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Physical Assessment 1 > Ch 8 and 9 Red Bolded Info > Flashcards

Ch 8 and 9 Red Bolded Info Flashcards

1
Q

insertion for tension pnumo decompression

A

2nd ICS

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2
Q

chest tube location

A

4th ICS

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3
Q

lower margin of an endotracheal tube on chest xray

A

T4

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4
Q

what runs along the inferior margin of each rib

A

neurovascular structures

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5
Q

where do we place needles (in according to ribs)

why?

A

SUPERIOR to rib margins bc neurovascular structures run along the inferior margin

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6
Q
  • landmark for thoracentesis

- needle insertion?

A

T7-T8–landmark

inser needle immediately superior to 8th rib

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7
Q

which lobe is MC for aspirational pnm

why?

A

right middle and lower lobe

bc right main bronchus is more vertical

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8
Q

accumulations of pleural efffusions can be?

A

transudates

exudates

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9
Q

what diseases cause transudative pleural effusions

A

HF
cirrhosis
nephrotic syndrome

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10
Q

what diseases cause exudative pleural effusions

A 
pnm 
malignancy 
PE 
TB
pancreatitis
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11
Q

what diseases causes irritation of the parietal pleura–causing pleuritic pain on deep inspiration

A 
viral plurisy 
pnm 
PE 
pericarditits 
collagen vasc disease
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12
Q 
viral plurisy 
pnm 
PE 
pericarditits 
collagen vasc disease

all cause what

A

pleuritic chest pain on deep inspiration

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13
Q

define a cough that is:

  1. acute
  2. subacute
  3. chronic
A
  1. <3 weeks
  2. 3-8wks
  3. 8+ weeks
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14
Q

MCC for acute cough

list other causes (7)

A

viral URI

OTHERS

  1. ACE inhibitors
  2. FB
  3. smoking
  4. HF left
  5. asthma
  6. pnm
  7. acute bronchitis
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15
Q

MC causes for subacute cough

A 
post-infectious cough 
pertussis 
acid reflux 
bacterial sinusitis 
asthma
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16
Q

MCC chronic cough

A 
post nasal drip 
asthma 
GERD 
chronic bronchitis 
bronchiectasis
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17
Q

describe mucoid sputum

seen with?

A

transluent white or gray

seen with viral URI and cystic fibrosis

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18
Q

descirbe puruelnt sputum

seen with>

A

yellow or green

bacterian pnm

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19
Q

foul smelling sputum assoc with

A

anaerobic lung abscess

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20
Q

thick tenacious sputum is seen with?

A

CF

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21
Q

large volume of purulent sputum seen with

A

bronchiectasis and lung abcess

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22
Q

diagnostically helpful s/s to r/i pnm

A

productive cough

fever

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23
Q

chest pain
dyspnea
orthopnea
all diagnostic s/s for?

A

Acute coronary syndrome

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24
Q

causes of cough + hemopytsis

A

bronchitis
malignancy
CF

less common: 
-bronchiectasis 
mitral stenosis 
Goodpasture syndrome 
Wegener granulomatosis
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25
Q

define life threatning hemoptysis

A

> 200 cm

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26
Q

blood originating from stomach is waht color

A

darker + mixed with food particles

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27
Q

blood from resp tract is what color

A

lighter vs the blood from GI

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28
Q

hallmark s/s of obstructive sleep apnea

A

daytime sleepines and snoring

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29
Q

PT population you can see obstructive sleep apnea

A 
obesity 
posterior malocclusion of jaw 
tx resistant HTN 
HF
AFIB 
stroke
DM2
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30
Q

bradypnea

A

under 14 with or w/o increase in tidal volume

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31
Q

tachypnea

A

over 20 and shallow

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32
Q

sighing respirations

A

breathing punctured by frequent signs– suggests hyperventillation syndrome

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33
Q

cheyne-stokes breathing

A

pds of deep breathing alternating with periods of apnea

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34
Q

ataxic breathing

A

irregular–perids of apnea, alternate with regular deep breaths which stop suddently for shot intervals

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35
Q

audible high pitched inspiratory whistling

A

stridor

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36
Q

stridor=

A

upper airway obstruction in larynx or trachea

emergency

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37
Q

wheezing is???

