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Physical Exam I > Exam 2 review (Abd, CV, Pulm/Thorax) > Flashcards

Exam 2 review (Abd, CV, Pulm/Thorax) Flashcards

1
Q

4 Steps of Abdominal Exam?

A
  1. Inspect
  2. Auscultate
  3. Percuss
  4. Palpation
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2
Q

Examine tender areas of abdomen first or last?

A

LAST!

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3
Q

When to auscultate abdomen in order of exam?

A

BEFORE percussion or palpation!

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4
Q

Auscultate with which side of stethoscope?

A

Diaphragm

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5
Q

3 types of abdominal pain?

A
  1. Visceral
  2. Parietal
  3. Referred
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6
Q

What causes Visceral Pain in abdomen?

A

Distention/Stretching of hollow abd organs

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7
Q

Visceral Pain in abdomen easy or difficult to localize?

A

Difficult

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8
Q

Quality types of Visceral Pain in abdomen? (Hint: 4 types)

A
  1. Gnawing,
  2. Burning
  3. Cramping
  4. Aching
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9
Q

Gnawing, burning, cramping, aching what types of abdominal pain?

A

Visceral Pain in abdomen

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10
Q

Steady aching pain in abdomen is what type of pain?

A

Parietal Pain

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11
Q

Parietal Pain in abdomen due to what?

A

Inflammation

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12
Q

Where is Parietal Pain located?

A

More precisely located over involved structures

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13
Q

What makes Parietal Pain worse?

A

Movement, like being in a bouncing ambulance

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14
Q

Which abdominal pain worse- Parietal Pain or Visceral?

A

Parietal Pain

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15
Q

Examples of abdominal Parietal Pain?

A

Appendicitis, internal bleeding when fingers withdrawn from palpation

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16
Q

Referred Pain in abdomen comes from where?

A

Distant sites

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17
Q

Heart ischemia causing epigastric discomfort is an example of what type of pain?

A

Referred pain

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18
Q

Referred Pain in abdomen localized or diffuse?

A

Localized

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19
Q

What causes Referred Pain in abdomen?

A

Dermatomal innervation

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20
Q

4 special tests for appendicitis?

A
  1. Heel tap
  2. Obturator
  3. Psoas
  4. Rovsing
    HOPR (the chief of police on Stranger Things)
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21
Q

Rovsing’s, Psoas, Obturator, and Heel Tap signs for which abdominal condition?

A

Appendicitis

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22
Q

Pain in RLQ during left-sided pressure which sign?

A

Rovsing. Appendicitis.

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23
Q

Describe Rovsings’s Sign. Which condition?

A

Pain in RLQ during left-sided pressure. Appendicitis.

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24
Q

Pain upon PT raising right thigh against hand pushing against right knee? Which abdominal condition?

A

Psoas Sign. Appendicitis.

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25
Q

Flex right thigh at hip, knee bent, rotate leg internally at hip is which sign? Which abdominal condition?

A

Obturator Sign for appendicitis

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26
Q

Positive Obturator Sign?

A

Right hypogastric pain. Appendicitis.

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27
Q

Obturator Sign’s sensitivity for appendicitis?

A

Very low sensitivity

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28
Q

What can Digitial Recal Exam in males and Pelvic Exam in females identify in appendicitis?

A

Atypically located appendix

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29
Q

DRE and Pelvic Exam for appendicitis senitivity?

A

Low sensitivity

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30
Q

Heel Tap test for which abdominal condition?

A

Appendicitis

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31
Q

Positive Heel Tap test?

A

Pain in RLQ after forcefully strike bottom of foot with closed ulnar hand. Appendicitis.

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32
Q

Murphy’s sign for which abdominal condition?

A

Cholecystitis

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33
Q

Which special test for Cholecystitis?

A

Murphy’s Sign

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34
Q

Positive Murphy’s Sign when…?

A

Sharp increase in RUQ tenderness from palpation with deep inspiratory effort. Cholecystitis.

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35
Q

How to do Murphy’s Sign?

A

Palpate liver at midclavicular line using finger hook technique. Cholecystitis.

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36
Q

What does Crunch Test show in abdomen?

A

Ventral Hernia

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37
Q

What will Crunch Test results show and not show?

A

Superficial masses remain palpable, intraabdominal masses not palpable

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38
Q

What type of pain in appendicitis?

A

Parietal Pain

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39
Q

Where does pain of appendicitis begin and then migrate to?

