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Physical Diagnosis > Block II > Flashcards

Block II Flashcards

1
Q

How many lobes does the R lung have?

A

3

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2
Q

How many lobes does the L 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

lateral, 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 on periphery.

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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 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/mid chest. 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, asthmaNormal 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: emphysemaAbdominal problems: ascites, turmorSuperficial: 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)

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43
Q

Shortness of breath

A

Dyspnea out of expected for level of physical activity

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44
Q

Tachypnea

A

Rapid, shallow

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45
Q

Bradypnea

A

Slow

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46
Q

Eupnea

A

Normal 12-20/min

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47
Q

Pleural rub

A

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

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48
Q

Cyanosis

A

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

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49
Q

Chest pain

A

Symptom of cardiac disease

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50
Q

Stridor

A

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

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51
Q

Orthopnea

A

Difficulty breathing relieved by positioning

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52
Q

Wheezing

A

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

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53
Q

Paroxysmal nocturnal dyspnea

A

Night time respiratory distress, related to posture

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54
Q

What is the order of the abdominal exam?

A

InspectionAuscultationPalpationPercussion

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55
Q

Gown draping for abdominal exam?

A

Expose from xyphoid process to pubic symphysis

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56
Q

2 types of abdominal sounds

A

Bowel sounds & bruits

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57
Q

Normal bowel sounds?

A

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

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58
Q

What would cause increased bowel sounds?

A

Gastroenteritis, intestinal obstruction, hunger.

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59
Q

What would cause high-pitched bowel sounds?

A

Intestinal fluid or air pressure

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60
Q

What would cause decreased bowel sounds?

A

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

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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.

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62
Q

What would cause a bruit in the bowel sounds?

A

Turbulent flow flow and vascular disease

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63
Q

Referred pain in the R shoulder

A

acute cholecystitis

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64
Q

Referred pain in the midsternal line

A

reflux

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65
Q

Referred pain in the right breast

A

cholecystitis

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66
Q

Referred pain in the epigastric region

A

angina

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67
Q

Referred pain in the RUQ

A

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

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68
Q

Referred pain in the LUQ

A

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

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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

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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

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71
Q

Referred pain in the testes

A

renal colic

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72
Q

Referred pain in the back

A

acute pancreatitis

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73
Q

Cullen sign

A

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

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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.

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75
Q

Grey Turner sign

A

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

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76
Q

Shifting dullness

A

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

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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)

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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.

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79
Q

Rovsing sign

A

RLQ pain intensified by LLQ palpation. Caused by peritoneal irritation or appendicitis.

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80
Q

Psoas sign

A

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

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81
Q

McBurney sign

A

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

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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.

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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.

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84
Q

Borborygmi

A

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

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85
Q

Hematochezia

A

passage of fresh (bright red) blood within stool

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86
Q

Constipation

A

difficulty in emptying the bowels, usually associated with hardened feces

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87
Q

Hematemesis

A

vomiting blood

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88
Q

Dysphagia

A

difficulty or discomfort with swallowing

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89
Q

Melena

A

dark tarry stools (indicates bleeding in upper GI)

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90
Q

Globus

A

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

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91
Q

Nausea

A

sickness with inclination to vomit

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92
Q

Flatus

A

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

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93
Q

Vomiting

A

eject matter from the stomach through the mouth

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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)

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95
Q

Diarrhea

A

loose, watery stools that occur more frequently than usual

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96
Q

Reflux

A

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

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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

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98
Q

Eructation

A

burp

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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).

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100
Q

Lymphadenopathy -localized

A

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

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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.

105
Q

a. pericardium

A

double-walled fibrous sac that holds the heart; contains heart, roots of the great vessels, and pericardial fluid; protects, lubricates, and fixes heart in place

106
Q

b. right and left ventricles

A

ventricles receive blood from the atria and then strongly pump it out during systolethick-walled, muscular, provides the “oomph” of the heart, most of the heart’s mass RV receives blood from RA, pumps to lungs via pulmonary artery LV receives blood from LA, pumps to aorta/body

107
Q

d. aortic valve

A

semilunar valve between LV and ascending aortaforced open in systoleone-way valve: prevents blood from flowing backward from the aorta into the LVTrileaflet (comprised of three leaves that come together when the valve is closed)

