Chapter 2 Physical Exam Flashcards
What part of the stethoscope is used for low frequency sounds?
Bell
What part of the stethoscope is used for high frequency sounds?
Diaphragm
What is the order of the four components of the heart exam?
1) Inspection
2) Palpation
3) Percussion (Omitted)
4) Auscultation
Where is the Apical impulse located?
5th Left intercostal space, midclavicular line
What can be used to estimate the size of the heart instead of percussion?
Point of maximum impulse (PMI)
Closure of the mitral/tricuspid valves
S1
Closure of the aortic/pulmonic valves
S2
Early diastole (passive filling) vibration of ventricular walls
S3
What age is early diastole (S3) a pathological finding?
40+ y/o
Ventricular filling from atrial kick (late diastole) loss of compliance or increase stroke volume secondary to high output
S4
Potential causes that would cause S4
1) HTN
2) Coronary Artery Disease
3) Aortic stenosis
4) Cardiomyopathy
In what type of person is the heart more vertical and central?
Slender person
What type of person will the heart lie more horizontally and to the left?
Stocky person
Wide apical pulsation would indicate what?
Left ventricular hypertrophy
Loss of palpable apical pulsation may indicate what?
Fluid, air, or displacement
Thrills are associated with what pathologies?
1) Failure of Semilunar valve to close
2) Aortic/Pulmonary stenosis
3) Atrial septal defect
Loud S1 would suggest?
1) Increased blood velocity
2) Mitral stenosis
3) Heart block
4) Hypertension
5) Calcification of the mitral valve
Loud S2 would suggest what?
1) Hypertension
2) Valve disorder
3) Stenosis
4) Fluid
Mitral/Tricuspid stenosis
Diastolic
Aortic/Pulmonic Regurgitation
Diastolic
Mitral/Tricuspid Regurgitation
Systolic
Aortic/Pulmonic stenosis
Systolic
Mid systolic click with late high-pitched murmur would suggest?
Mitral valve prolapse
Pericardial sac inflammation would cause what?
Friction ribs. Parietal and visceral layers would make a sound like grating, machine-like, rubbing.
What equipment do you need for a cardiac exam?
1) Pencil
2) 15cm ruler (tape and folding rulers)
3) Stethoscope with bell and diaphragm
4) BP Cuff
Difference between systolic and diastolic pressure
Pulse pressure
Which part of the BP is more responsive to stimuli?
Systolic
What is the expected difference of BP between arms?
10mm Hg or less
What happens to BP when you stand?
Systolic pressure drops and diastolic pressure rises
Pulse pressure of 4
Bounding, aneurysmal
Pulse pressure of 3
Full, increased
Pulse pressure of 2
Expected
Pulse pressure of 1
Diminished, barely palpable
Pulse pressure of 0
Absent, not palpable
Where do you listen for venous hums?
Jugular veins over right clavicle
Pitting edema 1+
Slight pit, disappears rapidly (2-3mm)
Pitting edema 2+
Somewhat deep pit, disappears in 10 to 15 seconds (4-5mm)
Pitting edema 3+
Noticeable deep pit that lasts more than a minute (6-7mm)
Pitting edema 4+
Very deep pit that lasts 2-5 minutes (8-9mm)
Clinical test for thrombosis
Homan’s sign
Typical adult range for BP
S: 100-140
D: 60-90
Pulse pressure range
30 to 40 mm Hg, even to as much as 50 mm Hg
Jugular distention >9 cm suggests what?
Ventricular failure
What happens to BP in old age?
Systolic increases, Diastolic decreases, with an overall increase in blood pressure
Mechanical wave propagated through a medium at high frequency to produce images of structures within the human body
Ultrasound
Sound in the mechanical vibrations that travels along longitudinal waves
Ultrasound
How are ultrasound waves generated?
Application of electric current to piezoelectric crystals in the US transducer (probe)
Phenomenon where distortion of a crystal causes an electrical change
Piezoelectric effect
Where can you find the best images in an ultrasound?
Directly below the probe
Ultrasound frequency used for deep abdominal imaging
Lower frequency
Ultrasound frequency used for shallow structures
Higher frequency
What color is tissue on an ultrasound?
Gray
What color is fluid on an ultrasound?
Black
Operating mode in which two-Demensional image is generated that portrays moving reflectors in color simultaneously with images
Color Flow Doppler
Regulates the amplification (brightness) of returning echoes to compensate for loss of transmitted sound caused by absorption and reflection
Gain
Refers to a lesion or tumor which produces a stronger echo than the surrounding structures
Hyperechoic
Refers to structures that contain fewer or weaker echoes than surrounding tissues
Hypoechoic
Ability to distinguish between two adjacent structures
Resolution
An electromechanical device that is part of an ultrasound system. The device that contacts the patient and converts electrical energy into mechanical energy and vice versa.
Transducer
How many colors does a color doppler have?
Two
What color is used to indicate flow going toward the probe?
Red
What color is used to indicate flow going away from the probe?
Blue
US probe used for abdominal and OB imaging
Curvilinear probes
US probe used for soft tissue and small parts imaging
Linear
US probe used to “bend” beam from flat, small footprint to a wider pie-shaped wedge distally
Phased array probe
Ultrasound, What will reveal a hypoechoic rim of fluid around the heart?
Pericardial effusion