A

Begins near umbilicus then migrates to RLQ

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40
Q

Who is less likely to report pain pattern in appendicitis?

A

Older adults

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41
Q

Position of PT during abdominal percussion?

A

On back, knees up, feet on exam table, arms at sides (not above head)

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42
Q

What does normal abdominal percussion sound like?

A

Mostly tympanic, scattered dullness from food and stool.

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43
Q

Normal span of liver percussion on right midclavicular line?

A

6-12cm

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44
Q

Where is the spleen percussed?

A

Traube’s Space (lower left anterior left wall)

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45
Q

What are the two types of percussion of the spleen?

A
  1. General Percussion

2. Splenic Percussion Sign

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46
Q

Normal sound when percussing the spleen?

A

Tympany

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47
Q

What is the normal result for General Percussion of the spleen?

A

Lateral Tympany (normal size spleen)

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48
Q

Where is the Splenic Percusison Sign percussed at? What does the PT have to do?

A

Lowest interspace at anterior axillary line (ALL) while PT is deeply inhaling

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49
Q

What does a dull sound mean when doing the Splenic Percussion Sign?

A

Splenomegaly (enlarged spleen)

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50
Q

Where does the spleen expand to when enlarged?

A

Expands anteriorly, downward, and medially

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51
Q

Can you palpate a spleen which is normal and not enlarged?

A

Usually not

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52
Q

What are the two types of palpation of the abdomen? Which comes first?

A

Light palpation then deep palpation

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53
Q

What are the 2 normal sounds when auscultating the abdomen?

A

Clicks and gurgles

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54
Q

How many clicks per minute should be heard when auscultating abdomen?

A

5-34/min

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55
Q

What does bulging abdominal flanks suggest?

A

Ascites

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56
Q

What is Bororygmi?

A

Prolonged gurgles d/t hyperperistalsis. Stomach growling.

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57
Q

What 2 things can caused increased bowel sounds?

A
  1. Diarrhea

2. Early intestinal obstruction

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58
Q

What 2 things can cause decreased bowel sounds?

A
  1. Adynamic ileus

2. Peritonitis

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59
Q

How long to listen to bowel sounds for if decreased

A

More than 2 minutes

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60
Q

What does a high pitch tinkle bowel sound indicate?

A

Intestinal fluid and air under tension in dialated bowel

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61
Q

What does a bowel sound of rush of high pitch plus cramps indicate?

A

Intestinal obstruction

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62
Q

What can altered bowel sounds suggest?

A

Diarrhea, intestinal obstructions, paralytic ileus, peritonitis

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63
Q

What sort of disease does an abdonimal bruit suggest?

A

Occlusive vascular disease

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64
Q

What does a bruit with both systolic and diastolic components suggest?

A

Atherosclerosis

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65
Q

What does a hepatic bruit suggest? (2 possible things)

A

Cirrhosis or hepatic carcinoma

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66
Q

What does bruit in epigastrum, RUQ, or LUQ + both systolic and diastolic components indicate?

A

Renal artery stenosis

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67
Q

What does an abdominal Friction Rub sound like?

A

Grating sound with respiratory variation

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68
Q

Where to auscultate for abdominal Friction Rub?

A

Over liver and spleen

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69
Q

What does an abdominal Friction Rub indicate?

A

Inflammation of peritoneal surface of organ

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70
Q

A hepatic friction rub + systolic bruit indicate?

A

Liver carcinoma

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71
Q

Describe sound of abdominal Venous Hum

A

Soft humming noise with both systolic and diastolic components

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72
Q

What does abdominal Venous Hum indicate?

A

Increased collateral circulation between portal and systemic systems (like hepatic cirrhosis)

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73
Q

Define Hyperaesthesia

A

Pain out of proportion

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74
Q

Hyperaesthesia is an indicator of what?

A

Peritoneal inflammation

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75
Q

What is Rebound Tenderness?

A

Hurts more when letting go from palpation

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76
Q

Rebound Tenderness is an indicator of what?

A

Peritoneal inflammation

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77
Q

What might the spleen do in mono, sickle cell, or hemolytic anemia?

A

Enlarge “splenomegaly”

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78
Q

Bladder shouldn’t be wider than what?

A

3cm

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79
Q

Anorexia followed by periumbilical pain then migration to the right side of the abdomen with pain preceding vomiting?

A

Appendicitis

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80
Q

Pain in RLQ suggests what?

A

Peritonitis

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81
Q

A sudden increase in pain and cessation of inhalation suggests…?