A

either expiratory or continuous

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38
Q

accessory muscle use signifies (2)

A

diff breathing from COPD
or
muslce fatigue

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39
Q

lateral displacement of trachea seen with

A

pnothorax
plerual eff
atelectasis

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40
Q

barrel chest ratio

A

over 0.9 for COPD

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41
Q

asymmetric chest expansion seen with

A

plerual effusion

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42
Q

retractions occur in?

A

COPD
severe asthma
upper airway obstruction

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43
Q

unilateral impairment or lagging suggests?

A

impaired resp movement on one or both sides

pleural effusion from asbestosis or silicosis
-also seen with phrenic nerve damage or trauma

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44
Q

intercostal tenderness develops over?

indicates?

A

over the inflammed pleurae

costochondritis

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45
Q

tenderness +bruising + bony step offs

A

fx rib

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46
Q

crepitus in chest wall

A

=chest wall edema seen in mediastinitis

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47
Q

sinus tracts suggests

A

underlying pleura and lung infection
TB
actinomycosis

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48
Q

unilateral decrease or delay in chest expansion occurs in?

A 
chronic fibrosis of underlying lung or pleura
plerual eff 
lobar pnm 
pleural pain assoc with splinting 
unilateral bronchial obstruction 
paralysis of hemidriaphrahm
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49
Q

unilateral decrease or delay in chest expansion occurs in?

A 
chronic fibrosis of underlying lung or pleura
plerual eff 
lobar pnm 
pleural pain assoc with splinting 
unilateral bronchial obstruction 
paralysis of hemidriaphrahm
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50
Q

define decreased or absent fremitus

A

when the voice is higher pitched or soft or when transmission of vibrations from larynx to the surface of the chest is impeded by a thick chest wall, an obstructed bronchus …

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51
Q

what dz cause decrease fremitus

A 
COPD 
obstructed bronchus 
thick chest wall 
plerural eff 
fibrosis 
air (pnothx) 
infiltrating tumor
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52
Q

asymmetric decrease fremitus raises likelihood of?

A

unliteral plerual eff, pnuthox, neoplasm

**all decrease tranmissions of low freq sounds*

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53
Q

asymmetric increased fremitus caused BY?

A

unilateral pnm via increasing transmissions thru consolidations

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54
Q

asymmetric increased fremitus caused BY?

A

unilateral pnm via increasing transmissions thru consolidations

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55
Q

dullness replaces resonance when?

A

fluid or solid tissue replaces air-containing lung

56
Q

dz states that cause dullness to percussion

A 
lobar pnm 
plerual eff 
hemothorax 
empyema 
firbous tissue 
tumor
57
Q

dullness is very very suggestive of?

A

pneumonic and pleral effusions

3-4X more likely

58
Q

generalize hyperresonance is common over (antomic location)

-what dz?

A

the HYPERinflated lungs

COPD
asthma

59
Q

unilateral hyperresonance suggests?

A

large pneumothorax or air filled bulla

60
Q

what do u do with your stethescope if there is chest hair

A

press dow harder or moisten the hair

61
Q

what do u do with your stethescope if there is chest hair

A

press dow harder or moisten the hair

62
Q

what dz cause transmisson of sound to be poor

A

pleural eff
pnumothorax
copd

63
Q

a gap b.w inspiration and expiration suggests?

A

bronchial breath sounds

64
Q

muscle contraction sounds?
what can eliminate this sound
how to reproduce these sounds on yourself?

A

muffled, low-pitched rumbling or roaring noises

change PT position–elms sound
to recreate: do a valsalva (bearing down)

65
Q

bronchial:

what is longer expirtion or inspiration

A

expiratory sounds last longer

66
Q

vesciular: what is longer? exp or insp

A

inspiration longer

67
Q

bronchial sounds is heard over?

