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Physical Diagnosis cont. > Block 2 > Flashcards

Block 2 Flashcards

1
Q

How many lobes does the R lung have?

A

3

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2
Q

How many lobes does the R lung have?

A

2

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3
Q

How high does the lung apex rise on the anterior chest?

A

2-4cm above the inner 1/3 of the clavicle

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4
Q

How low does the inferior border of the lung extend?

A

6th rib at mid-clavicular line & 9th rib at mid-axillary line

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5
Q

What are the borders of the lungs on the posterior?

A

Lower lungs mostly -T3 to T10 or 12

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6
Q

Where is the right middle lung lobe?

A

Anterior, between 4th and 6th rib. Lies between the horizontal fissure and the oblique fissure.

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7
Q

What is the angle of Louis?

A

Junction of manubrium and sternum. Attaches the 2nd ribs. Palpable landmark.

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8
Q

What is a VESICULAR breath sound and where is it heard?

A

Soft, low pitched, breezy. Over healthy lung tissue.

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9
Q

What is a BRONCIAL breath sound and where is it heard?

A

High-pitched, harsh, loudest. Heard over the trachea and bronchi. Abnormal if heard over peripheral lung tissue.

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10
Q

What is a BRONCHOVESICULAR breath sound and where is it heard?

A

Medium-pitched & intensity. Heard over major bronchi. Abnormal if heard over peripheral lung tissue.

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11
Q

What is a TRACHEAL breath sound and where is it heard?

A

High-pitched, harsh. Over trachea and neck. Think Darth Vadar.

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12
Q

Discontinuous breath sounds

A

Fine or course crackles. High (fine) or low (course) pitched discrete crackling sounds during inspiration. Not cleared by cough.

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13
Q

Continuous breath sounds

A

1) Ronchi: loud, low, course like a snore, inspiration or expiration, coughing may clear (d/t mucus)
2) Wheeze: musical or squeaking, continuous during inspiration or expiration

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14
Q

Pleural friction rub

A

Dry, rubbing, grating during inspiration or expiration. Inflammation of pleural survacles

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15
Q

Chest percussion: where should you hear resonance?

A

All areas of healthy lung tissue

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16
Q

Chest percussion: why would you hear hyperresonance?

A

Hyperinflation -emphysema, pneumothoras, asthma

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17
Q

Chest percussion: why would you hear dullness or flatness?

A

Abnormal findings: Pneumonia, atelecstasis, pleural effusion, pneumothorax, asthma
Normal findings: over heart, diaphragm, or bones of scapula or bigger muscles

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18
Q

Percussion: where would you here tympany?

A

Abdomen

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19
Q

Define bronchophony

A

Greater clarity and increased loudness of spoken sounds with auscultation

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20
Q

Define whispered pectoriloquy

A

Extreme bronchophony where a whisper is amplified.

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21
Q

Define egophony

A

Nasally distortion of spoken words heard through auscultation.

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22
Q

What do bronchophony, whispered pectriloquy and egophony indicate?

A

Consolidation in the lungs

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23
Q

What would diminished vocal resonance indicate?

A

Loss of tissue within respiratory tree

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24
Q

What is a normal diaphragmatic excursion?

A

3-6cm. **diaphragm normally higher on right d/t liver

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25
Q

What would cause a diminished diaphragmatic excursion?

A

Pulmonary problems: emphysema
Abdominal problems: ascites, turmor
Superficial: fractured rib

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26
Q

Normal A/P diameter

A

A/P should be about .7-7.5 of lateral diameter

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27
Q

Increased A/P diameter

A

Increases with age. Equal to lateral diameter indicates chronic condition.

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28
Q

Where do the bronchi bifurcate?

A

2nd intercostal space

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29
Q

What would decreased tactile fremitis indicate?

A

Excess air in lungs, emphysema, pleural thickening, effusion, massive pulmonary edema, bronchial obstruction.

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30
Q

What would increased tactile fremitis indicate?

A

Fluids or solid mass in lungs d/t consolidation, heavy bronchial secretions, compressed lung, tumor.

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31
Q

Barrel chest

A

D/t compromised respiration (chronic asthma, emphysema, CF). Ribs become horizontal, spine become kyphotic, prominent sternal angle.

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32
Q

Flail chest

A

A flapping, unfixed chest wall caused by loss of stability of the thoracic cage after fracture of the sternum and/or ribs. A symptom is paradoxical movement of a portion of the chest wall—that is, the affected area draws in when the patient breathes in and the rest of the chest expands, and the affected area moves outwards as the patient exhales and the rest of the chest contracts.