A

Cholecystitis

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82
Q

What position to examine Anterior Thorax?

A

Supine

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83
Q

What position to examine Posterior Thorax?

A

Sitting. Arms folded, hands resting on opposite shoulders to increase access to lung fields.

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84
Q

Normal respirations in adult?

A

14-20 breaths/min, quiet and regular.

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85
Q

Define tachypnea?

A

More than 25 breaths/min

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86
Q

Define Fremitus

A

Palpable vibrations transmitted thorugh bronchopulmonary tree to chest wall while speaking

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87
Q

Where is fremitus more prominent?

A

Interscapular area

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88
Q

Fremitus is easier to detect over which lung?

A

Right lung

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89
Q

Where does fremitus disappear?

A

Below diaphragm

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90
Q

Is fremitus a precise technique?

A

No. It’s imprecise but directs your attention.

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91
Q

How to detect fremitus?

A

Ball or ulnar surface of hand as patient said “99”

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92
Q

Where to place hands during tactile fremitus?

A

Symmetric sides of posterior thorax

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93
Q

How many spots to for anterior and posterior tactile fremitus?

A

Anterior=3 regions symmetric

Posterior=4 regions symmetric

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94
Q

What does an Asymmetric Decrease in Fremitus indicate? (Hint: 3 possible)

A

Unilateral pleural effusion, pnemothoax, or neoplasm

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95
Q

What does an Asymmetric Increase in Fremitus indicate?

A

Unilateral pneumonia

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96
Q

Vesicular, Bronchovesicular, Bronchial, and Tracheal are examples of what?

A

Breath sounds

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97
Q

Which is the normal breath sound?

A

Vesicular

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98
Q

Describe Vesicular breath sound (pitch, where heard, when heard)

A

Soft/low pitch, over most of both lungs, heart through inspiration and 1/3 of expiration

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99
Q

Describe Bronchovesicular breath sound (pitch, where heard, when heard)

A

Intermediate pitch sound. Over 1st and 2nd ICS, and between scapula. Inspiratory and expiratory sounds almost equal.

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100
Q

Describe Bronchial breath sound (pitch, where heard, when heard)

A

High pitch, loud, harsh. Over manubrium. Expiratory sound lasts longer than inspiratory.

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101
Q

Describe Tracheal breath sound (pitch, where heard, when heard)

A

Loud and harsh sounds. Heard over trachea. Inspiratory and expiratory sounds almost equal.

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102
Q

What to suspect if Bronchial and Bronchovesicular breath sounds heard in locations distant from where expected?

A

Suspect air-filled lung replaced by fluid filled or solid lung tissue. AKA consolidation.

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103
Q

Most important finding in breath sounds?

A

Presence of breath sounds!

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104
Q

Where do Bronchovesicular breath sounds occur?

A

Over 1st and 2nd ICS, and between scapula

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105
Q

Where do Bronchial breath sounds occur?

A

Over manubrium

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106
Q

Define “Adventitious Lung Sounds”

A

Added sounds over normal

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107
Q

Crackles, fine crackles, coarse crackles, wheezes, ronchi, and stridor are examples of what?

A

Aventitiuous lung sounds

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108
Q

Crackles aka?

A

Rales

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109
Q

Crackles are known as ____ in time

A

“Dots in time”

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110
Q

Crackles sound? Musical or not?

A

Discontinuous, non-musical popping sound

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111
Q

What does the sound of crackles represent in the lungs?

A

Small distal airways pop open during inspiration

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112
Q

Biphasic crackles may indicate what?

A

Pneumonia

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113
Q

Early inspiratory crackles may indicate?

A

COPD

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114
Q

Late inspiratory crackes may indicate?

A

Pulmonary fibrosis

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115
Q

Pulmonary Fibrosis and Interstitial Lung disease associated with which crackles?

A

Fine Crackles

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116
Q

Pitch and duration of Fine Crackles?

A

Soft and high pitch. Short duration.

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117
Q

Pitch and duration of Coarse Crackles?

A

Low frequency, longer duration than fine

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118
Q

Sound of Coarse Crackles? Where heard?

A

Popping sound. Heard over any lung region.

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119
Q

COPD, asthma, bronchiectasis, pneumonia, and HF associated with which crackles?

A

Coarse crackles

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120
Q

Pitch and sound of Wheezes? Musical?

A

Relative high pitch. Continuous musical sound.

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121
Q

What does wheezing suggest in airways?

