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Physical Assessment > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is breast tissue composed of?

A

glandular tissue in 15-20 lobes, suspensory ligaments (cooper’s), fat and adipose tissue

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2
Q

Axillary lymph nodes

A

central, pectoral, subscapular, lateral

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3
Q

supernumerary nipple

A

extra nipple along mammary ridge

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4
Q

tanner stage 1

A

pre-adolescent, elevation of nipple

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5
Q

tanner stage 2

A

breast bud stage, elevation of breast and nipple, enlargement of areola

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6
Q

tanner stage 3

A

further enlargement of breast and areola, menarchy

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7
Q

tanner stage 4

A

projection to form a second mound above the level of breast, menarchy

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8
Q

tanner stage 5

A

mature stage, projection of nipple only/areola recedes to level of breast

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9
Q

breast cancer risk factors

A

female over 50, personal and family history, BRCA 1/2 mutation, previous breast irradiation, menarche 50

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10
Q

breast cancer lifestyle risk factors

A

no kids or first kid after 30, long term hormone replacement therapy, alcohol 2-5 drinks daily, obesity, high fat diet, physical inactivity, not breast feeding

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11
Q

how long should a thorough breast exam take

A

3 min/breast

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12
Q

if lump is present what should be recorded

A

location, size, shape, consistency, mobility, distinctness, nipple, overlying skin color, tenderness, lymphadenopathy

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13
Q

gynecomastia

A

enlargement of flat disc of undeveloped breast tissue underneath male nipple

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14
Q

fibroadenomas

A

in age 15-25, usually single but can be multiple, well delineated, mobile, usually nontender, usually benign tumor

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15
Q

fibrocystic breast disease

A

age 30-50, regress after menopause except with estrogen therapy, round, well delineated, mobile, usually tender, lots of discomfort, single or mobile

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16
Q

Breast cancer

A

age 30 and older, most common in over 50, usually singular, irregular or stellate, firm or hard, not clearly delineated, can be fixed to skin or underlying tissues, usually nontender, usually ductal

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17
Q

peau d’or·ange

A

edema of breast, a pitted or dimpled appearance of the skin, especially as characteristic of some cases of breast cancer or due to cellulite

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18
Q

nipple retraction

A

suspensory ligament tightened up, possibly from breast cancer

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19
Q

Manubriosternal angle/angle of louis

A

important landmark for heart and lungs, site of trachea splitting, corresponds with the top of the heart, distinct bony ridge hooked to second rib

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20
Q

right lung fissures

A

oblique and horizontal

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21
Q

left lung fissures

A

oblique fissure

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22
Q

visceral pleurae

A

lines lungs

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23
Q

parietal pleurae

A

lines chest wall

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24
Q

functions of the lungs

A

supply O2 for energy production, remove CO2 as a waste product, maintain acid/base balance of arterial blood, maintain heat exchange

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25
Q

hypercapnia

A

increased CO2 in the blood increases breathing

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26
Q

hypoxemia

A

increased respirations due to an abnormally low concentration of oxygen in the blood

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27
Q

hypoventilation

A

low RR causes CO2 to build up –> respiratory acidosis

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28
Q

hyperventilation

A

rapid RR, low concentration of CO2

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29
Q

hacking cough is a sign of?

A

pneumonia

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30
Q

rust colored sputum

A

TB or pneumococcal pneumonia

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31
Q

frothy pink sputum

A

pulmonary edema

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32
Q

hemoptysis

A

coughing up blood due to TB, pulmonary embolus or heart failure, mitral valve stenosis due to increased pulmonary venous congestion (most common cardiac cause), pulmonary infarction, ruptured vessel

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33
Q

barrel chest is a sign of?

A

emphysema

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34
Q

Pectus excavatum

A

depressed breast bone, only an issue if it blocks lung expansion

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35
Q

Pectus carinatum

A

protruding breast bone

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36
Q

Kyphosis

A

tends to happen with older people because of osteoperosis/break down of spinal column, can affect ability to hear their breath sounds

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37
Q

scoliosis

A

sideways curvature of the spine

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38
Q

Anteroposterior: transverse diameter

A

1:2

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39
Q

coastal angle

A

should be

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40
Q

pink puffer

A

COPD, emphysema, chronic bronchitis, pink complexion + shortness of breath + tripod position

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41
Q

blue bloater

A

cyanosis, decreased capacity of lungs, right sided heart failure, COPD

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42
Q

tachypnea

A

> 20 RR, rapid breathing due to exercise, fever or acidotic

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43
Q

Kussmual

A

deeper rapid breathing, associated with metabolic acidosis

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44
Q

Cheyene-Stokes

A

respirations wax/wayne in a regular pattern, periods of apnea

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45
Q

where to palpate for symmetric expansion

A

T9 or T10

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46
Q

Tactile fremitus

A

Sound is conducted better through a dense or solid structure than porous so anything that increase density of lung will increase fremitus

