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Physical exam > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

S3 sounds

A
  • ventricular gallop
  • brief mid diastolic impulse
  • normal in kids, young adults, 3rd trimester
  • usually indicate pathologic change in ventricular compliance
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2
Q

S4 sounds

A
  • atrial gallop
  • impulse just before systolic apical beat
  • marks atrial contraction
  • d/t increased resistance to ventricular filling
  • usually indicate pathologic change in ventricular compliance
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3
Q

L sided causes of S4 sounds

A
  • HTN
  • myocardial ischemia
  • aortic stenosis
  • CMP
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4
Q

R sided causes of S4 sounds

A
  • pulmonary HTN

- pulmonic stenosis

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5
Q

heaves and lifts

A
  • felt with base of palm
  • will lift hand, indicate sustained impulses
  • produced by enlarged A or V, V aneurysms
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6
Q

thrills

A
  • use full hand to assess
  • humming vibrations
  • murmur + thrill= cardiac pathology
  • if present assess the area for murmur
  • impacts grading of murmurs
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7
Q

where are S1 sounds heard loudest

A
  • apex
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8
Q

where are S2 sounds heard loudest

A
  • base
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9
Q

adventitious breath sounds

A
  • added or superimposed sounds

- will not be heard if there is enough gas exchange

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10
Q

crackles

A
  • aka rales

- brief

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11
Q

wheezes

A
  • high pitched

- suggest narrowed airways

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12
Q

rhonchi

A
  • low pitched
  • suggest large airways
  • heard on inspiration
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13
Q

transmitted breath sounds

A
  • suggest air filled lungs have become airless/ consolidated

- bronchophony, egophony, whispered pectoriloquy

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14
Q

what are the types of breath sounds

A
  • vesicular
  • bronchovesicular
  • bronchial
  • adventitious
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15
Q

vesicular breath sounds

A
  • soft or low pitched
  • heard through inspiration
  • normal breath sounds
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16
Q

bronchovesicular breath sounds

A
  • inspiratory and expiratory breath sounds are equal in length
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17
Q

bronchial breath sounds

A
  • louder, harsher, higher in pitch
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18
Q

consolidation

A
  • airless lung
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19
Q

a wave

A
  • JVP corresponding to atrial contraction

- immediately precedes S1

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20
Q

increased a wave

A
  • increased resist to R atrial emptying
  • decreased R ventricular compliance- RVH, COPD, restrictive CMP, pulm valve stenosis
  • tricuspid stenosis
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21
Q

absent a wave

A
  • a fib

- junctional or ventricular rhythms

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22
Q

intermittent prominent a wave

A
  • cannon a waves
  • AV dissociation (complete heart block)
  • v tach
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23
Q

grade 1 murmur

A
  • very faint
  • listener must be “tuned in”
  • may not be heard in all positions
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24
Q

grade 2 murmur

A
  • quiet but immediately heard
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25
Q

grade 3 murmur

A
  • mod loud
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26
Q

grade 4 murmur

A
  • loud with palpable thrill
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27
Q

grade 5 murmur

A
  • very loud with thrill

- may be heard with stethoscope slightly off chest

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28
Q

grade 6 murmur

A
  • very loud with thrill

- may be heard with stethoscope entirely off chest

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29
Q

list the systolic murmurs

A
  • mitral regurgitation
  • aortic stenosis
  • tricuspid regurg
  • pulmonic stenosis
  • HOCM
  • ASD
  • VSD
  • “mr. AS tries pseudonyms”
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30
Q

when do systolic murmurs occur?

A

between S1 and S2

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31
Q

when do diastolic murmurs occur

A
  • between S2 and S2

- listen with diaphragm

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32
Q

what does S1 indicate

A
  • mitral and tricuspid valve closing

- systole

33
Q

what does S2 indicate

A
  • blood is ejected out of L ventricles
  • aortic and pulmonic valves close
  • diastole
  • immediately precedes carotid upstroke
34
Q

PMI

A
  • apical impulse
  • found at 5th IC space, 1 cm medial to MCL
  • should be less than 2.5 cm with brisk tap
  • if cannot find, put pt in LLD position
35
Q

special tests for ascites

A
  • shifting dullness
  • fluid wave
  • ballottement
36
Q

test for shifting dullness

A
  • have pt turn on side
  • percuss and mark boarders of dullness
  • in pts with ascites, tympani will shift to top when pt changes to lateral position
37
Q

test for fluid wave

A
  • have pt press side of hands down the midline of their abdomen
  • tap on one flank
  • pos for ascites= fluid wave felt on opposite flank
38
Q

ballottement

A
  • straighten and stiffen fingers, make brief jabbing motion to displace fluid
  • test for ascites
39
Q

special tests for appendicitis

A
  • McBurney’s point
  • Rovsing’s sign
  • psoas sign
  • obturator sign
40
Q

McBurney’s point

A
  • 2 in from ASIS on diagonal line to umbilicus
  • check for guarding, rigidity, or rebound tenderness
  • sign of appendicitis
41
Q