108
Q

c. right and left atria

A

atria receive blood from the circulation (body and lungs) and drain into ventricles relatively thin-walled, reservoirs RA receives deoxygenated blood from the body/vena cavae LA receives oxygenated blood from the pulmonary circulation via pulmonary veins

109
Q

e. pulmonic valve (AKA pulmonary valve)

A

semilunar valve between RV and pulmonary artery forced open in systoleone-way valve:Trileaflet

110
Q

f. the great vessels

A

collectively, the large vessels that route blood to and from the heart:

111
Q

j. tricuspid valve

A

AKA right atrioventricular valvebetween RA and RVopen in diastoleone-way valve: prevents blood from flowing backward from the RV into the RATrileaflet (comprised of three leaves that come together when the valve is closed)

112
Q

k. mitral valve

A

AKA left atrioventricular valve, AKA bicuspid valvebetween LA and LVopen in diastoleone-way valve: prevents blood from flowing backward from the LV into the LABileaflet (comprised of two leaves that come together when the valve is closed)

113
Q

A. Preload:

A

the initial stretching of the cardiac myocytes prior to contraction

114
Q

B. Afterload:

A

can be thought of as the “load” that the heart must eject blood against, closely related to aortic pressure

115
Q

C. Systole:

A

The part of the cardiac cycle during which the heart contracts, particularly the ventricles, resulting in a forceful flow of blood into both the systemic and pulmonary circulations. (M)

116
Q

D. Diastole:

A

That time between two contractions of the heart when the muscles relax, allowing the chambers to fill with blood; diastole of the atria precedes that of the ventricles; diastole alternates, usually in a regular rhythm, with systole. (M)

117
Q

S1:

A

produced by the closure of the mitral and tricuspid valves (CE)

118
Q

S2:

A

produced by the closure of the aortic and pulmonic valves (CE)

119
Q

S3 (S3 Gallop):

A

The first stage of diastole is a period of rapid ventricular filling. At the end of this stage of rapid filling, an S3 may be heard if the volume of blood that has been transferred is abnormally large, as in mitral regurgitation. The S3 gallop is thought to be the sound the ventricle makes when it is forced to dilate beyond its normal range due to volume overload in the atria (ex: heart failure). Conditions of high cardiac output (ex: thyrotoxicosis, severe anemia) can also cause an S3 gallop. (HS)

120
Q

S4 (S4 gallop):

A

The late stage of diastole is marked by atrial contraction. If the ventricle is stiff and non-compliant (ex: left ventricular hypertrophy secondary to longstanding severe hypertension, MI, or cardiomyopathies) then the pressure wave gradient generated as the atria contract generates an S4 sound. Ex of right sided S4: pulmonary hypertension, pulmonary stenosis (HS)

121
Q

Superior Vena Cava

A

routes deoxygenated blood from the head/neck/upper extremities (upper body) into the RA

122
Q

Inferior Vena Cava

A

routes deoxygenated blood from the abdomen/pelvis/lower extremities (lower body) into the RA

123
Q

Pulmonary Artery

A

routes deoxygenated blood from the RV to the lungs

124
Q

Aorta

A

routes blood from the LV to the body; ascending – arch – descending – thoracic – abdominal

125
Q

Pulmonary Veins

A

routes oxygenated blood from the lungs to the LA

126
Q

a. physiologic splitting

A

The pressure of the right side of the heart and left side of the heart are not the same. The right atrium, right ventricle, and pulmonary artery have a lower pressure than the left side of the heart. This results in sounds occurring at different times. For example, the aortic valve found on the left side will close before the pulmonic valve on the right side. This creates a split in S2 which can be broken down as sounds A2 and P2.

127
Q

b. pathologic fixed splitting-

A

A splitting of sounds A2 (aortic component of 2nd heart sound) and P2 (pulmonic component of 2nd heart sound) that is wide and there is no variation between respirations. This could be heard in atrial septal defect and right ventricular failure.

128
Q

pathologic splitting ii. paradoxic splitting-

A

During respiration there is a delay in the closure of the aortic valve (A2) creating an inconsistent movement of A2 and P2. The sounds are separate during expiration and sound closer together during inspiration. This could be heard with a left bundle branch block.