A

Suggests narrowed airways

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122
Q

What is happening in lungs during Wheezing?

A

Bronchial airway narrowed to point of closure.

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123
Q

Are wheezes localized or heard through lungs?

A

Can be either. Localized d/t foreign body, mucous plug, or tumor or throughout lungs.

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124
Q

Do wheezes disappear with cough?

A

No

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125
Q

Wheezes are typical in which respiratory disease?

A

Asthma

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126
Q

Pitch of Ronchi?

A

Relatively low-pitch

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127
Q

What does Ronchi suggest in large airways?

A

Suggests secretions in large airways

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128
Q

Do ronchi disappear with cough?

A

Yes

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129
Q

Pitch and sound of Stridor?

A

Continuous, high-pitch musical sound

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130
Q

What happening in respiratory tract during Stridor?

A

Narrowing of upper respiratory tract

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131
Q

Where is Stridor best heard and in which phase of breathing?

A

Over neck during inspiration

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132
Q

Stridor due to what in airway?

A

Airway obstruction

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133
Q

Which lung sounds are non-musical, dots in time?

A

Crackles

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134
Q

Pleural Rub pitch and sound?

A

Discontinuous, low-frequency, grating sound

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135
Q

Pleural Rub heard in which 2 regions of the lungs?

A
  1. Axilla

2. Base of lungs

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136
Q

Which pleura inflammed and roughened in Pleural Rub?

A

Inflammation and roughening of visceral pleural and it slides against parietal pleura

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137
Q

Mediastinal Crunch is a series of what sound and synchronous with what?

A

Series of precordial crackles synchronous with heart beat (not respiration)

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138
Q

Mediastinal Crunch d/t entry of what into the mediastinum?

A

Air entry into mediastinum causing mediastinal emphysema “pneumomediastinum”

139
Q

Where is pain in Mediastinal Crunch? Quality of pain?

A

Severe central chest pain

140
Q

Normal lung percussion sound?

A

Resonant

141
Q

A hyperresonant lung percussion sound due to what two things?

A
  1. Long standing asthma

2. Very long duration pneumothorax

142
Q

How many percussion spots on anterior and posterior thorax?

A

Anterior Thorax=6

Posterior Thorax=7

143
Q

What sort of pattern to use when percussion thorax?

A

Ladder pattern to compare symmetry

144
Q

Normal AP diameter of thorax?

A

1:2.

Can be 1:1 in aging.

145
Q

Pigeon Chest aka

A

Pectus Carinatum

146
Q

Sternal Angle at which rib?

A

2nd rib

147
Q

Interspace of ribs named for?

A

Named for rib above

148
Q

Where to insert needle for pneumothorax decompression?

A

2nd ICS

149
Q

Where to insert chest tube for pneumothorax?

A

4th ICS

150
Q

Landmark for Thoracentesis?

A

T7-T8

151
Q

Which ribs are floating?

A

11th and 12th. No anterior attachments.

152
Q

How many lobes in right lung?

A
  1. Upper, middle, lower.
153
Q

How many lobes in left lung?

A
  1. Upper and lower.
154
Q

Which fissure does the left lung not have which the right lung does have?

A

Horizontal “minor” fissure, divides middle and lower lobes.

155
Q

Auscultate lung sounds with which part of stethoscope?

A

Diaphragm

156
Q

What is principal muscle of inspiration

A

Diaphragm

157
Q

Is normal breathing audible?

A

Barely audible near open mouth

158
Q

What is a consolidation?

A

Airless lung tissue

159
Q

What does prolonged expiratory phase represent?

A

Obstructive respiratory disease

160
Q

What is the Pleximeter Finger?

A

Rests of surface, struck using the plexor finger

161
Q

How to make percussion louder?

A

Increase pressure with Pleximeter Finger

162
Q

Which finger strikes Pleximeter Finger?

A

Plexor Finger

163
Q

Strike the pleximeter finger using which part of the plexor finger?

A

Tip, not finger pad.

164
Q

Resonant percussion lung sounds represent what?

A

Normal sounds, chronic bronchitis, early L side HF

165
Q

Dull percussion lung sounds represent what? (3 things)

A
  1. Consolidation=airless lung tissue
  2. Atelectasis (lobar consolidation)
  3. Pleural effusion
166
Q

Hyperresonant percussion lung sounds represent what 3 conditions?

A
  1. Asthma
  2. COPD
  3. Pneumothorax
167
Q

Increased Egophony, Bronchophony, and Whistered Pectoriloquy can mean what has formed in the lungs?