A

manudrium— hearing larger airways

68
Q

crackles arise from abnormalities of?

A

parenchyma (CHF, pnm, etc) or of the airways (bronchitis)

69
Q

crackles arise from abnormalities of?

A

parenchyma (CHF, pnm, etc) or of the airways (bronchitis)

70
Q

crackles of CHF heard best where

A

posterior fields

71
Q

define inspissated

A

thickened secretions

72
Q

clearing of crackles, wheezes or rhonchi after coughing suggests?

A

inspissated (thick) secretions,
bronchitis
atelectasis

73
Q

stridor and layrngeal sounds best heard over?

A

neck

74
Q

wheezing and rhonchi are LEAST heard where

A

neck

75
Q

pleural rubs heard in?

A

PE

pleurisy pnm

76
Q

increased voice transmission suggest?

A

airways are blocked by inflammation or secretions

77
Q

“ee” sounds like?

indicates?

A

A
+egophony
lobar pnm from consolidation

78
Q

“ee” sounds like?

indicates?

A

A
+egophony
lobar pnm from consolidation

79
Q

only small/large euffions are detected anteriorly

A

LARGE

since they usually fall posterior with gravity

80
Q

dulness of right middle love pnm typically occurs where

A

behind right breast

81
Q

hyperinflated lung of COPD does waht to the liver

A

displaces the upper border of the liver downward and lowers the level of diaphragmatic dullness posteriorly

82
Q

Pts >60 YO with a forced expiratory time of >9 seconds are?

A

4x likely to have COPD

83
Q

increase in local pain —distant from hands—suggests?

A

rib fx rater than soft tissue injury

84
Q

define crackles

A

discontinuous nonmusical
early inspiration (COPD)
late inspiration (pulm fibrosis)
biphasic (pnm)

85
Q

are fine or coarse crackles more frequent ber breath?

A

fine

86
Q

define wheezing

A

continous musical

*cannot dissapear with coughing

87
Q

define rhonchi

A

similar to wheezing but just deeper in pitch

*can dissapear with coughing

88
Q 
explain findings for LHF: 
percussion 
trachea 
breath sounds 
adventitious sounds 
tacticle frem and voice transmission tests
A 
resonant percussion 
midline trachea 
vesicular normal breath sounds 
adventitious would : late inspiratory crackles in dependent portions of lungs--- sometimes wheezing 
normal tacticle fremitus
89
Q 
explain findings for lobar pnm: 
percussion 
trachea 
breath sounds 
adventitious sounds 
tacticle frem and voice transmission tests
A

dullness to percussion over affected area
midline trachea
bronchial breath sounds over the invovled area
adventious: late insp crackles over inv area
increased tacticle frem and voice transm
+egophony
+brochophony
+whispered pectr

90
Q 
explain findings for Pleural effusion: 
percussion 
trachea 
breath sounds 
adventitious sounds 
tacticle frem and voice transmission tests
A

dull to flat over aff area
shifted tachea TOWARDS unaffected side
decreased to absent breath sounds–sometimes bronchial breath sounds over the top of effusion
no adventious sounds—-maybe frictoin rub
decreased to absent tacticle fremitus

91
Q

what does it mean if PMI is on the right side

A

situs inversus and dextrocardia

92
Q

PMI > what number suggests LVH

A

2.5

93
Q

PMI >2.5

A

LVH

94
Q

at wht age do s3 and s4 become pathologic in nature

indicate waht

A

40

correlated with HF and acute myocardial ischemia

95
Q

CP in the absence of CAD on angiogram include?

A

microvascular cardiac nociception and abnormal cardiac nociception

96
Q

anterior CP that is tearing and ripping and radiating to the back

A

Acute aortic dissection

97
Q

Sudden dyspnea occurs in?

A

PE
spontaneous pnothx
anxiety

98
Q

orthopnea and PND occur with?

A

Left ven HF
mitral stenosis
obstructie lung dz

99
Q

PND can be mimcked by?