129
Q

electrical cycle in heart

A

SA node - contraction of atria, filling of ventricles (diastole)AV node — purkinje fibers — contraction of ventricles (systole)

130
Q

SA Node

A

natural pace maker

131
Q

auscultation position: aortic area

A

R 2 ICSaortic valve and S2

132
Q

auscultation position: pulmonic area

A

L 2 ICSpulmonic valve

133
Q

auscultation position: Erb’s point

A

L 3 ICSpulmonary artery - best for S2

134
Q

auscultation position: Tricuspid (apex)

A

L 4/5 ICSTricuspid

135
Q

auscultation position: Mitral

A

Lateral L 5/6 ICSS1

136
Q

Cardiac Exam Inspection acute

A

GA: signs of acute cardiac distress:Cyanosis, diaphoresis, pallor, cool temp, difficulty breathing, anxiety, Levine’s sign (clutching fist over chest)Apical impulse: beating of LV during systole at 4th or 5th LICS at midclavicular line. Not normally seen while supine. May need light.

137
Q

Cardiac Exam Inspection chronic

A

GA: signs of chronic heart conditions:Clubbing fingernails, xanthelasma (yellow waxy deposits on extremities & around eyes, d/t increase cholesterol)Obesity or coarction (underdeveloped lower extremities)

138
Q

Cardiac Exam Palpation

A

Patient elevated 30 degreesUse carotid pulse to detect timing of systole Palpate for PMI (apical impulse)If elsewhere than apex = abnormalityProvides estimation of size of heartAssess location, diameter (should be one ICS or 1 cm), amplitude (should be gentle), duration

139
Q

palpable cardiac abnormalities

A

lift, heave, thrillFor thrills, palpate over areas corresponding to valves

140
Q

Cardiac Exam: auscultation

A

Listen to all areas with pt. upright, supine & left lateral recumbentUpright leaning forward best to hear S2 & aortic murmurs LL recumbent best to hear S1, mitral murmurs, & low-pitched diastole filling soundsListen to all areas with bell and diaphragmSkin contact!Listening for: Normal & abnormal heart sounds, rate & rhythm

141
Q

5 Locations of cardiac exam

A

Aortic, Pulmonic, Erb’s, Tri, Mitral

142
Q

S1 heart sound

A

S1:Produced by closure of mitral and tricuspid valvesIndicates beginning of systoleLoudest over the apex of the heart; best heard with diaphragm of stethoscope

143
Q

S2 heart sound

A

S2:Produced by the closure of aortic and pulmonic valvesIndicates beginning of diastoleLoudest at left and right intercostal spaces (left for pulmonic valve, right for aortic valve); best heard with diaphragm of stethoscopeCan sometimes hear physiologic splitting of S2 on deep inspiration

144
Q

chest pain sx

A

levine’s sign, fist on chest, uncomfortable look

145
Q

fatigue sx

A

can’t maintain normal activitiescan’t keep up with contemporariessleeping moreunusual or persistent

146
Q

dyspnea sx

A

aggravated by exertiondifficult breathinglooking uncomfortable

147
Q

diaphoresis

A

excessive sweating

148
Q

syncope sx

A

associated with palpitationschange in posturehappen with looking up or turning headunusual exertion

149
Q

cyanosis sx

A

found in periphery firstblue/pallor colordecreased OX, decrease bloodflow

150
Q

cough sx

A

onset/duration?dry/wetincreased when laying down

151
Q

orthopnea sx

A

SOB while laying flatLV failurefixed by sitting up

152
Q

Claudication sx

A

pain during exercise from decreased blood flowmostly in legs, can be arms

153
Q

paroxysmal nocturnal dyspnea sx

A

SOB at nightcoughingawakens pt from sleep

154
Q

xanthelasma sx

A

waxy yellow deposits on skinaround eye/extensor surfacesincreased cholesterol in blood

155
Q

other organ systems evaluated with CV complaint

A

EKGdiaphragmlungsPVSmusculoskeletal complaints - shoulder pain/jaw pain/xyphoidyniaGI distrubances - heartburn, uclersanxiety