A

Consolidation

168
Q

Flat percussion note can be heard where? Duration?

A

Thigh. Short duraiton.

169
Q

Liver percussion note? Duration?

A

Dull . Medium duraiton.

170
Q

Tympanic percussion note can be heard where? Duration?

A

Gastric air bibble, puffed out cheek. Very long duration.

171
Q

Increased transmission of voice sounds (as above) suggests what?

A

Air-filled lung has become airless (alsoknown as consolidation).

172
Q

Chronic Bronchitis percussion sound?

A

Resonant

173
Q

Left-sided heart failure percussion sound?

A

Resonant

174
Q

Consolidation percussion sound?

A

Dull

175
Q

Atelectasis (lobar consolidation) percussion sound?

A

Dull

176
Q

Pneumothorax percussion sound?

A

Hyperresonant

177
Q

COPD percussion sound?

A

Hyperresonant

178
Q

Asthma percussion sound?

A

Resonant to hyperresonant

179
Q

COPD percussion sound?

A

Hyperresonant

180
Q

Which chamber of the heart occupies most of the anterior cardiac surface?

A

Right Ventricle

181
Q

The Inferior Border of the Right Ventricle lies below the junction of ____ and ____

A

Sternum and Xiphoid Process

182
Q

What two parts of the heart form a wedge-like structure behind and to the left of the sternum?

A

Right Ventricle + Pulmonary Artery

183
Q

The Right Ventricle and Pulmonary Artery join to form what at the level of the sternal angle?

A

Base of the Heart

184
Q

Superior aspect of the heart at the Right and Left 2nd ICS adjacent to the sternum?

A

Base of the Heart

185
Q

Which heart chamber is behind and to the left of the Right Ventricle?

A

Left Ventricle

186
Q

What is the tapered inferior tip of the Left Ventricle called?

A

Cardiac Apex

187
Q

The Cardiac Apex produces what impulse?

A

Apical Impulse

188
Q

What is the Apical Impulse called during palpation of the precordium?

A

Point of Maximum Impulse (PMI)

189
Q

Is the PMI always palpable?

A

No! Even in healthy PTs it’s not palpable.

190
Q

PMI makes up which border of the heart?

A

Left border

191
Q

Which ICS is the left border of the heart (made from the PMI) found?

A

5th ICS

192
Q

What is a normal PMI diameter in a supine patient?

A

1-2.5cm. About as large as a quarter.

193
Q

If PMI >2.5cm what does it mean?

A

LVH

194
Q

LVH will have a PMI above what?

A

> 2.5cm

195
Q

What can cause a PMI >2.5cm? (2 things)

A

HTN or aortic stenosis

196
Q

Where will the PMI be most prominent in RVH?

A

Xiphoid or Epigastric area

197
Q

What can cause RVH?

A

COPD

198
Q

Where do the Great Vessels of the heart lay?

A

Above heart

199
Q

What are the 4 Great Vessels of the heart?

A
  1. Venae Cava
  2. Pulmonary Artery
  3. Pulmonary Vein
  4. Aorta
200
Q

The Aorta curves up from which ventricle?

A

LV

201
Q

What does the Pulmonary Artery quickly bifurcate into?

A

R and L branches. From RV to lungs.

202
Q

The Venae Vaca is on which border of the heart?

A

Medial border

203
Q

Systole is between which S sounds?

A

S1 to S2

204
Q

Diastole is between which S sounds?

A

S2 to S1

205
Q

Which valves slam shut in Systole (S1 to S2)?

A

Mitral and Tricuspid valves slam shut

206
Q

Pitch of Systole (S1 to S2)? Changes with inspriation?

A

High pitch. Softer on inspiration.

207
Q

Where to listen/where is loudest place for Systole (S1 to S2)? Which part of stethoscope?

A

Listed at Apex with diaphragm

208
Q

Blood ejected from where in Diastole (S2 to S1)? Which valves slam shut?

A

Blood ejected from L.V.

Aortic and pulmonic valves slam shut.

209
Q

Where to listen/where is loudest place for Diastole (S2 to S1)? Which part of stethoscope?

A

Listen at base of heart with diaphragm.

210
Q

Pitch of Diastole (S2 to S1)?

A

High pitch

211
Q

S3 aka?

A

“Kentucky”

212
Q

S4 aka?

A

“Tennessee”

213
Q

Listen to S3 and S4 with which part of stethoscope? Why?

