everything? Flashcards
where is the radial artery palpated
between the tendon of flexor carpi radialis and tendon of brachioradialis
where is the ulnar artery
lies between the flexor digitorum superficialis and flexor carpi ulnaris
where do you palpate the brachial artery
medial to the biceps tendon
middle third of the humerus in the medial bicipital groove
where do you palpate the common carotid artery
medial border of sternocleidomastoid muscle
lateral border of thyroid cartilage
where do you palpate for the apex beat
5th ICS at mid clavicular line
why can you get a displaced apex beat
cardiomegaly
why do people have absent apex beats
pericardial effusion
obesity
pleural effusion
emphysema
what are parasternal heaves associated with
right ventricular hypertrophy
what causes thrills
turbulent blood flow
where is the aortic valve located
right sternal border - 2nd ICS
where is the pulmonary valve located
left sternal border - 2nd ICS
where is the tricuspid valve located
left 5th costosternal border
where is the mitral valve located
left 5th ICS at apex beat
what are some causes for ejection systolic murmur
aortic stenosis
pulmonary stenosis
aortic sclerosis
hypertrophic obstructive cardiomyopathy
atrial septal defect
what murmur do you hear on auscultation for aortic stenosis
ejection systolic murmur
what murmur do you hear on auscultation for aortic regurgitation
early diastolic murmur
what murmur do you hear on auscultation for mitral stenosis
mid diastolic murmur
what murmur do you hear on auscultation for mitral regurgitation
pan systolic murmur
where does the murmur radiate for aortic stenosis and for mitral regurgitation
aortic stenosis - radiates to carotid
mitral regurg - radiates to axilla
what are the different arteries you can palpate in the lower limb
femoral
popliteal
posterior tibial
dorsalis pedis
what are the borders of the heart
right border - 3rd CC to 6th CC - 1cm from the sternal edge
left border - 2nd ICS (2.5cm from eternal edge) to left 5th ICS at MCL
Upper border - 3rd CC (1cm from eternal edge) to 2nd ICS (2.5cm from sternal edge)
Lower border - 6th CC 1cm from sternal edge to 5th ICS at MCL
where do you palpate the carotid artery pulse
in the neck
between the lateral side of the thyroid cartilage
and medial border of sternocleidomastoid muscle
where do you palpate the superficial temporal artery
front of tragus ear
where do you palpate the subclavian artery
palpated in the supraclavicular fossa region
at angle between clavicle and sternocleidomastoid
what are the 2 types of aortic dissection and what do they present with
type A = severe chest pain, anterior and posterior (ascending and thoracic aorta)
type B = back pain, chest and abdo pain (descending aorta)
what do you look for on general inspection in a cardio examination
pacemaker
bruising
surgical scars
wasting - cachexia
what do you look for on general inspection in abdo examination
surgical scars
bruising, asymmetry
distension, masses, hernia
what are the 9 regions of the abdomen
right hypochondriac
epigastric
left hypochondriac
left lumbar
umbilical
right lumbar
right iliac fossa/region
hypogastric/suprapubic
left iliac fossa/region
what organ is found in right hypochondriac
gallbladder
and liver
what organs are found in epigastric region
stomach
duodenum
pancreas
what organ is found in left hypochondriac region
pancreas
what organs are found in the umbilical region
small bowel
retroperitoneal structures
what organ is found in right lumbar region
kidney
what organ is found in the left lumbar region
kidney
what organs are found in right iliac fossa
appendix and caecum
what organs are found in the hypochondriac/suprapubic region
bladder
uterus
adnexa
what organs are found in the left iliac fossa
sigmoid colon
is the spleen retro or intraperitoneal
intraperitoneal
between which ribs do u find the spleen
9-11
what are some causes of splenomegaly
portal hypertension secondary to liver cirrhosis
haemolytic anaemia
congestive heart failure
splenic mets
glandular fever
what are the causes for bilaterally enlarged kidneys
polycystic kidney disease
amyloidosis
what is a cause for a unilaterally enlarged kidney
renal tumours
what is tenderness
minimal pressure over a wide area –> peritonitis and sometimes anxiety
what is guarding
tends to contract voluntarily when palpation causes pain
what is rigidity
inflammation of parietal peritoneum, reflex contraction, involuntary guarding, abdominal wall may not show any movements of inspiration
what is rebound tenderness
generalised or localised peritonitis, if the abdominal wall is compressed slowly and then released –> sharp stabbing pain
how would you describe the abdominal aortic pulse in a normal healthy individual
Non expansile pulsatile pulse
what could be the cause of an expansile mass
abdominal aortic aneurysm
at what level does the aorta bifurcate
L4 !!!
