all of it Flashcards
afterload
force against which ventricles push to eject blood - depends on arterial blood pressure and vascular tone
preload
degree of myocardial distention before shortening-increased stretch=increased force of contraction=increase cardiac output
gallop
S3 becomes intense and easy to hear, the resulting sequence of sounds simulates a gallop–called pre-diastolic gallop rhythm
click
semilunar valve stenosis will cause ejection clicks, mitral valve prolapse (less sharp of a sound) will be associated with mid-late systole
snap
stenosis of mitral valve will cause OPENING snap (usually opening of valves is silent) - loud snap=still mobile valve
S3
phase 2 of diastole, S3 is heard if an abnormal volume of blood is transferred into ventricle (sound is b/c ventricle dilates beyond the normal)
S4
late diastole, @ “atrial kick” sound is generated by pressure wave gradient and if ventricle is stiff and non compliant
grade 1-3 murmur
- faint, difficult to hear
- quiet but heard
- moderately loud, no thrill
grade 4-6 murmur
- loud with palpable thrill
- loud with palpable thrill, audible with stethoscope barely touching chest
- very loud with thrill, may be audible without stethoscope
pulsas alternans
alternating pulse with small amplitude and one with large amplitude–REGULAR rhythm (seen in L ventricular failure)
pulsas bigeminus
normal pulsation followed by premature contraction; the amplitude of premature contraction is less than regular (rhythm disorder)
pulsas bisiferans
best detected at carotid artery-characterized by 2 main peaks, 1st peak is “percussion wave” and 2nd peak is “tidal wave” (aortic stenosis + aortic insufficiency)
pulsas paradoxis
major decrease in amplitude of pulse during inspiration and increase in amplitude during expiration-rate is the same (asthma, emphysema, pericardial effusion)
pulse deficit
difference in rate auscultory and palpated–(a-fib)
homan sign
flex knee slightly and dorsiflex foot - calf pain is (+) sign and suggest thrombosis of superficial vein
vesicular breath sounds
soft, low pitched, heard over most fields long inspiration short expiration
bronchial
fast inspiration and slow expiration; high pitched, heard over manubrium
tracheal breath sounds
high pitched, harsh, heard over trachea, equal on inspiration and expiration
bronchovesicular breath sounds
medium pitched, heard mostly in first and second ICS anteriorly; equal inspiration and expiration
egophony
“eeee” to “aaaa” - intensity of spoken voice is intensified and has a nasal quality (upon auscultation) which would indicate consolidation
whispered pectoriloquy
whisper is clearly heard through stethoscope–increased intensity and pitch (consolidation in lungs, pneumonia, fibrosis)
bronchophony
increased clarity and loudness of spoken sounds (consolidation)
consolidation
alveolar space that contains something other than air (could be pulmonary edema, pus or other exudates with pneumonia)
tactile fremitus increase
pneumonia, tumor, pulmonary edema - increases when lung density increases
tactile fremitus decreases
decreased when lung tissue is replaced by fluid or air (pleural effusion, emphysema, pneumothorax, atelectasis, foreign body)
scoliosis
spine curved laterally
kyphosis
“round back” or “hunchback” - over curvature of thoracic vertebrae
gibbus
extreme kyphosis (almost like a pointy or 90 deg angle)
lordosis
inward curvature of the lumbar and cervical spine
pectus carinatum
bowing of anterior chest cavity
pectus excavatum
concavity of anterior chest wall
Grey Turner Sign
flank bruising (retroperitoneal hemorrhage)
Cullen Sign
peri umbilical echymosis (indicating intra abdominal bleed)
Murphy Sign
cholecystitis test - palpate the liver margin and have patient take a deep breath - abrupt halt of inspiration (+) sign
Rovsing Sign
palpation of LLQ increases pain in RLQ (+) sign if painful - apendicitis
McBurney Sign
point in RLQ between umbilicus and R anterior superior iliac spine - pain in this area is a + sign for apendicitis
Blumberg Sign
aka rebound tenderness
Psoas Sign
R hand on pt’s R leg, have them raise the leg, RLQ pain is + sign for apendicitis
Obturator Sign
bend knee and rotate medially and laterally (+) RLQ pain is indication of apendicitis
claudication
impairment in walking (pain, tenderness, muscle fatigue) due to ischemia–relieved with rest, site of pain distal to stenosis
orthopnea
SOB that begins or increases with lying down; relieved with sitting up
paroxysmal nocturnal dyspnea
sudden severe SOB and coughing that occurs at night; sitting upright may or may not relieve the problem
xanthelasma
yellow tinted, irregularly shaped lesions on peri orbital rims
paraphimosis
when the foreskin of an uncircumcised male cannot be pulled back over the head of the penis
hypospadias
birth (congenital) defect in which the opening of the urethra is on the underside of the penis
condyloma
genital wart
peyronie disease
The disease may cause pain, hardened, big, cord-like lesions (scar tissue known as “plaques”), or abnormal curvature of the penis when erect due to chronic inflammation of the tunica albuginea
hydrocele
a fluid-filled sack in the scrotum
spermatocele
benign cystic accumulation of sperm occurring on the epididymis
varicocele
abnormal totruosity and dilation of veins of the pampiniform plexus within the spermatic cord
epispadias
malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis
cryptorchidism
absence of one or both testes from the scrotum. It is the most common birth defect regarding male genitalia
direct inguinal hernia
occurs through external inguinal ring; located in Hesselbach triangle; rarely enters scrotum
indirect inguinal hernia
occurs through internal inguinal ring; can remain in canal, exit the external ring and may pass into scrotum; may be bilateral
femoral hernia
occurs through femoral ring, femoral canal and fossa ovalis