156
Q

hypotension

A

low BP

157
Q

postural/ orthostatic hypotension

A

abnormal decrease in BP from sitting to standing

158
Q

hypertension

A

> 140/90

159
Q

normotension

A

<120/80

160
Q

heart murmur intensity grade 1

A

Grade 1: faint, intermittent

161
Q

heart murmur intensity grade 2

A

Grade 2: quiet but easy to hear

162
Q

heart murmur intensity grade 3

A

Grade 3: moderately loud, no palpable thrill

163
Q

heart murmur intensity grade 4

A

Grade 4: loud, palpable thrill

164
Q

heart murmur intensity grade 5

A

Grade 5: loud, palpable thrill; can hear with stethoscope barely touching chest

165
Q

heart murmur intensity grade 6

A

Grade 6: very loud, palpable thrill; can hear with stethoscope off chest

166
Q

seven dimensions of a heart murmur

A

timing/durationpitchintensity (grading scale)patternlocationradiationrespiratory phase variations

167
Q

b. pitch: (murmur)

A

high, medium, or low? Bell or diaphragm?

168
Q

a. timing and duration (murmur)

A

between S1 and S2, or S2 and S1? Short or prolonged?

169
Q

MURMUR d. pattern: crescendo

A

: increased blood velocity; decresendo: decreased blood velocity; square/plateau: constant intensity

170
Q

e. location MURMUR

A

: where is it auscultated best?

171
Q

MURMUR f. radiation:

A

do you hear it only over the specific valve or elsewhere? sound generally transmitted in direction of blood flow

172
Q

g. respiratory phase variations: MURMUR

A

impacted by inspiration/expiration? variation of intensity, quality, timing? if venous return issue, increase with insp, decrease with

173
Q

external cues to peripheral health

A

Hair pattern on extremities Skin color:o Cyanosis at extremities, lips and noseo Ruboro Palloro mottlingCapillary refill time <2seconds Temperature of skinPulse strength and regularityDependent edema

174
Q

List the sequence of blood flow through the systemic circulatory system.

A

LV - aorta - brain/lower body/liver/mesentery - through cap beds - exchange of OX - leaves brain/liver/lower body/mesentery – SVC/IVC – RA — RV —- Lungs — reOX – LA — LV

175
Q

arterial pulse

A

pressure wave through system from ventricular contraction

176
Q

arterial BP

A

force exerted by blood against wall of artery as ventricles contract and relax

177
Q

Variable in arterial pulse

A

blood volumedistensibility of aortaviscosity of bloodperipheral arterial resistance

178
Q

characteristics of jugular venous pressure (JVP)

A

Jugular veins reflect activity/competency of the right side of the heart Visibility of jugular venous pulsations/fluttering indicates right atrial pressure

179
Q

normal range for JVP

A

The vertical distance from the sternal angle to the straight edge is the JVP valueNormal range is < 3 cm

180
Q

Normal range for CVP

A

CVP (central venous pressure) can be approximated:5cm + JVP = CVPNormal CVP is 7 cm, upper limit is 9 cm

181
Q

carotid -

A

just below angle of jaw

182
Q

abdominal aorta -

A

left lateral and superior to umbilicusAusculate before palpating!Only pulse where both hands needed to apply deep pressurePulsations should be less than 2.5 cm apart

183
Q

femoral -

A

crease of groin

184
Q

brachial -

A

medial antecubital fossa of elbow

185
Q

radial -

A

thumb side of wrist where it creases

186
Q

ulnar

A
  • pinky side of wrist where it creases
187
Q

dorsalis pedis

A
  • top of foot, between metatarsals 1 and 2
188
Q

popliteal

A
  • directly behind (flexed) kneemost difficult pulse to find of peopleIf non-palpable, ensure dosalis pedis and posterior tibialis are symmetrical with good amplitude
189
Q

posterior tibialis

A
  • posterior to medial malleolus of ankle
190
Q

Amplitude’s for Pulses 0-4

A

0=no palpable pulse 1=diminished2=normal / expected 3=full / increased4=bounding

191
Q

a. pulsus alternans- PE findings:

A

Pulse has constant rate and rhythm but amplitude (force) alternates between a smaller amplitude and larger amplitude

192
Q

a. pulsus alternans - Clinical significance:

A

Can be due to left ventricular dysfunction/failure

193
Q

b. pulsus bigeminus - Clinical significance:

A

Can be due to heart disease, digitalis toxicity, or a temporary benign finding.

194
Q

b. pulsus bigeminus- PE findings:

A

Normal pulse beat followed by a premature beat (due to premature ventricular contraction) and a pause. Premature beat’s amplitude (force) is less than the amplitude of the normal beat.