what are the names of the horizontal planes (5)
transpyloric plane
subcostal plane
supracristal
intertubercular
interspinous
at what vertebral level is the transpyloric plane
L1
what organs do you find in the transpyloric plane
fundus of the gallbladder
pylorus of the stomach
neck of pancreas
renal hilum
duodenojejunal flexure
end of spinal cord
at what vertebral level is the subcostal plane
L3
what organ is found in the subcostal plane (its not acc an organ its like sm else…)
origin of the inferior mesenteric artery
at what vertebral level do you find the supracristal plane and what happens here
L4
bifurcation of the aorta
at what vertebral level is the intertubercular plane
L5
what do you find in the intertubercular plane
tubercle of the crest of ilium
at what vertebral level is the interspinous plane found on
S2
it is the horizontal plane through the anterior superior iliac spines
when you percuss the liver how does the sound change
from resonant to dull as you pass the border of the liver
what are the surface markings of the liver
right 5th rib at mid clavicular line
lower end of sternum
left 5th rib at mid clavicular line
costal margin at right mid axillary line
what do you test for in shifting dullness
ascites (if area now sounds resonant = ascites)
(due to liver cirrhosis)
what could be the cause of absent bowel sounds
paralytic ileus or peritonits
what are the bowel sounds heard if someone has an intestinal obstruction
high pitched and frequent sounds
(tinkling)
what are the 3 regions where urinary tract stones reside
the pelvic ureteric junction
across the sacroiliac joint
vesicoureteric junction
what is the gold standard imaging modality used for the diagnosis of urinary tract stones
ultrasound scan
what are the surface markings of the spleen
from ribs 9-11
between mid axillary line and lateral border of erector spinae muscles
where are the ureters
5cm lateral to the posterior median line at L1 level
to posterior superior iliac spine
what is the position and exposure for the respiratory examination
45 degrees
exposed from waist up
what can cause tracheal deviation away from the lung lesion
TENSION PNEUMOTHORAX
extensive pleural effusion
chest expansion
what can cause tracheal deviation towards the lung lesion
upper lobe collapse
upper lobe fibrosis
pneumectomy
at what level does the trachea bifurcate into the left and right main bronchi
at the level of the sternal angle = T4/T5
which lobes (upper/middle/lower) does anterior chest wall expansion tell you about
upper and middle lobes
which lobes (upper/middle/lower) does posterior chest wall expansion tell you about
lower lobes
what is a cause of unilateral decreased expansion (in the chest wall)
pneumothorax
pleural effusion
collapsed lung
consolidation
what can cause a bilaterally decreased chest wall expansion
asthma or COPD
what can cause hyper resonant sounds on percussion of the chest wall
pneumothorax
hollow bowels
COPD
what can cause hyporesonant sounds on percussion of the chest wall
pleural effusion (stoney, dull)
lung tumour (flat, dull)
consolidation (flat, dull)
collapse (flat, dull)
where do you auscultate for bronchial sounds and what do they sound like
(idk if u have to know this tbh)
- over trachea
- over suprasternal notch
- over manubrium
- over sternal angle
- over sternoclavicular joints
high pitch sounds
where do you auscultate for vesicular sounds and what do they sound like
present over the rest of the chest area where normal lung tissue is present
low pitch sounds
what are some causes for reduced intensity of vesicular sounds
shallow breathing
airway obstruction
hyperinflation
pneumothorax
pleural effusion
pleural thickening
obesity
in obstructive lung disease, what phase becomes prolonged - the inspiratory or expiratory phase
expiratory phase
what causes a decrease in tactile vocal fremitus
caused by a decrease in density :. pneumothorax/COPD
or pleural effusion
what causes an increase in tactile vocal fremitus
increase in density
consolidation in pneumonia/tumour tissue in cancer
what are the cervical lymph nodes you need to palpate
submental
submandibular
preauricular
postauricular
occipital
superior deep cervical
inferior deep cervical
supraclavicular
what are some causes of cervical lymphadenopathy (enlarged lymph nodes)
tuberculosis
lung cancer metastasising to lymph nodes
sarcoidosis
resp tract infection
in which condition do you see a meniscus sign on chest x ray
pleural effusion
what is silhouette sign on a CXR
loss of a normal border of a structure on CXR
what is the triangle of safety used for
chest drains
what are the borders for the triangle of safety
lateral edge of pectoralis major
base of axilla
Horizontal line at level of 5th ICS
lateral edge of latissimus dorsi
what are the surface markings of the lung
- check med ed guide bc its too confusing
what are the 2 types of knee deformities
valgus - knock kneese
varus - bow legged
what condition can cause warmth at the knee joint
septic arthritis
what is the name given to swelling in the politeal fossa
bakers cyst
what is an effusion caused by (in the knee)
(an excess of..)
