hyperinflation
Dullness over lungs indicates what?
Bone, impaired air exchange, consolidation
Increased resonance of the spoken voice with auscultation
Bronchophony
Intelligibility of the whispered voice to auscultation in presence of consolidation
Pectoriloquy
“e” sounds like “a” with auscultation in presence of consolidation
Egophony
Place backs of hands on the back and have patient say “99” and feel for increased vibration
Tactile fremitus
Sounds more loud and clear over one lung may indicate what condition?
Pneumonia
Decreased resonance on one side of the lungs could indicate what condition?
Bleb
What other exams should be done with respiratory?
Cardiovascular, peripheral signs with respiratory; ENT is often indicated
What condition includes prolonged expiration and wheezing?
Asthma
What condiiton is collapse of the lung?
Atelectasis
What would be a significant finding of atelectasis?
Absence of lung sounds or very muted
What would be significant findings of bronchitis?
Diminished lung sounds and hacking non productive cough
Significant findings of pneumonia
febrile, crackles, rhonchi, diminished breath sounds, egophony, bronchophony, and whisper pectoriloquy, dullness over area of consolidation
What condition may cause displacement of the trachea?
pneumothorax
Significant findings of pulmonary embolism
pleuritic chest pain with or without dyspnea; possible low grade fever; hypoxia
Findings of emphysema.
barrel shaped chest; scattered crackles or wheezes; overinflated lungs are hyperresonant; prolonged expiratory effort.
Findings of COPD
rhonchi, inspirational crackles; breath sounds diminished; diminished vocal fremitus; cyanosis; distention of neck veins with right sided heart failure
What part of the cardiac cycle includes ventricular contraction ejecting blood?
Systole
What part of the cardiac cycle includes ventricular dilation and contraction of the atria draws blood into ventricles from the atria?
Diastole
What is the first heart sound?
mitral and tricuspid valves close
What is the second heart sound?
aortic and pulmonic valves close
What is the third heart sound?
mitral and tricuspid valves open
What is the fourth heart sound?
atria contract and empty
What heart sounds are in systole?
1,2, and 3
What heart sounds are in diastole?
4
Which EKG waves indicate atrial depolarization?
P wave
Which EKG waves indicate stimulation of the atria to initial stimulation of the ventricles?
PR interval
Which EKG waves indicate spread of a stimulus through the ventricles?
QRS complex
Which EKG waves indicate ventricular repolarization?
ST segment and T wave
Which EKG wave is sometimes seen and indicates repolarization of Purkinje fibers
U wave
Which electrical node is located in the right atrium?
SA
Which electrical node is located in the atrial septum?
AV
Where is the point of maximum impulse (PMI) located?
4th intercostal space
Where is the aortic valve area?
2nd intercostal space, right pulmonic border
Where is the pulmonic valve area?
2nd intercostal space, left pulmonic border
Where is the second pulmonic area (ERB’s point)
3rd intercostal space, left pulmonic border
Where is the tricuspid area?
4th intercostal space
Where is the mitral area?
5th intercostal space
What is the range of intensity of murmurs?
1- barely audible to VI- loud, audible without stethoscope
What grade of murmurs include a thrill?
IV and V
Where does the mitral sound radiate to?
axilla
Where does the aortic and pulmonic sounds radiate to?
carotids
How do you differentiate between a systolic and diastolic murmur?
If carotid impulse the same as what you are hearing it is a systolic murmur
What is the most common cause of heart murmur in elderly?
aortic stenosis
What is the most common cause of heart murmur?
mitral regurgitation
Name the Systolic murmurs
MR ASS mitral regurgitation and aortic stenosis=systolic
Name the Diastolic murmurs
MS ARD (mitral stenosis and aortic regurgitation)
What characteristics of murmurs are assessed?
location, timing and duration, pitch and intensity; pattern; quality; radiation; variation with respiratory phase
What is the range for muscle grading?
1-5
Muscle grading: visible or palpable muscle response
1
Muscle grading: full or partial ROM but not against gravity
2
Muscle grading: full ROM but not against resistance
3
Muscle grading: full ROM against some reistance
4
Muscle grading: full ROM against full resistance
5
Which tests are used to evaluate rotator cuff impingement or tear?
