Clinical Relevance and Surface Anatomy (Questions after the physical exam) Flashcards
Name some causes of tracheal deviation
Pneumothorax
pleural effusion
mediastinal shift (secondary to tumor and lymphadenopathy)
goitre - retrosternal
What are the possible causes of asymmetrical chest expansion?
secondary to localised lung disease (conslidation, collapse, effusion, pneumothorax)
Generally speaking, what is bronchial breathing associated with?
consolidation (nonspecific) caused by infection, malignancy, edema
A stony dull percussion note is suggestive of…?
a pleural effusion
In the setting of advanced liver disease, what is asterixis caused by?
hepatic encepphalopathy due to hyperammonaemia which interferse with brain cell function
At what level of serum bilirubin is jaundice able to be detected in the sclera?
> 50umol/L
Where are spider naevi usually found? Why this distribution?
neck, chest, arms, back in distribution of superior vena cava
Name the peripheral stigmata of chronic liver disease
palmar erythema clubbing dupytren's contracture leuchonychia icteric scleria spider naevi (>3) gynaecomastia ascities caput medusa Swelling of ankles
Describe the surface anatomy of the right kidney
superior pole at rib 12
inferior pole at L3
(recall that L4 corresponds to iiac crest)
List 4 signs of anemia
pale palmar creases
tachycardia
pale conjunctiae
failure to thrive
When using your stethoscope, murmurs are best heard using the ____ because _____
diaphragm, better for high pitched sounds
What are 5 signs of CCF?
lethargy decreased capillary return tachycardia tachypnoea lowered BP elevated JVP apex beat deviate left crackles bibasal pitting edema (peripheral lower limbs if ambulating; sacral if bed bound)
pallor
irregular pulse
cyanosis
pulsatile hepatomegaly
Name some physiological/patient factors that may influence the accuracy of a BP reading
anxiety exercise caffiene nicotine alcohol hydration status
In what clinical circumstances might you see a postural drop in BP?
dehydration
diabetes
anti-hypertensive medications
What is the clinical use of a peak flow meter
monitoring obstructive airways disease to guide therapeutic regime
Which measure of nutritional status is considered most accurate (BMI vs. WHR) and why?
WHR because BMI does not differentiate between muscle and fat mass
Which vital sign is under voluntary control?
respiratory rate
What features of a pulse are clinically important?
rate, rhythm, strength
What would an irregular irregular pulse suggest?
Atrial fibrillation
What is the clinical significance of an elevated JVP?
Increased right atrial pressure
Can signify RHF, pulmonary hypertension
WRT technique what can influence the accuracy of a BP recording?
cuff size, tightness, cuff lining up with brachial artery, posture of the patient, legs crossed, arms not at the height of the heart
Where do you look for signs of central cyanosis and what does it signify?
tongue/lips = central hypoxia
Where would you look for leuchonychia?
finger nails
Where would you look for caput medusa?
umbilical region
Where would you look for peripheral cyanosis
extremities (fingers)
Where would you look for pitting edema
ankles/legs - sacrum if bed bound
Where would you look for spider naevi
neck, back, arms, chest
Where would you look for tachyarrythmia
wrist pulse, chest
Where would you look for murmur of Aortic stenosis
right 2nd intercostal space