A

Bell. More sensitive to lower pitch sounds

214
Q

Which chamber is galloping in S3?

A

Ventricular gallop

215
Q

Which chamber is galloping in S4?

A

Atrial gallop

216
Q

Pitch of S3? Change with inspiration?

A

Low pitch. Increases with inspiration.

217
Q

Where to listen for S3? Which part of stethoscope?

A

Apex with bell.

218
Q

What is rapidly filling with S3?

A

Rapid ventricular filling

219
Q

Pitch of S4? Change with inspiration?

A

Low pitch, increase with inspiration.

220
Q

PT position listening to S3?

A

Supine on L lateral

221
Q

PT position listening to S4?

A

Supine or left semilateral.

222
Q

Where to listen for S4? Which part of stethoscope?

A

Apex with bell.

223
Q

Describe ejection in S4

A

Forceful atrial ejection into distended ventricle

224
Q

How to listen to 5 cardiac areas?

A

Listen from apex-to-base or base-to-apex. Inch from area to area listening for a change in tone.

225
Q

Acronym for 5 cardiac areas?

A 
All=Aortic area
PAs=Pulmonic area
Easily=Erb’s point
Take=Tricuspid area
Money=Mitral area
226
Q

Location of Aortic Area?

A

Right 2nd ICS

227
Q

Location of Pulmonic Area

A

Left 2nd ICS

228
Q

Location of Erb’s Point?

A

Left 3rd ICS at left sternal border

229
Q

Location of Tricuspid Area?

A

Left 4th ICS at sternal border

230
Q

Location of Mitral Area?

A

Left 5th midclavicular line

231
Q

What is a cardiac murmur attributed to?

A

Turbulent blood blood.

232
Q

What are cardiac murmurs diagnostic of?

A

Valvular heart disease

233
Q

Are systolic murmurs always d/t valve disease?

A

No! Systolic murmurs point to valvular disease but can be physiologic flow murmurs arising from normal heart valves.

234
Q

Do diastolic murmurs usually represent valvular heart disease?

A

Yes! Diastolic murmurs usually represent valvular heart disease.

235
Q

Most common kind of heart murmur?

A

Midsystolic ejection murmurs are the most common kind of heart murmur.

236
Q

What is an innocent murmur?

A

Without any detectable physiologic or structural abnormality

237
Q

What is a physiologic murmur due to?

A

Physiologic changes in body metabolism

238
Q

What is a pathologic murmur?

A

Arising from structural abnormalities in the heart or great vessels.

239
Q

How many grades of murmurs are there?

A

6

240
Q

Describe Grade 1 Murmur

A

Very faint, not heard in all positions

241
Q

Describe Grade 2 Murmur

A

Quiet, heart immediately with stethoscope on chest

242
Q

Describe Grade 3 Murmur

A

Moderately loud

243
Q

Describe Grade 4 Murmur

A

Loud with palpable thrill

244
Q

Describe Grade 5 Murmur

A

Very loud with thrill. May be heard with stethoscope partly off chest.

245
Q

Describe Grade 6 Murmur

A

Very loud with thrill. May be heard with stethoscope entirely off chest.

246
Q

Define Thrill

A

Vibration sensation felt on ball of hand due to underlying turbulent blood flow

247
Q

Define Heave/Lift

A

Sustained impulses that rhythmically lift fingers on chest. D/T enlarged atrium or ventricle.

248
Q

Memory tool for systolic murmurs?

A 
MR. AS TRies PSeudonums , ASD, VSD, HOCM
MR=mitral regurg
AS=aortic stenosis
TR=tricuspid regurg
PS=pulmonic stenosis
249
Q

What will an innocent or physiologic murmur do upon sitting?

A

Decrease or disapepar

250
Q

What position to augment/accentuate the sound of Aortic Stenosis?

A

Sit and lean forward

251
Q

What position to augment/accentuate the sound of HOCM?

A

Stand

252
Q

What will squating or valsalva do to HOCM sound?

A

Squat=Decrease sound

Valsalva=Louder sound

253
Q

How to augment/accentuate the sound of Tricuspid Regurg?

A

Inspiration

254
Q

How to augment/accentuate the sound of Aortic Regurg?

A

Sit, lean forward, hold breath after exhale

255
Q

How to augment/accentuate the sound of Mitral Stenosis?

A

Mild exercise (handgrips) with exhalation

256
Q

What does Jugular Venous Pressure reflect?