Neer test, Hawkins test
Test: internally rotate and forward flex arm at the shoulder: presses supraspinatus muscle against anteroinferior acromion
Neer test
Test: forward flexing shoulder to 90 degrees, flex elbow to 90 degrees and then internally rotate arm to its limit
Hawkins test
What tests can measure strength of rotator cuff muscles?
Supraspinatus (empty can test), subscapularis, infraspinatus and teres minor
Test; abduct arms 90 degrees and flex shoulders forward 30 degrees; apply downward pressure on distal humerus when arms are rotated so that thumbs point down or up
Supraspinatus (empty can test)
Test: arm at side, elbow flexed 90 degrees; rotate forearm medially against resistance
subscapularis
Test: arm at side, elbow flexed 90 degrees, and rotate arm laterally against resistance
infraspinatus and teres minor
What tests can be done for impingement syndrome of the rotator cuff?
empty can test, neers test, painful arc, hawkins, opposition to internal and external rotation
What test can be done for impingement syndrome of the AC joint
cross body adduction
What test can be done for impingement syndrome of the bicep tendonitis?
Speed test
What tests can be done to indicate shoulder instability or dislocation?
Apprehension test, sulcus sign, and internal rotation greater than internal rotation
Test: lay on back and externally rotate arm
Apprehension test
Test: squaring off of shoulder; divot where ball of humerus is dislocated from AC
Sulcus sign
What indicates a rare posterior dislocation of the shoulder?
Internal rotation of the shoulder is greater than external rotation
What tests indicate thoracic outlet syndrome?
Wright’s test and Adson’s test
Test: fully abduct the arm shoulder while palpating the radial pulse; if pulse decreases, positive for thoracic outlet syndrome
Wright’s test
Test: abduct arm to 30 degrees and hyperextend with head turned toward affected side. If pulse diminishes, sign is positive for thoracic outlet syndrome
Adson’s test
How do you test for deQuervain’s tendonitis?
Finklestien’s sign
Test: make fist with fingers overlying thumb. provide ulnar deviation of the wrist. Pain in first compartment indicates a positive sign
Finklestien’s sign
Carpal tunnel syndrome association tests
Tinel test; Phalen; thumb opposition
Test: tap on ulnar nerve of wrist; positive sign is pins and needles
Tinel test
Test: inverted prayer; positive sign is burning, tingling, or numb sensation over the thumb, index, middle, and ring fingers
Phalen test
Flexion of fingers
90 degrees
Hyperextension of fingers
30 degrees
flexion of wrist
90 degrees
hyperextension of wrist
70 degrees
radial rotation of wrist
20 degrees
ulnar rotation of wrist
55 degrees
forward flexion of shoulder
180 degrees
hyperextension of shoulder
50 degrees
abduction of shoulder
180 degrees
adduction of shoulder
50 degrees
internal and external rotation of the shoulder
90 degrees
Shoulder shrug tests which cranial nerve?
XI spinal accessory
How do you test the ulnar nerve?
OK sign
How do you test the medial nerve of the wrist?
crossing fingers
How do you test the radial nerve?
thumbs up
Arthritis: ulnar deviation
rheumatoid
Arthritis: boutonniere deformities
rheumatoid
Arthritis: Bouchard’s nodes
PIP, osteo
Arthritis: Herberden’s nodes
DIP, osteo
Swan neck deformity
rheumatoid
PIP hyperextension and DIP flexion
boutonniere deformity
Large knuckles
bouchard’s nodes
Bony growth on the finger joints nearest the finger tip (DIP) and sometimes on PIP
Herberden’s nodes
DIP hyperextension and PIP flexion
Swan neck
Back flexion
70-90 degrees
Back hyperextension
30 degrees
Back lateral bending
35 degrees
rotation of upper trunk
30 degrees
Tests for nerve rot impingement
straight leg raising test, Bragard stretch test; sitting knee extension; femoral stretch test
Test for shortened iliopsoas muscle
Thomas test
Test: examiner lifts the patient’s leg while the knee is straight. Positive sign is sciatic pain when the straight leg is between 30 and 70 degrees. Could indicate herniated disc at about L5
Straight leg raising test
Test: straight leg lift to 60 degrees, dorsiflex the foot. Positive if pain from hip to knee. Indicates nerve involvement at L4,5, and S1
Bragard stretch test
Test: patient supine on exame table and holds uninvolved knee to his or her chest, while allowing the involved extremity to lie flat. Holding the knee to the chest flattens ou the lumbar lordosis and stabilizes the pelvis. If the iliopsoas muscle is shortened, or a contracture is present, the lower extremity on the involved sid will be unable to fully extend at the hip
Thomas test
Test: lay flat and cross ankle over the knee; may indicate contractures in hip
Ileopsoas
Test: test leg is flexed and the thigh abducted and externally rotated. If pain is elicited on the ipsilateral side anteriorly, it is suggestive of a hip joint disorder on the same side.
