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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
What would cause a diminished diaphragmatic excursion?
Pulmonary problems: emphysema Abdominal problems: ascites, turmor Superficial: fractured rib
26
Normal A/P diameter
A/P should be about .7-7.5 of lateral diameter
27
Increased A/P diameter
Increases with age. Equal to lateral diameter indicates chronic condition.
28
Where do the bronchi bifurcate?
2nd intercostal space
29
What would decreased tactile fremitis indicate?
Excess air in lungs, emphysema, pleural thickening, effusion, massive pulmonary edema, bronchial obstruction.
30
What would increased tactile fremitis indicate?
Fluids or solid mass in lungs d/t consolidation, heavy bronchial secretions, compressed lung, tumor.
31
Barrel chest
D/t compromised respiration (chronic asthma, emphysema, CF). Ribs become horizontal, spine become kyphotic, prominent sternal angle.
32
Flail chest
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.
33
Scoliosis
Lateral curvature of the spine
34
Kyphosis
Increased convex curvature of thoracic spine
35
Gibbus
Similar to kyphosis but with an extreme sharp angular deformity in the mid-thoracic region
36
Lordosis
Accentuation in lumbar curvature of spine
37
Pectus carinatum/excavatum
Carinatum: forward protrusion of sternum (pigeon chest) Excavatum: Depression of sternum (funnel chest), may cause fatigue SOB, pain, tachycardia
38
Cough
Forceful expiration that clears irritants/secretions. Note: dry or moist, rapid or slow onset, frequency, regularity, pitch, postural influences, quality.
39
Sputum production
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.
40
Hemoptysis
Coughing up blood
41
Dyspnea
Difficulty breathing
42
Pulsus paradoxus
Abnormally large decrease in systolic BP and pulse amplitude during inspiration (>10mg drop)
43
Shortness of breath
Dyspnea out of expected for level of physical activity
44
Tachypnea
Rapid, shallow
45
Bradypnea
Slow
46
Eupnea
Normal 12-20/min
47
Pleural rub
Friction between parietal and visceral pleurae d/t inflammation of pleural surfaces.
48
Cyanosis
Bluish skin and mucous membranes d/t low O2 blood levels
49
Chest pain
Symptom of cardiac disease
50
Stridor
Harsh, high pitched sound during inspiration d/t laryngeal or tracheal obstruction
51
Orthopnea
Difficulty breathing relieved by positioning
52
Wheezing
High-pitched, musical hissing. Small/narrowed airways d/t asthma, COPD, bronchitis
53
Paroxysmal nocturnal dyspnea
Night time respiratory distress, related to posture
54
What is the order of the abdominal exam?
Inspection Auscultation Palpation Percussion
55
Gown draping for abdominal exam?
Expose from xyphoid process to pubic symphysis
56
2 types of abdominal sounds
Bowel sounds & bruits
57
Normal bowel sounds?
5-35 sounds per minutes. Irregularly occurring clicks or gurgles.
58
What would cause increased bowel sounds?
Gastroenteritis, intestinal obstruction, hunger.
59
What would cause high-pitched bowel sounds?
Intestinal fluid or air pressure
60
What would cause decreased bowel sounds?
Peritonitis or paralytic ileus. Absent sounds along with pain is a sign of emergency.
61
What would cause a friction rub in the bowel sounds?
Heard (rarely) during respiration. Indicates inflammation of peritoneal surface from tumor, infection, or infarct.
62
What would cause a bruit in the bowel sounds?