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47
Q

Increased fremitus could be a sign of

A

pneumonia

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48
Q

decreased fremitus could be a sign of

A

obstructive bronchitis

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49
Q

bronchovesicular sounds

A

Inspiration = expiration, heard mid chest and between scapula

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50
Q

vesicular sounds

A

soft and low pitched, heard on most of lung surface, Inspiration > expiration

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51
Q

Bronchophony

A

tactile fremitus is abnormally clear rather than muffled, could be caused by the solidification of lung tissue (lung cancer) or fluid in the alveoli (pneumonia)

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52
Q

Egophony

A

E to A changes, increased resonance often caused by lung consolidation and fibrosis, could indicate pneumonia

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53
Q

Whispered Pectoriloquy

A

louder clear whispered “99“ rather than faint or absent sound, could be a sign of pneumonia or cancer

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54
Q

infants have a rounded thorax until?

A

age 6

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55
Q

infants breath through nose rather than mouth until

A

age 3 months

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56
Q

infant RR

A

30-40 breaths / min

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57
Q

infants have bronchovesicular sounds in peripheral lung field until

A

age 6

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58
Q

older adult chest changes…

A

increased AP:transverse, kyphosis, compensates by holding head extended and tilted back, decreased chest expansion, fatigue easily

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59
Q

atelectasis

A

partial or complete collapse of the lung usually due to anesthesia

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60
Q

atelectasis signs

A

trachea may be shifted towards involved side, absent tactile fremitus, dull percussion over affected area, absent breath sounds

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61
Q

Consolidation (pneumonia) signs

A

trachea is midline, increased tactile fremitus over affected area, dull percussion, bronchial breath sounds, late inspiratory crackles over involved area

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62
Q

bronchitis signs

A

trachea is midline, normal tactile fremitus, resonant percussion, vesicular breath sounds, possibly scattered coarse crackles or wheezes or rhonchi

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63
Q

emphysema

A

damaged alveoli

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64
Q

emphysema signs

A

trachea is midline, decreased tactile fremitus bc alveoli can’t get the air out so more trapped in lungs, hyperresonant percussion, decreased breath sounds to absent, possible scattered crackles, wheezes and rhonchi

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65
Q

bronchitis

A

inflammation of lining of bronchial tubes

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66
Q

pneumonia

A

fluid filled, infection of alveoli

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67
Q

asthma signs

A

trachea is midline, decreased tactile fremitus, resonant or hyperresonant percussion, breath sounds obscured by wheezes, possible crackles

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68
Q

asthma

A

Constriction in trachiobronchial tree & edema & mucus & bronchospasm, lungs will over inflate during asthma attack

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69
Q

pleural effusion

A

A buildup of fluid between the tissues that line the lungs and the chest, collapses the alveoli

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70
Q

pleural effusion signs

A

trachea shifted toward opposite side, decreased to absent tactile fremitus, dull to flat percussion, decreased to absent breath sounds, possible pleural friction rub

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71
Q

pneumothorax

A

collapsed lung usually due to injury - either air leaking into pleural space or a leak in the chest wall

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72
Q

pneumothorax signs

A

trachea shifted toward opposite side, decreased tactile fremitus due to pleural air, hyperresonant percussion, decreased to absent breath sounds, possible pleural rub

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73
Q

congestive heart failure signs

A

trachea is midline, decreased tactile fremitus, resonant percussion, vesicular breath sounds, possible crackles and wheezes

74
Q

where is the apical pulse?

A

5th intercostal space in adults and 4th in children, midclavicular line, point of maximal impulse

75
Q

what is S1

A

closing of AV valves during systole, ventricles contract, mitral closes before tricuspid

76
Q

what is S2

A

closing of semilunar valves during diastole, ventricles relax, aortic closes before pulmonic

77
Q

where is S1 loudest

A

apex of the heart

78
Q

where is S2 loudest

A

loudest at the base

79
Q

S3

A

aka ventricular gallop, occurs when ventricles are resistant to early rapid filling (protodiastolic) bc they are stiff, occurs right after S2 when atrial blood is flowing in, one of the first signs of CHF, can be normal in the young or pregnant

80
Q

S4

A

aka atrial gallop, occurs at the end of diastole (atrial kick), when ventricles are resistant they vibrate, occurs right before S1, pathological but can sometimes happen in athletes

81
Q

what can cause a murmur

A

increased blood velocity, thinner blood, structural defect in valve

82
Q

what is normal CO

A

4-6L of blood/min

83
Q

cardiac output formula

A

strove volume x heart rate

84
Q

blood pressure formula

A

CO x systemic vascular resistance

85
Q

preload

A

volume of venous return during diastole

86
Q

afterload

A

the pressure the ventricle has to overcome to pump it’s blood

87
Q

Where do men feel heart attacks

A

sternal chest pain, jaw and left arm

88
Q

where do women feel heart attacks

A

back pain

89
Q

hematemesis

A

old blood vomit

90
Q

visceral pain

A

when hollow organs forcefully contract or become distended or when solid organs swell against their capsules

91
Q

what does visceral pain feel like

A

gnawing, cramping, aching, difficult to localize

92
Q

epigastric pain?

