CPT I - PRACTICAL 1 Flashcards
What bone and lung anatomy correlates with T3?
Spine of scapula
Oblique fissure
What scapula and rib anatomy correlates with T7?
Inferior angle of scapula
Rib 8 directly across
What rib attaches to sternal angle? What segment of the lung?
Rib 2
Anterior segment of upper lobes
What is the costophrenic angle?
Inferior angle of thorax formed by costal cartilages of ribs
SCM innervation?
Accessory nerve (CN XI)
Scalenes innervation?
C4-C8
Upper traps innervation?
Spinal Accessory nerve (CN XI)
Abs innervation?
T5-L1
Where does the oblique fissure start and end?
Spinous process of T3
6th costochondral at midclavicular line
Where does horizontal fissure start and end?
Oblique fissure at midaxillary line
4th costochondral at sternum
Where does the cardiac notch start and end?
4th costochondral at sternum
6th rib at midclavicular line
What kind of valve is Aortic? Where do you listen to it? What parts of the heart does it separate?
AV valve is semilunar
At R sternal border, 2nd IC space
Left ventricle –> aorta
What kind of valve is Pulmonic? Where do you listen to it? What parts of the heart does it separate?
PV valve is semilunar
At L sternal border, 2nd IC space
Right ventricle –> pulmonary artery
What kind of valve is Tricuspid? Where do you listen to it? What parts of the heart does it separate?
TV valve is atrioventricular
At L sternal border, 5th IC space
Right atrium –> ventricle
What kind of valve is Mitral? Where do you listen to it? What parts of the heart does it separate?
MV valve is atrioventricular
At midclavicular line, 5th IC space
Left atrium –> ventricle
What is S1? Where is it best heard?
Closure of AV valves
Start of systole
Best heard at mitral valve
What is S2? Where is it best heard?
Closure of the SL valves
Start of diastole
Best heard at aortic valve
What is S3? Clinical indication?
Ventricular gallop occurring right before diastole (lub-dub-dub)
Indicates CHF
Poor ventricular compliance, turbulent flow in early diastole
What is S4? Clinical indication?
Atrial gallop occurring right before systole (la-lub-dub)
Indicates many cardio or pulmonary disorders; may be normal in children/young adults
Exaggerated atrial contraction, turbulent flow in late diastole
What is the normal sequence of breathing (3 parts)
Abdominal rise
Lateral costal expansion
Upper chest expansion
Which is longer: inhalation or exhalation?
Inhalation
What is jugular venous distention a sign of?
Right-sided heart failure
What is bilateral lower extremity edema a sign of?
Right-sided heart failure
What is unilateral LE edema a sign of?
DVT or blockage of lymphatic system
What part of the stethoscope do you use for heart sounds? For lung sounds?
Heart: diaphragm (s1-2) and bell (s3-4)
Lung: diaphragm
Where are murmurs heard best?
Loudest at affected valve
What are the 3 normal sounds of ventilation?
Tracheal/bronchial
Bronchovesicular
Vesicular
What is a wheeze?
High pitch - narrowing of airways, especially on inhalation typically
What is a crackle?
Bubbles/popping - fluid or secretions, airway opening
What is pleural rub?
Grating/friction - inflammation, pleura rubbing together
What is bronchophony?
Alveoli filled with fluid or replaced by soft tissue
What is egophony?
Bleating sound often by lung consolidation and fibrosis
What is whispered pectoriloquy?
Increased loudness of whispering
Where do you test upper chest expansion symmetry?
thumbs at sternal notch (jugular notch)
Where do you test diaphragmatic expansion symmetry?
thumbs at xiphoid process
Where do you test lateral costal expansion symmetry?
thumbs inside inferior angle (cup the angle with thumb and index)
How do you test tactile fremitus?
Patient says 99 while placing hands in chest symmetry test positions.
Where do you measure chest expansion?
Axillary folds
Xiphoid
Midway between xiphoid and umbilicus
How do you test Rubor of Dependency?
Patient in dependent position
Observe vein quality, color, capillary refill, temperature
Lay patient supine, elevate leg to 45 deg (30 sec)
Note paleness in foot
Sit patient back up and note color in foot
Arterial insufficiency if
- Takes 30 seconds to get back to normal color
- Foot rebounds with deep rubor
How do you test Venous filling time?
Positioning the same for Rubor of Dependency
Choose a specific vein to observe
Start in dependent supine leg elevated dependent
Count with watch time it takes veins to reappear
Normal time for veins to reappear: 10-15 sec
How do you test Homan’s sign?
Supine or long sitting
Squeeze under gastroc and DF ball of foot
Positive = pain
Not best test; can be other causes of pain
S/S: swelling, warmth, localized calf pain, redness