synovial fluid
in the tap method/sweep test, what is the name of the pouch that needs to be emptied
suprapatellar pouch
what muscles perform flexion of the knee
hamstring muscles
- semitendinosus
- semimembranous
- biceps femoris
what muscles perform extension of the knee joint
quadriceps muscles
- vastus medialis
- vastus lateralis
- vastus intermedialis
- rectus femoris
what are the angles for the range of motion a patient can actively extend/flex their leg/knee
0 to 135 degrees
what are the angles for the range of motion you can passively flex/extend a patients knee
-10 to 145 degrees
up to how many degrees is hyperextension normal
10 degrees
how many cm of movement suggests an ACL pathology
> 1.5 cm
what motor neuron lesions cause hypertonia/hyper reflexia
upper motor neuron lesions
what do lower motor lesions cause
hypotonia
hyporeflexia
what disease could cause rigidity
parkisons disease
what score do you use to assess power
MRC muscle power scale
what would be the score on the MRC scale for a patient who can only perform the barest flicker of movement of muscle - but not enough to move the muscle it is attached to
1/5
what is the MRC muscle power scale out of and what is the highest you can score on it
out of 5
5/5
describe the muscle power of a patient who scores 0/5 on the MRC power scale
no movement
what would be the score for a patient on the MRC scale who has normal strength
5/5
what would be the score for a patient on the MRC scale who can voluntarily move muscle but not enough to overcome gravity
2/5
describe a patients power with a score of 3/5 on the MRC power scale
voluntary movement capable of overcoming gravity but not able to overcome applied resistance
describe a patients power with a score of 4/5 on the MRC power scale
voluntary movement capable of overcoming resistance
what are the nerves (roots) tested in the biceps reflex
C5, C6
what are the nerves (roots) tested in the triceps reflex
C7, C8
what are the nerves tested in the supinator (wrist) reflex
C6
what muscles are involved in flexion of the hip
psoas major
iliacus
(sartorius, rectus femoris, pectineus)
- femoral nerve
what muscles are involved in extension of the hip joint
gluteus maximus (inferior gluteal nerve)
what muscles cause abduction of the hip joint
gluteus medius and gluteus minimus
(superior gluteal nerve)
what muscles cause adduction of the hip joint
adductor longus
adductor brevis
adductor magnus
- obturator nerve
what muscles are involved in dorsiflexion
tibialis anterior
extensor hallucis longus
extensor digitorum longus
- innervated by deep fibular nerve
what nerve is involved in plantarflexion
tibial nerve
S1-2
what are the nerves involved in the knee jerk reflex
L2-4 (some people say L3-4 though so double check)
what are the nerves involved in the ankle jerk reflex
S1-2
describe sciatica and what is it caused by
pain radiating from the posterior back into the buttock, posterior/lateral thigh and into leg
- caused by herniated lumbar intervebral disc compressing L5-S1 component of sciatic nerve
what are the borders of the femoral triangle
inguinal ligament
sartorius
adductor longus
what is compartment syndrome caused by and presentations
pressure in the muscle compartment is so high that venous drainage becomes blocked
ischaemia and death can arise
causes : fractures, burns, infections or prolonged limb compression
presents with 6 Ps
pallor
pulselessness
paralysis
perishingly cold
pain
paraesthesia
what is the risk, freq of monitoring and clinical response for a news2 score of 0
low risk
minimum 12 hourly monitoring
continue with NEWS2 monitoring
what is the risk, freq of monitoring and clinical response for a news2 score of 1-4
low risk
minimum 4-6 hourly
inform registered nurse who must assess patient and determine if more freq monitoring or escalation of care
what is the risk, freq of monitoring and clinical response for a news2 score of 3 in a single parameter
low medium risk
minimum 1 hourly
registered nurse informs medical team who will decide escalation of care
what is the risk, freq of monitoring and clinical response for a news2 score of 5-6
medium risk
minimum 1 hourly
registered nurse immediately inform medical team looking after patient and request urgent assessment by clinician
what is the risk, freq of monitoring and clinical response for a news2 score of 7+
high risk
continuous monitoring
registered nurse immediately informs medical team at specialist registrar level
emergency assessment
consider transfer to level 2/3 care or higher dependency unit
What are the borders of the liver
Right 5th rib in the mid clavicular line to the left 5th ICS in the mid clavicular line
Right 5th rib in mid clavicular line to right costal cartilage at mid axillary line
Left 5th ICS at mid clavicular line to right costal cartilage at mid axillary line (goes through 8/9th costal cartilage)
What is the surface marking of the gallbladder
At level of right 9th costal cartilage where MCL and transpyloric plane meet
What are the borders of the spleen
Between ribs 9-11
Posterior abdominal wall
Between left mid axillary line and lateral border of erector spinae muscles
What are the surface markings of the kidney
Posterior abdominal wall
4-5cm from the posterior median line
3-4cm from the supracristal plane
Right kidney is 2-3cm lower from left
What are the surface markings for the abdominal aorta
Line from Xiphisternal joint to umbilicus and extends to supracristal plane