Rovsing’s sign

A
  • press in LLQ
  • pos= pain in RLQ
  • sign of appendicitis
42
Q

psoas sign

A
  • place hand above pts R knee and have them do SLR against resistance
  • turn pt on L side and extend R leg at hip
  • pos= abdominal pain
  • sign of appendicitis
43
Q

obturator sign

A
  • flex pts R hp with knee bent and then IR leg
  • pos= pain in R hypogastric region
  • sign of appendicitis
44
Q

special tests for cholecystitis

A
  • murphy’s sign
45
Q

murphy’s sign

A
  • hook fingers under R costal margin
  • ask pt to take a deep breath while you press up and in
  • pos= sharp increase in tenderness and sudden stop of inspiration
  • test for cholecystitis
46
Q

crunch test

A
  • test for ventral hernia
  • have pt raise head/ shoulders off table
  • if pt has hernia it will bulge
47
Q

what are the different types of abdominal pain

A
  • visceral
  • parietal
  • referred
48
Q

visceral pain

A
  • distention/ stretching of hollow abdominal organs
  • typically palpable near midline
  • gnawing, burning, cramping, aching pain
  • sweating, pallor, n/v, restlessness when severe
49
Q

parietal pain

A
  • abd wall inflammation, parietal inflammation
  • steady aching pain- usually worse than visceral
  • more precisely localized over structures, pt can point to pain
  • aggravated by movement or coughing, pt prefers to lie still
50
Q

referred pain

A
  • pain felt at distant sites that are innervated at roughly same spinal level
  • may be felt superficially, or deeply
  • usually localized
51
Q

where is pain in abdomen usually referred from

A
  • chest
  • spine
  • pelvis
52
Q

normal findings for tactile fremitus

A
  • feel vibrations
53
Q

decreased tactile fremitus

A
  • obstructed bronchus
  • COPD
  • pneumothroax
  • pleural effusion
  • fibrosis
  • tumor
54
Q

increased tactile fremitus

A
  • pneumonia
55
Q

normal JVP

A
  • < 3 cm above sternal angle
  • < 8/9 cm in total distance from right atria
  • normally falls with inspiration
56
Q

increased JVP causes

A
  • HF
  • tricuspid stenosis
  • chronic pulmonary HTN
  • pericardial disease
57
Q

Kussmaul’s sign

A
  • JVP rises with inspiration

- suggests impaired filling of RV

58
Q

hepato-jugular reflex

A
  • when pressure is applied in RUQ JVP rises
59
Q

primary Raynaud phenomenon

A
  • episodic reversible vasoconstriction in fingers and toes
  • triggered by cold temps
  • no definable cause
  • capillaries are normal
  • distal portion of fingers
  • usually only painful if ulcers present
  • numbness and tingling common
60
Q

secondary Raynaud phenomenon

A
  • si/sx related to autoimmune diseases

- can be d/t occupational vascular injury or drugs

61
Q

peripheral arterial disease

A
  • atherosclerotic disease -> obstruction of peripheral arteries
  • exertional claudication, may progress to sx at rest
  • atypical leg pain
  • usually found in calf
  • can occur in buttock, hip, high, foot depending on level of obstruction
  • rest pain in distal toes or forefoot
62
Q

acute arterial occlusion

A
  • d/t embolism or thrombosis

- distal pain usually in foot and leg

63
Q

surgical abdomen

A
  • pain prior to vomiting
64
Q

sternal angle land marks

A
  • aka angle of louis
  • T4
  • Rib 2
65
Q

where is the inferior angle of the scapula

A
  • posterior of rib 7
66
Q

what is normal AP diameter of the chest

A
  • 1:2

- may increase with age or chronic bronchitis

67
Q

what is another word for chest expansion

A
  • lung excursion
68
Q

what is the normal liver size

A
  • 6-12 cm at midclavicular line in males
69
Q

aortic stensosis

A
  • systolic murmur
  • found at 2nd and 3rd interspaces
  • radiates to carotid and apex
  • harsh quality
  • heard best when pt is sitting and leaning forward
70
Q

HOCM

A
  • systolic murmur
  • found at 3rd and 4th interspaces
  • radiates to apex
  • medium intensity
  • decreases with squatting and valsalva release
  • increases with standing and valsalva strain
71
Q

pulmonic stenosis

A
  • systolic murmur
  • found at 2nd and 3rd interspaces
  • radiates towards L shoulder and neck
  • crescendo decrescendo
  • harsh quality
72
Q

mitral regurgitation

A
  • systolic murmur
  • found at apex
  • radiates to L axilla
  • does not change with inspiration
  • holosystolic
73
Q

tricuspid regurgitation

A
  • systolic murmur
  • blowing, holosystolic
  • found at lower L sternal boarder, if RVD then may be heard at apex
  • increases with inspiration
74
Q

ventricular septal defect

A
  • systolic murmur
  • heard at 3rd, 4th and 5th interspaces
  • intensity increases with smaller defect
  • pitch is higher with smaller defect
  • holosystolic
75
Q

aortic regurgitation

A
  • heard at L 2nd, 3rd and 4th interspaces
  • radiates to apex if loud
  • heard best with diaphragm
  • blowing decrescendo
  • heard best when pt is sitting, leaning forward, with breath held after exhalation
76
Q

mitral stenosis

A
  • usually limited to apex without radiation
  • decrescendo low pitched rumble
  • presystolic accentuation
  • use bell to hear
  • heard best in LLD position
  • mild exercise (handgrip) may worsen
77
Q

venous hum

A
  • continuous murmur without silent interval
  • loudest in diastole
  • heard above medial third of clavicles esp on right
  • obliterated when pressure applied to IJV
  • heard best with bell
78
Q

pericardial friction rub

A
  • heard best in 3rd interspace next to sternum when pt is sitting and leaning forward
  • superficial sound that seems “close to stethoscope”
  • scratchy, scraping quality
  • heard best with diaphragm
79
Q

patent ductus arteriosus

A
  • found at 2nd left interspace
  • radiates to L clavicle
  • usually loud, machinery like

Physical exam (3 decks)

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