Cough Wk 3

Question 1

palpation of thorax

Answer 1

palpate for pain, tenderness, masses, sensations

• posterior
  - apex
  - interscapular
  - triangle
  - medial lung
  - lateral lung
• anterior
  - apex
  - under mid clavicle
  - bilateral bottom sternum
  - lateral lung
• tacile fremitus (99)
• respiratory excursion (tissue crease)
• tracheal tug (just below thyroid)

Question 2

Percussion of thorax

Answer 2

compare side to side 
    posterior:
-lung apices
-interscapular (cross arms)
-triangle (arms up)
-medial lung
-lateral lung
     anterior:
-apex
-under clavicle
-bilateral bottom sternum
-lateral lung

• – diaphragmatic excursion
• seated, deep breath, hold, percuss down scapular line until dullness, mark
• breath out, hold and work along same path until dullness hear

Question 3

Auscultate chest and lung

Answer 3

• listen to each area anterior and posterior for pitch, intensity, duration
• listen for normal breath sounds vesicular, brochovesicular, bronchial
• listen for adventitious sounds crackles, wheezes, rubs
• listen for vocal resonance
  - bronchophony (normal)
  - whispered pectoriloquy
  - egophony (E)

Question 4

Test for costochondritis

Answer 4

knife edge of hand on either side of sternum

Question 5

test for rib fractures

Answer 5

knife edge of one hand

Question 6

Palpation of abdomen

Answer 6

• ask if patient has empty bladder
• palpate for pain, tenderness, muscle gaurding, masses
• light palpate 3 spots per quad
• 1/2 sit up, palpate 3 spots
• to differentiate, a mass dissappears it is deep
• palpate urinary bladder across ASIS

Question 7

Livers edge manuevers

Answer 7

• ———standard ———————–
  
  • breath and hold, go under ribs, palpate deep during exhalation
• ———middletons—————–
• same as standard with patients fist under bottom ribs
• ———–Hooking————
• hook fingers under right costal margin, stand facing patients feet, breath in and hold, press in and up upon exhalation

Question 8

Kidney entrapment

Answer 8

????squeeze kidney, breath and hold

Question 9

Check for spleen

Answer 9

??stand on patients right, reach across with left hand under spleen, right hand to push

Question 10

Percussion of liver

Answer 10

percuss right side from mid clavicle down, then mark, percuss from costal border up, then mark

Question 11

Percussion of spleen

Answer 11

begin percussion at left midAXILLARY line downward and slighly lateral as ribs curve, usually #6-10 ribs

Question 12

Percussion of gastric air bubble

Answer 12

straight down mid clavicular line on left

Question 13

Percussion of 4 quadrants and distented bladder

Answer 13

same as palpation

Question 14

Auscultate for bowel sounds and friction rubs

Answer 14

DIAPHRAGM
-bowel sounds 3 spots per quad for frequency and character
     hyperactive 35 per min
     normoactive 5-35 per min
     hypoactive less than 5 per min
     absent 0 per min, emergency
friction rubs
   -liver (mid clav line)
   -spleen (mid axillary line)

Question 15

Psoas sign

Answer 15

stabilize right hip. have pt try to bring right leg up, resist

-pain in the lower right quadrant indicates appendicitis

Question 16

Obturator sign

Answer 16

-knee and hip at 90 rotate leg away from body

pain in lower right quadrant indicates ruptured appendix or pelvic abcess

Question 17

Murphys punch

Answer 17

place hand over kidney, punch hand

-pain indicates inflamed kidney due to variety of disorders

Question 18

Rebound Tenderness

Answer 18

rebound all 4 quads

Question 19

Blumbergs sign

Answer 19

is the return to position of the structures which were compressed by fingers producing a sharp stabbing pain at the site indicates peritonitis

Question 20

Rovsing Sign

Answer 20

rebound tenderness in the lower left quadrant producing pain over the lower right quadrant from the umbilicus indicates appendicitis