A

stomach

93
Q

RUQ pain

A

liver or gallbladder

94
Q

pain by belly button

A

appendix

95
Q

pubic/sacral pain

A

rectum, colon, bladder, uterus

96
Q

parietal pain

A

inflammation from the hollow or solid organs that affect the parietal peritoneum, more severe and not easily localized

97
Q

referred pain

A

originates at different sites but shares innervation from the same spinal level

98
Q

abdominal pain could be referred to

A

shoulder

99
Q

heart pain and GERD could be referred to

A

left arm

100
Q

kidney stones or renal colic could be referred to

A

back

101
Q

hematochezia

A

blood in stool

102
Q

melena

A

black, tarry stool, indicates blood in colon or higher up

103
Q

ventral hernia

A

defects in abdominal wall through which tissue protrudes

104
Q

lipoma

A

common, benign, fatty tumors usually located in subcutaneous tissue, soft and often lobulated, slips out from under finger when pressed down

105
Q

epigastric hernia

A

defect in linea alba

106
Q

incisional hernia

A

protrusion through operational scar

107
Q

umbilical hernia

A

defect in umbilical ring

108
Q

aortic pulse in epigastric area

A

amplitude is increased with aneurysm or solid structure

109
Q

borborygmi

A

intestinal rumbling

110
Q

order of assessment for abdomen

A

inspect, auscultate, percuss, palpate

111
Q

where to start auscultating bowel sounds

A

ileocecal valve in RLQ

112
Q

Auscultate vascular sounds in abdomen at

A

aorta, L&R renal arteries, L&R iliac arteries, L&R femoral arteries

113
Q

arterial bruits with systolic and diastolic components is a sign of

A

partial occlusion of aorta or large arteries

114
Q

liver span on midclavicular line

A

6-12cm

115
Q

what could cause enlarged liver

A

chf, hepatitis

116
Q

liver scratch test

A

define liver borders when abdomen is tense or distended, place stethescope over liver and scratch over RLQ, when sound is magnified that is the liver edge

117
Q

costovertebral tenderness

A

pressure from fingertips can produce tenderness due to kidney infection but may also be musculoskeletal

118
Q

normally palpable abdominal structures

A

full bladder, sigmoid colon with feces, ascending colon, fetus, edge of liver, lower right kidney

119
Q

abnormal palpable abdominal structures

A

descending colon, enlarged liver, enlarged spleen (3x), enlarged nodular liver, enlarged gallbladder, enlarged kidney

120
Q

signs of aorta aneurysm

A

decreased femoral pulses, aorta width is >5cm, bruit

121
Q

how to assess for acute cholecystitis

A

murphy’s sign - palpate for liver and if patient can’t exhale it is a positive sign for inflamed gallbladder

122
Q

how to assess for appendicitis

A

rebound tenderness, rovsing’s sign (push on LLQ and pain will radiate to RLQ), psoas sign (have pt lift up leg against pressure, if there is pain in abdomen that is a positive sign), obturator test (internal/external rotation of hip, pain in abdomen is a positive sign)

123
Q

how to assess for ascites

A

protuberant abdomen with bulging flanks, percuss abdomen and if there is ascites flanks will be dull

124
Q

a sign of peritonitis

A

rebound tenderness

125
Q

myocardial ischemia

A

oxygenated blood supply is not getting to the myocardium, usually occurs when metabolic supply of the body increases

126
Q

myocardial infarction

A

blood supply is cut off by a clog

127
Q

anasarca

A

can happen with kidney/liver/heart failure, generalized edema everywhere

128
Q

chest lift is a sign of

A

ventricular hypertrophy, lifts with systole

129
Q

right ventricular hypertrophy could be seen

A

sternal border

130
Q

left ventricular hypertrophy could be seen

A

apex

131
Q

mitral valve location

A

5th intercostal space, midclavicular line

132
Q

tricuspid valve location

A

5th intercostal space, near sternal border

133
Q

pulmonary valve location

A

2nd intercostal space, left sternal border

134
Q

aortic valve location

A

2nd intercostal space, right sternal border

135
Q

physiologically split S2 is

A

normal during inspiration, aortic closes before pulmonic because there is more blood in the lungs so less blood in the left side

