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Advanced Health Assessment > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

bronchial/tubular breath sounds

A

heard at trachea

expiration longer

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2
Q

vesicular

A

heard at lung periphery

I>E, low pitched, breezy

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3
Q

bronchovesicular

A

mainstem bronchi
I=E
medium volume

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4
Q

COPD and tactile fremitis

A

feel at apex, but dec as you go to base

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5
Q

causes of dec tactile fremitis ‘99’

A

pleural effusion, obstructed bronchus, COPD, tumor, thick chest wall, pneumothorax

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6
Q

causes of increased tactile fremitits

A

PNA, consolidated tissue

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7
Q

excursion

A

chest expansion measured at costal margin

-normal 3-5 cm

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8
Q

COPD and excursion

A

decreased, trouble moving air

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9
Q

COPD notes

A

barrel chest, 1:1 ratio, dec excursion, hyperresonance with percussion, dec breath sounds, dec tactile fremitis

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10
Q

PNAs

A

adventitious sounds, inc tactile fremitis, bronchial breath sounds, dull percussion

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11
Q

egophony

A

ee will sound like ay, PNA

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12
Q

bronchocophy

A

1-2-3, will sound clearer, PNA

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13
Q

whispered pectoriloquy

A

pt whisper sounds louder, PNA

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14
Q

atypical PNAs

A

legionella (smoker, immune compromised), chlamdophlia (mild), mycopasmic (young people)

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15
Q

bronchitits

A

cough most common symptom

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16
Q

asthma

A

see if they can say full sentences

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17
Q

pneumothorax

A

unequal excursion, dec tactile, dec breath sounds, may have hyperresonance that side

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18
Q

rhonchi

A

airway is obstructed by thick secretions, muscular spasm or new growth, usually expiratory, larger airways

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19
Q

stridor

A

acute distress, foreign body, tumor, severe bronchospasm, louder in neck

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20
Q

grunting

A

trouble moving air out, expiratory sound, kiddos common

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21
Q

pleural friction rub

A

high pitchy, scratchy, unaffected by coughing, abnormally placed bronchial sounds, consolidated pnas

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22
Q

acute cough

A

< 3 weeks, Hx: ACE, GERD, URI, COPD

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23
Q

precordium

A

apex, LLSB, base left, base right

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24
Q

pulsations

A

common at apex, shouldn’t feel at base

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25
Q

lifts/heaves

A

assoc with left vent hyper, pulsations so great it lifts your hand

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26
Q

thrusts

A

l vent hypertrophy

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27
Q

thrills

A

will also hear murmurs

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28
Q

cardiac site pneumonic

A

all patients take meds

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29
Q

aortic

A

2nd intercostal right of sternum, “right base”

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30
Q

aortic stensosis

A

may radiate to carotids, LSB or apex, associated with thrill

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31
Q

pulmonic

A

2nd intercostal space left of sternum, “left base”

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32
Q

tricuspid

A

4th and 5th intercostal space to the left sternal border

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33
Q

apex/mitral area

A

5th intercostal space at the midclavicular line

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34
Q

erbs point

A

3rd interspace at left sternal border, murmurs

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35
Q

s1 ‘lub’

A

mitral and tricuspid closing, heard at apex, beginning of systole

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36
Q

accentuated s1

A

fever, exercise, anemia, mitral stenosis

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37
Q

dim s1

A

conduction defect

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38
Q

normal split s1

A

mitral then tricuspid, stuttering sound, listen over tricuspid area or LLSB

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39
Q

abnormal split s1

A

BBB

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40
Q

s2 ‘dub’

A

aortic and pulmonic closing, heard at base

41
Q

accentuated s2

A

HTN, inc peripheral vascular resistance

42
Q

dim s2

A

shock

43
Q

normal split s2

A

varies with inspiration, hear at pulmonic area

44
Q

abnormal split s2

A

BBB

45
Q

s3

A

failing heart, not normal after age 30, 1-2-3, kentucky, heard at apex with bell

46
Q

s4

A

stressed heart, late diastole with atrial kick

4-1-2, tennessee, apex with bell, sit lateral recumbent

47
Q

s4 can be caused by

A

atherosclerosis, HTN, CAD, late diastolic filling sound associated with atrial kick