195
Q

c. pulsus bisferiens- PE findings:

A

Pulse has two peaks during systole-the first is the “normal” pulse that occurs during ventricular contraction, but the second is an early diastole due to a backflow of blood; best noticed with palpation of carotid artery

196
Q

-c. pulsus bisferiens Clinical significance:

A

Can be due to severe aortic regurgitation or aortic stenosis (narrowing) coupled with aortic insufficiency.

197
Q

d. pulsus paradoxus- PE findings:

A

Atypical decrease in systolic arterial blood pressure (>10 mm Hg) and amplitude (force) during inspiration (breathing in). Normally there is a slight decrease in BP with inspiration, but it’s less than 10 mm Hg. May be detected with palpation, but much easier to detect by taking pt’s BP.

198
Q

d. pulsus paradoxus - Clinical significance:

A

Can be due to emphysema, asthma, premature heart contraction, tracheobronchal obstruction, or pericardial effusion (fluid around the heart).

199
Q

e. pulse deficit- PE findings:

A

difference between the rates in pulse when auscultating the heart’s apex (assessing the pulse using stethoscope over apex of heart) versus palpating a peripheral artery (e.g. taking someone’s radial pulse)

200
Q

e. pulse deficit - Clinical significance:

A

Occurs when ventricular contraction doesn’t eject a sufficient amount of blood to produce a pulse wave in the arteries. Often associated with premature beats, pulsus bigeminus, and atrial fibrillation.

201
Q

a. venous insufficiency (chronic)Assess:

A

IPPA of lower extremities, Trendelenberg retrograde filling test, Hx of phlebitis, leg injury

202
Q

a. venous insufficiency (chronic) Findings:

A

Brawny ankle edema and induration, stasis pigmentations, varicosities, ankle ulcerations, pitting edema, cyanosis/erythema

203
Q

b. venous obstructionAssess:

A

IPPA of lower extremities, pain and swelling in ankle, Homan’s sign; calf measurement

204
Q

b. venous obstruction Findings:

A

DVT –> PE, unilateral pitting edema, acute superficial thrombophlebitis

205
Q

c. arterial insufficiency (chronic)Assess:

A

IPPA of lower extremities; postural color changes

206
Q

c. arterial insufficiency (chronic) Findings:

A

Cool, pale (upon elevation), thin, shiny atrophic skin around ankle/lower leg. Loss of hair over foot and toes; thickened toenails; gangrene; pain that goes away upon resting

207
Q

d. arterial obstructionAssess:

A

IPPA of upper and lower extremities; Allen test;

208
Q

d. arterial obstruction Findings:

A

Pain, numbness, tingling, weakness, pallor –> Acute Arterial Occlusion;

209
Q

e. varicositiesAssess:

A

Inspection of lower limbs, palpate for increased venous pressure.

210
Q

e. varicosities Findings:

A

Dilated, tortuous, visibly blue/purple veins. Sometimes painful. Indicative of chronic venous insufficiency.

211
Q

f. dependent edema / pitting and nonpittingAssess:

A

Firmly over bony prominence comparing like areas and recording topographic areas. Please refer to lecture slides for picture.

212
Q

f. dependent edema / pitting and nonpitting Findings:

A

Bilateral indicates systemic. Unilateral indicates local. “4+ pitting edema from _______ to _______.” CHF —> Edema go higher and higher on Lower Ext.

213
Q

g. claudicationAssess:

A

Hx of pain caused by too little blood flow during exercise. Generally affects the blood vessels in the legs, but claudication can affect the arms, too.

214
Q

g. claudication Findings:

A

Sx of peripheral vascular disease

215
Q

h. capillary refillAssess:

A

Pinch fingernails or toenails and observe for capillary refill < 2 seconds.

