Exam 2 Flashcards
bronchial/tubular breath sounds
heard at trachea
expiration longer
vesicular
heard at lung periphery
I>E, low pitched, breezy
bronchovesicular
mainstem bronchi
I=E
medium volume
COPD and tactile fremitis
feel at apex, but dec as you go to base
causes of dec tactile fremitis ‘99’
pleural effusion, obstructed bronchus, COPD, tumor, thick chest wall, pneumothorax
causes of increased tactile fremitits
PNA, consolidated tissue
excursion
chest expansion measured at costal margin
-normal 3-5 cm
COPD and excursion
decreased, trouble moving air
COPD notes
barrel chest, 1:1 ratio, dec excursion, hyperresonance with percussion, dec breath sounds, dec tactile fremitis
PNAs
adventitious sounds, inc tactile fremitis, bronchial breath sounds, dull percussion
egophony
ee will sound like ay, PNA
bronchocophy
1-2-3, will sound clearer, PNA
whispered pectoriloquy
pt whisper sounds louder, PNA
atypical PNAs
legionella (smoker, immune compromised), chlamdophlia (mild), mycopasmic (young people)
bronchitits
cough most common symptom
asthma
see if they can say full sentences
pneumothorax
unequal excursion, dec tactile, dec breath sounds, may have hyperresonance that side
rhonchi
airway is obstructed by thick secretions, muscular spasm or new growth, usually expiratory, larger airways
stridor
acute distress, foreign body, tumor, severe bronchospasm, louder in neck
grunting
trouble moving air out, expiratory sound, kiddos common
pleural friction rub
high pitchy, scratchy, unaffected by coughing, abnormally placed bronchial sounds, consolidated pnas
acute cough
< 3 weeks, Hx: ACE, GERD, URI, COPD
precordium
apex, LLSB, base left, base right
pulsations
common at apex, shouldn’t feel at base
lifts/heaves
assoc with left vent hyper, pulsations so great it lifts your hand
thrusts
l vent hypertrophy
thrills
will also hear murmurs
cardiac site pneumonic
all patients take meds
aortic
2nd intercostal right of sternum, “right base”
aortic stensosis
may radiate to carotids, LSB or apex, associated with thrill
pulmonic
2nd intercostal space left of sternum, “left base”
tricuspid
4th and 5th intercostal space to the left sternal border
apex/mitral area
5th intercostal space at the midclavicular line
erbs point
3rd interspace at left sternal border, murmurs
s1 ‘lub’
mitral and tricuspid closing, heard at apex, beginning of systole
accentuated s1
fever, exercise, anemia, mitral stenosis
dim s1
conduction defect
normal split s1
mitral then tricuspid, stuttering sound, listen over tricuspid area or LLSB
abnormal split s1
BBB
s2 ‘dub’
aortic and pulmonic closing, heard at base
accentuated s2
HTN, inc peripheral vascular resistance
dim s2
shock
normal split s2
varies with inspiration, hear at pulmonic area
abnormal split s2
BBB
s3
failing heart, not normal after age 30, 1-2-3, kentucky, heard at apex with bell
s4
stressed heart, late diastole with atrial kick
4-1-2, tennessee, apex with bell, sit lateral recumbent
s4 can be caused by
atherosclerosis, HTN, CAD, late diastolic filling sound associated with atrial kick
murmurs
turbulent flow within the heart, can be normal in kids and young adults
bruits
turbulent flow outside the heart in the arteries
physiologic murmurs
caused by temporary increase in blood flow (anemia, fever, pregnancy, hyperthyroidism), heard at 2nd-4th interspaces between LSB and apex
systolic murmurs
innocent, MV prolapse, mitral regurg, aortic stenosis, hypertrophic cardiomyopathy, pulmonary stenosis
mitral regurg
heard at apex, may radiate to L axilla or LSB
tricuspid regurg
heard at LSB, may radiate to R of sternum or xyphoid area.
aortic stenosis
heartd at aortic/pulm area, often loud & associated with thrill.
diastolic murmurs are never innocent
aortic regurg or mitral stenosis
grade 4-6 mumurs
not normal, feel thrill at 4
rubs
high pitched, scratchy, pericarditis, best heart at left lateral sternal border with diaphragm with pt leaning forward, systolic/diastolic sound
Pt at risk for cardiac tamponade
click
systolic sound, hearing valves open
mitral valve prolapse
high pitch, heard at apex
snaps
opening of mitral or triscupid, diastolic sound heard at apex, caused by mitral stenosis
left lateral recumbiant
best for s4 and s3
leaning forward
pericardial friction rub
PMI details
felt at apex, should be less than 2cm
JVP
shouldn’t be greater than 3cm
carotids
check bruits and feel thrills
HTN
> 140/>90
venous insufficiency
+ pulses, + edema, heavy, stasis ulcers at ankles, skin is leathery and thick, brownish and cyanotic, normal temp
arterial insufficiency
diminished or absent pulses, little to no edema, + pain, cold feet, shiny thin and hairless skin, wounds on toes (gangrene), pallor with elevation, dusky red when dependent
ABI test
normal 1, can’t do in diabetics
allens test
fist, compress arteries, see pallor and then return of color
CHF
inc JVP and s3 gallop
edema
measure JVP to see if cardiac cause
stable angina
persistent, recurring chest pain that usually occurs with exertion, could feel like indigestion, might spread to arms/back, can be triggered by stress
prizmetals/variant angina
caused by coronary artery spasm, usually at rest, often severe, relieved by angina meds/Ca channel blockers
MI
can radiate to back, neck, jaw, shoulders and arms (esp left)
- Last more than a few min, goes away and comes back, varies with intensity
RLQ
appendix
RUQ
liver, pancreas
LUQ
stomach, spleen
normal ab percussion
tympany
normal liver
6-12 at midclav line, or 4-8 at midsternal, scratch test
spleen palpated
LUQ
spleen percussed
Left axillary line, resonance changes to dullness with deep breath, left lateral recumbinant
kidneys
CVA, pain with patting can be pyelonephritis
normal aorta size
2.5-3 cm
hepatomegaly
varicose or distended veins
hepatic and splenic friction rub
tumor, gonococcal infection
cullens sign
bruised umbilicus, intraperitoneal bleed
gray-turners sign
bruised flank
dissecting triple a
back pain
appendicitis pain
umbilicus first them RLQ
diverticulitis pain
LLQ
kidney infection pain
flank pain
jaundice
dark urine, clay stool
rebound tenderness
peritoneal irritation
+ murphys
arrest of inspiration while palpating RUQ, could be cholecystitis, pancreatitis, hepatitis, peptic disease
+ obturator test
pain with internal thigh rotation
+ psoas
lay on side and pull right leg back and pain
+rovsigs sign
pain in RLQ when LLQ palpated, appendicitis