Patric test
Diminished patellar reflex involves which dermatome?
L4
Which dermatome causes weak dorsiflexion and extension of great toe?
L5
Which dermatome causes weak plantar flexion and diminshed Achilles reflex?
S1
Knee flexion
130 degrees
Knee extension
0 degrees
knee hyperextension
15 degrees
Test: checks for effusion; push down on patella and would be able to feel it hit the femoral head and float back up
Ballottment
Test: milk fluid distally from suprapatellar pouch. Repeat several times; press behind patella lateral margin; swelling reappears in knee joint effusion
Bulge sign
Test: knee is flexed at 20-30 degree angle with the patient supine. The examiner should place one hand behind the tibia and the other grasping the patient’s thigh; Tibia is pulled forward to assess the amount of anterior motion of the tibia in comparison to the femur
Lachman’s test
Test: have the patient lie supine and extend the knee; stabilize the femur with one hand and hold the ankle with your other hand. Apply varus or valgus force against the ankle and internal/external rotation. Laxity indicates injury to the lateral collateral ligamen
Valgus (adduction) and Varus (abduction) stress test
Tests for knee effusions
Ballottment; Bulge sign
Tests for meniscal tears
McMurray or Apley (don’t do this one- can cause cartilage tear)
Tests for ligamental injuries
Anterior and posterior drawer test; Lachman test; Varus and Valgus stress test
Foot dorsiflexion
20 degrees
plantar flexion
45 degrees
Foot inversion
30 degrees
Foot eversion
20 degrees
Test: crank foot inversion
Tallar tilt test
What does the tib fib squeeze test for?
fracture
Test: When calf squeezed, calf should naturally plantar flex
Thompson test
What does the Thompson test check for?
achilles tendon issues
Pneumonic for conditions that mimic psych issues
Thinc Med
What are the conditions that mimic psych issues?
Tumors, Hormones; Infections and immune diseases; Nutrition; CNS; Misc (sleep apnea, CHF, anemia); Electrolyte; Drugs
Pneumonic for depression symptoms
SIGECAPS
What are depression symptoms?
Sleep disorder; Interest deficient; Guilt; Energy deficient; Concentration deficient; Appetite disorder; Psychomotor; Suicidal
What is the pneumonic for bipolar disorder symptoms?
DIGFAST
What are bipolar disorder symptoms?
Distractibility; Insomnia; Grandiosity; Flight of ideas; Activity increase; Speech; Thoughtless risk
Autism symptoms are usually seen by what age?
3
ADHD symptoms are seen by what age?
12
Does Delirium, Dementia, or mood disorder come on suddenly?
Delirium
Causes of Delirium
Dementia; Electrolyte disorders; Lung, liver, heart, kidney, brain; Infection; Rx drugs; Injury, pain, stress; Unfamiliar environment; Metabolic dementia
Pneumonic used for Alcohol abuse
CAGE
Alcohol abuse symptoms
Concern, cut down; Annoyed; Guilt; Eye-opener
Left affected stroke symptoms
neglect of affected side; impulsive; lack of insight regarding disability
Right affected stroke symptoms
often have speech/language disorder; tend to need motivation; insight usually intact
Lacunar stroke symptom
coordination or balance