A

nocturnal asthma attacks

100
Q

anasarca

A

severe generalized edema sacrum–>abdomen `

101
Q

a high arm level will make a falsey ___ BP

A

low bp

102
Q

at lower levels– the BP will be falsey _____

A

high

103
Q

JVP measures?

A

elevations in fluid volume of heart

104
Q

how to lay a hypovolemic or septic pT in order to see jugular veins

A

supine

105
Q

elevated JVP highly correlated with? (6)

A

acute and chronic HF

  • tricuspid stenosis
  • chronic pulm HTN
  • SVC obstruction
  • cardiac tamponade
  • constrictive pericarditis
106
Q

in PT who has obstrucitve lung dz, the JVP will appear?

A

elevated on expiration
and
veins collapse on inspiration

DOES NOT indicate HF

107
Q

elevated JVP is over ____% diagnostic for?

A

> 95% diagnostic for increased left vent end diastolic pressure and low left ventrictular EF

108
Q

abnormally prominent A waves ocurr in? (5)

A 
tricuspid stenosis 
1st 2nd 3rd HB 
SVT 
pulm HTN 
pulmonc stenosis
109
Q

absent a waves indicates?

A

afib

110
Q

inreased V waves seen with? 3

A

tricuspid regurg
atrial septal defects
constricitve pericarditis

111
Q

tortuous and kinked carotid artery produces?

A

inulateral pulsatile bulge

112
Q

causes of decreased jugular pulsastions

A

drecreas SV from shock or MI

local athersclerotic narrowing or occulsion

113
Q

putting pressure on cartoids may cause?

A

reflex bradycardia or drop in BP

114
Q

bounding carotid pulse seen in?

A

aortic regurg

115
Q

carotid upstroke is delyed in?

A

aortic stenosis

116
Q

carotid upstroke is ____ in aortic stenosis

A

delayed

117
Q

pulsus alternans

A

rhyhtm of pulse remains but the force of arterial pulse alternartes b/w strong and weak

118
Q

paradoxical pulse

A

varies with respirations

*greater than normal drop in BP

119
Q

pressure when korotkoff sounds are first heard?

A

highest systolic pressure respiratory cycle

120
Q

Korotkoff sounds

A

are generated when a blood pressure cuff changes the flow of blood through the artery.

121
Q

MCC for paradoxical pulse

A

asthma
Obstructive dz
pericardial tamponade
acute PE

122
Q

thrills

A

aortic stenosis

123
Q

bruits caused by?

A 
athlresclerosis 
or 
tortuous carotid artery 
external carotid arterial dz 
aortic stenosis 
hyperthyroidsm
124
Q

carotid artery stenosis causes?

A

strokes

doubles the risk of CHD

125
Q

opening snap

A

mitral stenosis

126
Q

soft decrescendo
diastolic
high pitch murmur

A

aortic regurg

127
Q

in sinus situs inversus what is on the right side and left sides?

A 
RIGHT: 
heart 
tri-lobed lung 
stomach 
spleen

LEFT:
liver
GB

128
Q

hyperkinetic high amplitude impulse occurs in?

A

hyperthyroidism

129
Q

left displacement toward the axillary line from ventricular dilation is seen in?

A

HF
cardiomyipathy
ischemic HD

130
Q

in the Left lat decubitus position, a ____ PMI with a diameter >3cm signals LVH enlargement

A

diffuse

131
Q

normal PMI

A

3-4 cm

132
Q

PMI >4 cm means

A

left ventricualr overload 5x more likely

133
Q

palpable s2 points to?

A

increased pulmonary artery pressure from pulmonary HTN

134
Q

what does laying PT in left lateral decubitcus do?

A

accentuates a left sided S3 and 4 and mitral murmurs—esp mitral stenosis

135
Q

MC extra sound to hear on ausc?

A

systolic click of mitral valve prolapse

136
Q

mitral regurg usually radiates where

A

axilla

Physical Assessment 1 (7 decks)

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