A

Right Atrium pressure

257
Q

What does Right Atrium pressure in turn equal? (hint: 2)

A
  1. Centrous venous pressure

2. RV end-diastolic pressure

258
Q

Best vein/place to estimate JVP?

A

Right internal jugular vein

259
Q

What looking for on surface of neck for JVP measurment?

A

Transmitted pulsations from right internal jugular vein

260
Q

What is the dominant movement of the JVP?

A

Inward!

261
Q

What can the dominant movement of the JVP on the neck be confused with?

A

Outward Carotid movement

262
Q

To find highest point of int jugular pulsation (aka meniscus) raise bed to what degree?

A

60 degrees

263
Q

Once find meniscus of int jugular do what?

A

Make a 90 degree angle with the sternal notch and measure vertical distance from sternal notch to horizontal level of int jugular. Add 5cm to this distance.

264
Q

Normal Jugular Venous Pressure distance?

A

≤9cm

265
Q

If JVP is >9cm what does it mean about the right atrial volume?

A

Increased right atrial volume.

HF, tricuspid valve dz, pulm stenosis, pericardial dz, etc.

266
Q

A very low JVP can mean what?

A

Hypovolemia

267
Q

If PT is hypovolemic do what with head of bed for JVP measurment?

A

Lower head of bed

268
Q

If PT is hypervolemic do what with head of bed for JVP measurment?

A

Raise head of bed

269
Q

JVP levels above 9 cm reflect?

A

Increased right atrial volume

270
Q

A-wave corresponds to what?

A

Atrial contraction

271
Q

Absent A-waves mean what? (hint 2 things)

A
  1. Afib

2. Junctional/ventricular rhythms

272
Q

Afib or junctional/ventricular rhythms do what to A-waves?

A

Absent

273
Q

X-descent corresponds to what?

A

Atrial relaxation

274
Q

C-wave represents to what?

A

Bulging of tricuspid valve during systolic contraction

275
Q

Which wave represents bulging of tricuspid valve during systolic contraction?

A

C wave

276
Q

V-wave reflects what?

A

Increased atrial pressure as venous return increases after systole

277
Q

Which wave reflects increased atrial pressure as venous return increases after systole

A

V-wave

278
Q

V-wave is prominent with which valvular heart dz?

A

Severe tricuspid regurg

279
Q

Severe tricuspid regurg causes which wave to be prominent?

A

V-wave

280
Q

What does the Y-descent represent?

A

Reduced pressure observed with tricuspid valve opening and atrial emptying during systole

281
Q

Which descent is represented by reduced pressure observed with tricuspid valve opening and atrial emptying during systole

A

Y-descent

282
Q

Does JVP normally rise of fall with inspiration?

A

Falls with inspiration

283
Q

What does JVP do with Kussmal’s Sign?

A

Kussmaul’s sign is the observation of a JVP that rises with inspiration.

284
Q

What does Kussmal’s Sign suggest to right ventricle? Due to what? (Hint: 2 things)

A

Impaired filling of the right ventricle. Due to:

  1. Fluid in the pericardial space, or
  2. Poorly compliant myocardium or pericardium.
285
Q

Firm pressure applied to the abdomen’s RUQ will do what to blood return to heart? What is this reflex called?

A

Hepato-Jugular Reflex. Increase blood volume return to Right Atrium.

286
Q

What will the Hepato-Jugular Reflex do in a patient with normal cardiac function?

A

Increased volume of blood return is accommodated and only a transient change in the intensity of the JVP is observed

287
Q

What will the Hepato-Jugular Reflex do in a patient with impaired right cardiac function?

A

Progressive rise in CVP and, subsequently, increased JVP waveform intensity

288
Q

Carotid pulse used to detect what 2 conditions?

A
  1. Stenosis

2. Aortic valve insufficiency

289
Q

PT at what angle when assessing carotid pulse?

A

30 degrees

290
Q

Where to palate right carotid artery?

A

Lower 1/3 of neck

291
Q

Where is carotid sinus? What to do with it?

A

Upper 1/3 of neck. Avoid it or you can slow down the heart (reflex bradycardia) or drop in BP.

292
Q

4 types of carotid pulse amplitudes?

A
  1. Thready
  2. Weak
  3. Strong
  4. Bounding
293
Q

What does the amplitude of the carotid pulse correlate with?

A

Pulse pressure

294
Q

What makes up the contour of the carotid pulse wave?

A

Speed of upstroke, duration of summit, and speed of downstroke

295
Q

Describe the normal carotid speed of upstroke

A

Brisk

296
Q

What S sounds does the carotid upstroke follow and preceed?