136
Q

valve stenosis occurs when

A

valve is opening

137
Q

valve regurgitation occurs when

A

valve is closing

138
Q

what is the worst kind of murmur

A

diastolic

139
Q

mitral valve prolapse sign

A

midsystolic click and murmur

140
Q

3 differences in fetal heart

A

ductus venosus (hepatic bypass that compensates for the fact the baby is getting blood from umbilical vein instead of own body), foramen ovale (opening between R and L atrium, closes when o2 hits baby’s lungs), patent ductus arteriosis (shunts blood from pulmonary artery to aorta to bypass lungs)

141
Q

intermittent claudication

A

a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries

142
Q

myocardial ischemia causes of chest pain

A

stable (typical) angina, unstable angina, variant angina, myocardial infarction

143
Q

mitral valve prolapse

A

one or both leaflets prolapse back into atria during systole

144
Q

pericarditis

A

inflammation of the pericardium caused by a virus/bacteria/uremia/lupus/neoplasm may cause precordial chest pain, pain is crushing in the retrosternal area

145
Q

dissecting aneurysm

A

tearing of arterial intima (inner layer of aorta) which causes blood to surge through the tear and the layers dissect, tearing pain radiating to back or neck

146
Q

pulmonary embolism

A

dyspnea, but can be asymptomatic, blood clot in lungs that can travel

147
Q

pleurisy

A

inflammation of pleura, gets worth when breathing and better when holding breath

148
Q

pulmonary hypertension

A

dyspnea, uncomfortable nonradiating constriction across chest

149
Q

mediastinal emphysema

A

free air in the mediastinum produces chest tightness and dyspnea, hamman’s sign can be heard over precordium

150
Q

esophageal spasm

A

substernal pain and dysphagia, may mimic angina

151
Q

esophageal reflux

A

substernal burning or cramping radiates into arms, neck, jaw, can be relieved with antacids

152
Q

gallstone colic

A

RUQ pain radiating to back or right shoulder or chest

153
Q

dyspnea

A

shortness of breath, uncomfortable awareness of breathing

154
Q

orthopnea

A

dyspnea when laying down, relieved by sitting up

155
Q

paroxysmal nocturnal dyspnea

A

dyspnea after laying down for a few hours, wake up with SOB

156
Q

pulmonary edema

A

pulmonary congestion bc of left sided heart failure, anxious dyspnea

157
Q

Paroxysmal atrial tachycardia

A

period of rapid heart beat that begins and ends suddenly

158
Q

ectopic beats

A

disturbance to heart rate because of electrical problem

159
Q

cardiac syncope causes

A

arrhythmia that reduces SV, cardiac outflow obstruction, ischemia, carotid sinus syncope, hypovolemia

160
Q

central cyanosis

A

decreased pulmonary venous saturation (tetralogy of fallot in children)

161
Q

fatigue caused by decreased CO is worse when

A

evening

162
Q

fatigue caused by anxiety/depression is worse when

A

in the morning

163
Q

Orthostatic hypotension causes

A

vascular volume loss, redistribution of blood volume, prolonged bedrest, vasovagal fainting, ANS dysfunction

164
Q

orthostatic hypotension

A

systole decreases no more than 15 mmhg and HR increases up to 10 beats/min when changing from supine to standing

165
Q

what would displace the PMI downward and left

A

left ventricular dilation (volume overload)

166
Q

what would increase the force and duration of PMI

A

left ventricular hypertrophy

167
Q

the bell of the stethoscope picks up

A

S3 and rumble of mitral stenosis

168
Q

the diaphragm of stethoscope picks up

A

S1, S2 and S4

169
Q

S1 coincides with

A

carotid artery pulse

170
Q

early systolic ejection click is a sign of

A

aortic stenosis, pulmonic stenosis

171
Q

opening snap is a sign of

A

mitral stenosis

172
Q

newborn HR and BP

A

higher and lower

173
Q

JVP reflects

A

right atrial pressure, clinical indicator of cardiac function and right heart hemodynamics

174
Q

normal JVP

A

8-9cm

175
Q

peripheral arterial disease

A

common circulatory problem in which narrowed arteries reduce blood flow to your limbs, intermittent claudification

176
Q

venous peripheral vascular disease

A

swelling in limbs

177
Q

allen test

A

depress radial artery with closed fist, open back up, should pink back up via ulnar artery, if it doesn’t it is occluded

178
Q

chronic arterial insufficiency signs

A

claudification, decreased pulses, pale or dusky red on dependency, cool, mild or absent edema, thin/shiny skin, loss of hair and thickening toenails, ulcers on toes or points of trauma, possible gangrene

179
Q

chronic venous insufficiency signs

A

no pain or aching, normal pulses, cyanotic on dependency, brown pigmentation, normal temp, edema, ulcers on sides of ankles, no gangrene

180
Q

homan’s sign

A

left pts leg and flex the foot, if there is deep calf pain that could be a sign of DVT, very unreliable

Physical Assessment (3 decks)

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