216
Q

h. capillary refill Findings:

A

Greater than 2 seconds indicative of arterial inefficiency

217
Q

bruits and where to look

A

turbulent bloodflow through vessels - may be an obstruction/stenosis/restrictionusing diaphragm listen for bruits overcarotidsfemoraliliacrenalaortic

218
Q

a. paraphimosis:

A

foreskin becomes trapped behind the glans penis

219
Q

o. cryptorchidism:

A

undescended testicle

220
Q

n. femoral hernia:

A

bulging of intestines through the femoral ring

221
Q

m. direct inguinal hernia:

A

doesn’t go through internal inguinal ring; through external right; hernia bulges anteriorly, pushes against side of finger

222
Q

l. indirect inguinal hérnia:

A

through internal ring; most common type of hernia, pts often young males; pain on straining; touches fingertip on exam

223
Q

k. epispadias:

A

urethral deformity; can open on top, side, or be open along length of penis

224
Q

j. testicular tumor:

A

câncer that develops in the testicles

225
Q

b. hypospadias:

A

urethral opening is on underside of the penis

226
Q

i. epididymitis:

A

inflammation of infection of the epididymis; generally caused by chlamydia, gonorrhea, or E. Coli

227
Q

h. varicocele:

A

enlargement of the veins within the scrotum

228
Q

g. spermatocele:

A

benign, sperm-filled cyst at the head of the epiddidymis

229
Q

f. hydrocele:

A

collection of fluid in the scrotum

230
Q

e. peyronie disease:

A

connective tissue disorder; chronic inflammation and scar tissue formation in the túnica albugínea

231
Q

d. condyloma:

A

presence of warts caused by HPV

232
Q

c. chancre:

A

painless ulceration formed during primary stage of syphilis

233
Q

techniques used to minimize patient anxiety associated with a genital examination

A

chaperoneanswers all questions before examination positions they will be in equipmentinstruction

234
Q

Male genital self exam (GSE)Step 1:

A

Patient should hold penis in handInspect head of penis for lesions or masses (if not circumcised, pull back foreskin)Palpate head of penis feeling for bumps, sores, warts or blisters.

235
Q

Step 2: Male genital self exam (GSE)

A

Inspect urethral meatus, squeeze to see if there is any discharge.

236
Q

Step 3: Male genital self exam (GSE)

A

Patient should examine entire shaft.Evaluate for any lesions, sores or masses.Use a mirror to visualize the underside.

237
Q

Step 4: Male genital self exam (GSE)

A

Patient should then examine the base of the penis by moving pubic hair out of the way.

238
Q

Step 5: Male genital self exam (GSE)

A

Scrotum evaluationPatient should hold each testicle gently while inspecting and palpating using lighter then firmer pressure.

239
Q

sequence and examination techniques for male GU AdultInspection

A

lesions, chancres, pubic hair patterns, note circumcised or uncircumcised, position, meatus position/stenosis, phimosis and paraphimosis

240
Q

sequence and examination techniques for male GU Adult Palpation:

A

tenderness/nodularities/lesions - palpate top to bottomside to sidestrip the urethra looking for any abnormal discharge or blood at urethral meatus. Open meatus to inspect for discharge, lesions.

241
Q

Scrotum: Inspection

A

extreme asymmetry - skin (rashes/redness), separate hair to look at skin,

242
Q

Scrotum: Palpation

A

P: cremasteric reflex - tongue blade stroked on inside of thigh - testicle on that side should rise voluntarily - tests T12-L1-L2 nerves

243
Q

Testis:

A

isolate one testicle at a time - can ask pt to hold penis out of the way, roll testicle around in fingers - smooth - not overly tender - note contours during palpation -

244
Q

Hernia:

A

follow spermatacord up to pelvis, toothpick feeling is the vas defrens, find the external inguinal ring - place tip of finger here and have pt cough/bear down. ,

245
Q

indirect hernia

A

If bulge felt on tip of finger =

246
Q

direct hernia

A

if bulge felt on side of finger =

247
Q

Adolescent: GU male

A

allay anxiety, protect privacy, inspect/palpate - Tanner stage

248
Q

Child GU Male

A

lesions, malformations, discharge, masses, hernias

249
Q

Infant GU Male

A

Mostly looking for congenital abnormalities, urethral placement, retractability of foreskin, descent of testicles (1-2 months) masses (transilluminate)

250
Q

male erection

A

two corpora cavernosa become engorged with blood via arterial dilation and decreased venous flowautonomic nervous systemlocal synthesis of nitric oxide

251
Q

male ejaculation

A

emission of secretions from vas defrens, epididimides, prostate and seminal vesicles

252
Q

male orgasm

A

constriction of vessels supplying blood to corpora cavernosa and gradual subsiding of sexual arousal

Physical Diagnosis (1 decks)

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