48
Q

murmurs

A

turbulent flow within the heart, can be normal in kids and young adults

49
Q

bruits

A

turbulent flow outside the heart in the arteries

50
Q

physiologic murmurs

A

caused by temporary increase in blood flow (anemia, fever, pregnancy, hyperthyroidism), heard at 2nd-4th interspaces between LSB and apex

51
Q

systolic murmurs

A

innocent, MV prolapse, mitral regurg, aortic stenosis, hypertrophic cardiomyopathy, pulmonary stenosis

52
Q

mitral regurg

A

heard at apex, may radiate to L axilla or LSB

53
Q

tricuspid regurg

A

heard at LSB, may radiate to R of sternum or xyphoid area.

54
Q

aortic stenosis

A

heartd at aortic/pulm area, often loud & associated with thrill.

55
Q

diastolic murmurs are never innocent

A

aortic regurg or mitral stenosis

56
Q

grade 4-6 mumurs

A

not normal, feel thrill at 4

57
Q

rubs

A

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

58
Q

click

A

systolic sound, hearing valves open

59
Q

mitral valve prolapse

A

high pitch, heard at apex

60
Q

snaps

A

opening of mitral or triscupid, diastolic sound heard at apex, caused by mitral stenosis

61
Q

left lateral recumbiant

A

best for s4 and s3

62
Q

leaning forward

A

pericardial friction rub

63
Q

PMI details

A

felt at apex, should be less than 2cm

64
Q

JVP

A

shouldn’t be greater than 3cm

65
Q

carotids

A

check bruits and feel thrills

66
Q

HTN

A

> 140/>90

67
Q

venous insufficiency

A

+ pulses, + edema, heavy, stasis ulcers at ankles, skin is leathery and thick, brownish and cyanotic, normal temp

68
Q

arterial insufficiency

A

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

69
Q

ABI test

A

normal 1, can’t do in diabetics

70
Q

allens test

A

fist, compress arteries, see pallor and then return of color

71
Q

CHF

A

inc JVP and s3 gallop

72
Q

edema

A

measure JVP to see if cardiac cause

73
Q

stable angina

A

persistent, recurring chest pain that usually occurs with exertion, could feel like indigestion, might spread to arms/back, can be triggered by stress

74
Q

prizmetals/variant angina

A

caused by coronary artery spasm, usually at rest, often severe, relieved by angina meds/Ca channel blockers

75
Q

MI

A

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

76
Q

RLQ

A

appendix

77
Q

RUQ

A

liver, pancreas

78
Q

LUQ

A

stomach, spleen

79
Q

normal ab percussion

A

tympany

80
Q

normal liver

A

6-12 at midclav line, or 4-8 at midsternal, scratch test

81
Q

spleen palpated

A

LUQ

82
Q

spleen percussed

A

Left axillary line, resonance changes to dullness with deep breath, left lateral recumbinant

83
Q

kidneys

A

CVA, pain with patting can be pyelonephritis

84
Q

normal aorta size

A

2.5-3 cm

85
Q

hepatomegaly

A

varicose or distended veins

86
Q

hepatic and splenic friction rub

A

tumor, gonococcal infection

87
Q

cullens sign

A

bruised umbilicus, intraperitoneal bleed

88
Q

gray-turners sign

A

bruised flank

89
Q

dissecting triple a

A

back pain

90
Q

appendicitis pain

A

umbilicus first them RLQ

91
Q

diverticulitis pain

A

LLQ

92
Q

kidney infection pain

A

flank pain

93
Q

jaundice

A

dark urine, clay stool

94
Q

rebound tenderness

A

peritoneal irritation

95
Q

+ murphys

A

arrest of inspiration while palpating RUQ, could be cholecystitis, pancreatitis, hepatitis, peptic disease

96
Q

+ obturator test

A

pain with internal thigh rotation

97
Q

+ psoas

A

lay on side and pull right leg back and pain

98
Q

+rovsigs sign

A

pain in RLQ when LLQ palpated, appendicitis

Advanced Health Assessment (3 decks)

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