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33
Q

Scoliosis

A

Lateral curvature of the spine

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34
Q

Kyphosis

A

Increased convex curvature of thoracic spine

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35
Q

Gibbus

A

Similar to kyphosis but with an extreme sharp angular deformity in the mid-thoracic region

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36
Q

Lordosis

A

Accentuation in lumbar curvature of spine

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37
Q

Pectus carinatum/excavatum

A

Carinatum: forward protrusion of sternum (pigeon chest)
Excavatum: Depression of sternum (funnel chest), may cause fatigue SOB, pain, tachycardia

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38
Q

Cough

A

Forceful expiration that clears irritants/secretions. Note: dry or moist, rapid or slow onset, frequency, regularity, pitch, postural influences, quality.

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39
Q

Sputum production

A

Mucus material from lungs brought up by coughing. Any more than a small amount of sputum suggests disease. Acute onset: infection. Chronic problem: indicates anatomic change.

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40
Q

Hemoptysis

A

Coughing up blood

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41
Q

Dyspnea

A

Difficulty breathing

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42
Q

Pulsus paradoxus

A

Abnormally large decrease in systolic BP and pulse amplitude during inspiration (>10mg drop)

43
Q

Shortness of breath

A

Dyspnea out of expected for level of physical activity

44
Q

Tachypnea

A

Rapid, shallow

45
Q

Bradypnea

A

Slow

46
Q

Eupnea

A

Normal 12-20/min

47
Q

Pleural rub

A

Friction between parietal and visceral pleurae d/t inflammation of pleural surfaces.

48
Q

Cyanosis

A

Bluish skin and mucous membranes d/t low O2 blood levels

49
Q

Chest pain

A

Symptom of cardiac disease

50
Q

Stridor

A

Harsh, high pitched sound during inspiration d/t laryngeal or tracheal obstruction

51
Q

Orthopnea

A

Difficulty breathing relieved by positioning

52
Q

Wheezing

A

High-pitched, musical hissing. Small/narrowed airways d/t asthma, COPD, bronchitis

53
Q

Paroxysmal nocturnal dyspnea

A

Night time respiratory distress, related to posture

54
Q

What is the order of the abdominal exam?

A

Inspection
Auscultation
Palpation
Percussion

55
Q

Gown draping for abdominal exam?

A

Expose from xyphoid process to pubic symphysis

56
Q

2 types of abdominal sounds

A

Bowel sounds & bruits

57
Q

Normal bowel sounds?

A

5-35 sounds per minutes. Irregularly occurring clicks or gurgles.

58
Q

What would cause increased bowel sounds?

A

Gastroenteritis, intestinal obstruction, hunger.

59
Q

What would cause high-pitched bowel sounds?

A

Intestinal fluid or air pressure

60
Q

What would cause decreased bowel sounds?

A

Peritonitis or paralytic ileus. Absent sounds along with pain is a sign of emergency.

61
Q

What would cause a friction rub in the bowel sounds?

A

Heard (rarely) during respiration. Indicates inflammation of peritoneal surface from tumor, infection, or infarct.

62
Q

What would cause a bruit in the bowel sounds?

A

Turbulent flow flow and vascular disease

63
Q

Referred pain in the R shoulder

A

acute cholecystitis

64
Q

Referred pain in the midsternal line

A

reflux

65
Q

Referred pain in the right breast

A

cholecystitis

66
Q

Referred pain in the epigastric region

A

angina

67
Q

Referred pain in the RUQ

A

pleuritic pain, cholecystitis, perforated gastric ulcer, biliary stones/colic, hepatitis, hepatomegaly, RLL pneumonia

68
Q

Referred pain in the LUQ

A

splenic infarct, pancreatitis, splenic rupture, gastric ulcer, aortic aneurysm, perforated colon, LLL pneumonia

69
Q

Referred pain in the RLQ

A

appendicitis (starts as periumbilical), R salpingitis, PID, ectopic pregnancy, ruptured ovarian cyst, tubo-ovatian abscess, renal stone, hernia, diverticulitis, perforated cecum

70
Q

Referred pain in the LLQ

A

diverticulitis (also down L leg), R salpingitis, PID, ectopic pregnancy, ruptured ovarian cyst, sigmoid diverticulitis, tubo-ovarian abscess, renal stone, hernia, perforated colon, ulcerative colitis

71
Q

Referred pain in the testes

A

renal colic

72
Q

Referred pain in the back

A

acute pancreatitis

73
Q

Cullen sign

A

Bluish periumbilical discoloration at the umbilicus that indicates intraperitoneal hemorrhage (intrabdominal bleeding)

74
Q

Ballottement

A

A palpatory technique used to detect or examine a floating object in the body, such as an organ. It is used in examining the abdomen esp. when ascites is present. Pressing at 90 angle into abdomen.