Turbulent flow flow and vascular disease
63
Referred pain in the R shoulder
acute cholecystitis
64
Referred pain in the midsternal line
reflux
65
Referred pain in the right breast
cholecystitis
66
Referred pain in the epigastric region
angina
67
Referred pain in the RUQ
pleuritic pain, cholecystitis, perforated gastric ulcer, biliary stones/colic, hepatitis, hepatomegaly, RLL pneumonia
68
Referred pain in the LUQ
splenic infarct, pancreatitis, splenic rupture, gastric ulcer, aortic aneurysm, perforated colon, LLL pneumonia
69
Referred pain in the RLQ
appendicitis (starts as periumbilical), R salpingitis, PID, ectopic pregnancy, ruptured ovarian cyst, tubo-ovatian abscess, renal stone, hernia, diverticulitis, perforated cecum
70
Referred pain in the LLQ
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
Referred pain in the testes
renal colic
72
Referred pain in the back
acute pancreatitis
73
Cullen sign
Bluish periumbilical discoloration at the umbilicus that indicates intraperitoneal hemorrhage (intrabdominal bleeding)
74
Ballottement
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
Grey Turner sign
A blue discoloration of the skin around the flanks in a patient with hemorrhagic pancreatitis.
76
Shifting dullness
A test for ascites. Determine border of tympany and dullness. Reposition patient: dullness will shift if ascites present.
77
Murphy sign
Test for inflamed gallbladder: Abrupt cessation of inspiration on palpation of gallbladder (below liver margin at lateral border of rectus abdominis)
78
Fluid wave
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
Rovsing sign
RLQ pain intensified by LLQ palpation. Radiation of rebound tenderness. Caused by peritoneal irritation or appendicitis.
80
Psoas sign
Test for peritoneal inflammation (often appendicitis): If flexing or stretching psoas muscle causes RLQ pain.
81
McBurney sign
Test for peritoneal inflammation (often appendicitis): palpation of Mc Burney point in RLQ. RLQ pain is positive McBurney sign.
82
Obturator sign
Test for peritoneal inflammation: flex hip and knee with patient supine and passively rotate. RLQ pain is positive obturator sign.
83
Blumberg sign
Test for peritoneal inflammation by pressing deeeply into abdomen at 90 angle and withdrawing quickly. Rebound tenderness would be a positive Blumberg sign.
84
Borborygmi
Rumbling, gurgling, tinkling noises heard on auscultation due to hyperactive intestinal peristalsis.
85
Hematochezia
passage of fresh (bright red) blood within stool
86
Constipation
difficulty in emptying the bowels, usually associated with hardened feces
87
Hematemesis
vomiting blood
88
Dysphagia
difficulty or discomfort with swallowing
89
Melena
dark tarry stools (indicates bleeding in upper GI)
90
Globus
persistent or intermittent sensation of a lump or foreign body in throat; between meals; no dysphagia
91
Nausea
sickness with inclination to vomit
92
Flatus
gas in or from the stomach or intestines, produced by swallowing air or by bacterial fermentation
93
Vomiting
eject matter from the stomach through the mouth
94
Singultus
hiccup (the state of having reflex spasms of the diaphragm accompanied by a rapid closure of the glottis producing an audible sound)
95
Diarrhea
loose, watery stools that occur more frequently than usual
96
Reflux
backward flow of the contents of the stomach into the esophagus that causes heartburn
97
Gastroparesis
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
Eructation
burp
99
Heel jar test
Test for peritoneal inflammation: Patient stands on tip toes then drops to heels (or patient is supine and strike their heels).
100
Lymphadenopathy -localized
Enlargement of lymph nodes. Palpable for superficial nodes. Suggest regional infection or disease.
101
Lymphadenopathy -generalized
Enlarged lymph nodes all over the body suggest systemic inflammatory, infectious, or malignant process. (TB or syphillis)
102
Lymphedema
Swelling of subcutaneous tissue from obstruction of lymphatic vessels or lymph nodes. Non-pitting.
103
Lymphadenitis
Inflammation of lymph nodes; stretch skin and may cause breakthrough weeping. (ie buboes in bubonic plague)
104
Lymphangitis
Inflammation of lymph vessels. Seen as red streaking along the drainage course of the vessel.

Physical Diagnosis cont. (2 decks)

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