B4-003 CV and Pulmonary Exam Flashcards
most prominent posterior spinous process
C7
respiratory excursion assesses for
symmetrical expansion of lungs
vibratory sensation of speaking
tactile fremitus
incresed fremitus indicates
- consolidation of lung tissue
- pneumonia
decreased fremitus indicates
- lung tissue not touching pleura
- effusion or pneumothorax
bilateral decrease in fremitus indicates
- COPD
- air trapped
if you’re worried about phrenic nerve injury, where should you percuss?
diaphragm
heard best: over most of both lungs
vesicular
heard best: 1st and 2nd intercostal spaces anteriorly and between scapula
broncho vesicular
heard best: over manubrium
bronchial
heard best: over the trachea in neck
tracheal
inspiratory sounds last longer than expiratory sounds
vesicular
inspiratory and expiratory sounds are almost equal
2
- bronchovesicular
- tracheal
expiratory sounds last longer than inspiratory sounds
bronchial
intermittent, non musical, brief
crackles (rales)
sound like velcro
fine crackles
thought to be from closed airways popping open in inspiration
crackles
crackles may indicate
- pulmonary fibrosis
- CHF
- pneumonia
sinusoidal, musical, prolonged
wheezes/ronchi
relatively high pitched with hissing or shrill quality
lung sound
wheezes
relatively low pitched with snoring quality
lung sound
ronchii
- harsh sounds that diappear after coughing
- indicate secretions
ronchi
heard without a stethoscope, indicates emergency
lung sound
stridor
inspiratory stridor indicates
supra-glottic obstruction
expiratory stridor suggets
lower tracheal obstruction
egophony indicates
- consolidation of lung tissue
- pneumonia
bronchophony indicates
- consolidation
- changes in clarity
JVD provides information about
pre load volume
feels like a “cat purring”
thrill
thrill or bruit at the carotid may indicate
artherosclerosis
rhythm to different amplitude beats indicating ventricular dysfunction
pulsus alterans
pulses paradoxus is assessed via
blood pressure cuff
pulsus paradoxus is a sign of
cardiac tamponade
best heard: right upper sternal border at 2nd intercostal space
aortic valve
best heard: left upper sternal border at 2nd intercostal space
pulmonic valve
best heard: left lower sternal border around 4th-5th intercostal space
tricuspid
best heard: 5th intercostal space medial to mid clavicular line
mitral valve
closure of tricuspid and mitral
s1
closure of pulmonic and aortic
s2
- occurs between s1 and s2
- rapid contracture
systole
- occurs between s2 and s1
- slow filling
diastole
split s2 is normal in
young people
split s2 in older patients may indicate
- pulmonary hypertension
- bundle branch blocks
loudest over apex with radiation to left axilla
mitral regurg
diastolic decresendo
aortic regurg
systolic cresendo-decresendo
aortic stenosis
diastolic decresendo-cresendo
mitral stenosis
systolic
holosystolic
mitral regurg
soft, trained ear can detect
murmur grading
grade 1
louder, most clinicians can detect
murmur grading
grade 2
loud, most medical students can detect
murmur grading
grade 3
associated with thrill
mumur grading
grade 4
associated with thrill, may be able to hear with stethoscope just off chest
murmur grading
grade5
associated with thrill, can hear without stethoscope
grade 6
- early diastolic filling from volume overload or systolic dysfunction
- blood hitting ventricular wall
s3
increased work of atria to overcome hypertrophic ventricular wall
s4
s3 and s4 may be normal in
children/young adults
will quiet when sitting
sign of chronic hypoxia
clubbing
correct order for cardiac and pulmonary assessments
expose, look, feel, listen
S1 should occur immediately before
right carotid pulsation
S2 sould occur after
right carotid pulsation
decreased intrathoracic pressure leading to increased pulmonary artery flow and delay in pulmonic valve closure
physiologic S2 split
normal finding in young people
- prolonged RV systole from an undiagnosed atrial septal defect
- does not change with inspiration or expiration
pathologic S2 split
sound of blood quickly decelerating after crossing the mitral valve
S3
ventricular gallop
heart sound found in CHF or late pregnancy
S3
heart sound caused by a hypertrophic left ventricle leading to increased atrial contraction
S4
heart sound associated with hypertrophic cardiomyopathy
S4
harsh systolic murmur that decreases in intensity when squatting
hypertrophic cardiomyopathy
pulses should be assessed
bilaterally
absent breath sounds with tympany to percussion over anterior chest and deviation of trachea
tension pneumothorax
discontinous, fine sounds like velcro at end of inspiration
fine crackles
CHF
high pitched, musical, continous sounds at end of expiration
wheezes
asthma
- loud, high pitched sound throughout inspiration over trachea
- heard without stethoscope
stridor
tracheal obstruction
bronchial sounds in the periphery indicate
lung consolidation
manuever to bring heart closer to chest wall to fine PMI
lay patient on left side while you palpate
palpating the anterior chest wall with the pall of your hand will help feel
thrills
lower lobes are heard best
posterior back
upper lobes are best heard
over anterior chest
right middle lobe is best heard
over mid axillary line and
inferior right anterior chest
heard over right sternal border at the 2nd intercostal space
aortic
heard over left sternal border at 2nd intercostal space
pulmonic
heard over left sternal border at the 4th intercostal space
tricuspid
heard over apex at 5th intercostal space medial to midclavicular line
mitral
aortic valve murmurs radiate to
carotid arteries