75
Q

Grey Turner sign

A

A blue discoloration of the skin around the flanks in a patient with hemorrhagic pancreatitis.

76
Q

Shifting dullness

A

A test for ascites. Determine border of tympany and dullness. Reposition patient: dullness will shift if ascites present.

77
Q

Murphy sign

A

Test for inflamed gallbladder: Abrupt cessation of inspiration on palpation of gallbladder (below liver margin at lateral border of rectus abdominis)

78
Q

Fluid wave

A

Tests for ascites by having patient place their hand in mid abdomen as a barrier. Tap on one side while palpating the other side. If wave transmitted, positive for ascites.

79
Q

Rovsing sign

A

RLQ pain intensified by LLQ palpation. Radiation of rebound tenderness. Caused by peritoneal irritation or appendicitis.

80
Q

Psoas sign

A

Test for peritoneal inflammation (often appendicitis): If flexing or stretching psoas muscle causes RLQ pain.

81
Q

McBurney sign

A

Test for peritoneal inflammation (often appendicitis): palpation of Mc Burney point in RLQ. RLQ pain is positive McBurney sign.

82
Q

Obturator sign

A

Test for peritoneal inflammation: flex hip and knee with patient supine and passively rotate. RLQ pain is positive obturator sign.

83
Q

Blumberg sign

A

Test for peritoneal inflammation by pressing deeeply into abdomen at 90 angle and withdrawing quickly. Rebound tenderness would be a positive Blumberg sign.

84
Q

Borborygmi

A

Rumbling, gurgling, tinkling noises heard on auscultation due to hyperactive intestinal peristalsis.

85
Q

Hematochezia

A

passage of fresh (bright red) blood within stool

86
Q

Constipation

A

difficulty in emptying the bowels, usually associated with hardened feces

87
Q

Hematemesis

A

vomiting blood

88
Q

Dysphagia

A

difficulty or discomfort with swallowing

89
Q

Melena

A

dark tarry stools (indicates bleeding in upper GI)

90
Q

Globus

A

persistent or intermittent sensation of a lump or foreign body in throat; between meals; no dysphagia

91
Q

Nausea

A

sickness with inclination to vomit

92
Q

Flatus

A

gas in or from the stomach or intestines, produced by swallowing air or by bacterial fermentation

93
Q

Vomiting

A

eject matter from the stomach through the mouth

94
Q

Singultus

A

hiccup (the state of having reflex spasms of the diaphragm accompanied by a rapid closure of the glottis producing an audible sound)

95
Q

Diarrhea

A

loose, watery stools that occur more frequently than usual

96
Q

Reflux

A

backward flow of the contents of the stomach into the esophagus that causes heartburn

97
Q

Gastroparesis

A

delayed gastric emptying= a medical condition consisting of a paresis (partial paralysis) of the stomach, resulting in food remaining in the stomach for an abnormally long time

98
Q

Eructation

A

burp

99
Q

Heel jar test

A

Test for peritoneal inflammation: Patient stands on tip toes then drops to heels (or patient is supine and strike their heels).

100
Q

Lymphadenopathy -localized

A

Enlargement of lymph nodes. Palpable for superficial nodes. Suggest regional infection or disease.

101
Q

Lymphadenopathy -generalized

A

Enlarged lymph nodes all over the body suggest systemic inflammatory, infectious, or malignant process. (TB or syphillis)

102
Q

Lymphedema

A

Swelling of subcutaneous tissue from obstruction of lymphatic vessels or lymph nodes. Non-pitting.

103
Q

Lymphadenitis

A

Inflammation of lymph nodes; stretch skin and may cause breakthrough weeping. (ie buboes in bubonic plague)

104
Q

Lymphangitis

A

Inflammation of lymph vessels. Seen as red streaking along the drainage course of the vessel.

Physical Diagnosis cont. (2 decks)

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