A

Following S1 almost immediately, proceeds S2

297
Q

DEscribe duration of carotid summit?

A

Smooth

298
Q

Describe speed of carotid downstroke relative to the upstroke

A

Less abrupt than upstroke

299
Q

What does Aortic Stenosis do to the carotid upstroke?

A

Delays it

300
Q

Describe a carotid thrill

A

Vibration, like purring cat

301
Q

Can thrills in aortic stenosis can be transmitted to the carotid arteries?

A

Yes they sure can, batman

302
Q

Descrube a carotid bruit

A

Turbulent swishing sound whie PT holding breath

303
Q

Which artery pulsations are used to time the cardiac cycle?

A

carotid

304
Q

Carotid pulsations are aligned with ___________ _______?

A

Ventricular systole

305
Q

If there is a carotid bruit or thrill which artery to use instead to time the cardiac cycle?

A

Brachial artery

306
Q

What does the Allen Test compare?

A

Patency of ulnar and radial arteries.

307
Q

What does the Allen Test ensure?

A

Patency of ulnar artery before puncturing radial artery for blood draw

308
Q

How to do Allen Test?

A

Make fist, compress both arteries with thumbs until hand is pallor, release ulnar thumb and check for flushing of palm.
Negative=Palmar flushing within 3-5 sec
Position=Palmar pallor d/t ulnar art occlusion

309
Q

Allen Test negative when?

A

Palmar flushing within 3-5 seconds when ulnar artery decompressed

310
Q

Allen Test positive when?

A

Palmar pallor d/t ulnar artery occlusion

311
Q

What is the cause of a Pericardial Friction Rub?

A

Pericarditis

312
Q

What is inflammed in Pericardial Friction Rub?

A

Inflammation of visceral and partietal pericardium

313
Q

Sound of Pericardial Friction Rub? Heard where?

A

High pitch, coard grating sound.

Heard in Left 3 ICS.

314
Q

What position PT in to hear Pericardial Friction Rub?

A

Sitting, learning forward, forced expiration, and breath held. Left 3 ICS.

315
Q

Pericardial Friction Rub has components of what?

A

Both systole and diastole

316
Q

What happens ventricules during a Gallop Rhythm?

A

Rapid rate of ventricular filling

317
Q

Which heart phase does Gallop Rhythm occur in? (Hint: systole or diastole)

A

Diastole only!

318
Q

What are the two Gallop Rhythm?

A

S3=ventricular gallop

S4=atrial gallop

319
Q

What is “galloping” in S3?

A

Ventricular gallop. Rapid filling of the ventricles.

320
Q

What is “galloping” in S4?

A

Atrial gallop. Forceful ejection of blood from artium into ventricles.

321
Q

What is a Summation Gallop?

A

S3 and S4 merge into one loud extra heart sound during a rapid heart rate

322
Q

Murmur + Thrill=?

A

Cardiac Pathology

323
Q

Which chest ICSs to palpate?

A

3, 4, 5, 6 ICS

324
Q

Palpate chest from ____ _______ ________ ____ toward _______.

A

From left anterior axillary line toward sternum

325
Q

Normal palpation sound of chest wall?

A

Resonand

326
Q

Abnormal palpation sound of chest wall?

A

Dull

327
Q

Where will the first dull note be when palpating chest wall?

A

Sternum

328
Q

“Vibrating sensation felt on ball of hand due to underlying turbulent blood flow.”

A

Thrill. Felt during chest wall palpation.

329
Q

“Sustained impulses that rhythmycally lift fingers on chest due to enlarged atrium or ventricle.”

A

Heave/Lift.

330
Q

Thrill felt with which murmur grades?

A

4, 5, and 6

331
Q

Where is PMI palpated?

A

5th ICS

332
Q

PMI aka

A

Apical Impulse

333
Q

What happens to fingers in Primary Raynaud’s Phenomenon?

A

Episodic reversible vasoconstriction in fingers and toes.

334
Q

What triggers Primary Raynaud’s Phenomenon?

A

Cold temperate

335
Q

Is the cause known for Primary Raynaud’s Phenomenon?

A

No discernable cause.

336
Q

Where is pain/numbness/tingling in Primary Raynaud’s Phenomenon?

A

Distal portions of ≥1 fingers

337
Q

What are signs/symptoms of Secondary Raynaud’s Phenomenon related to?

A

Autoimmune diseases

338
Q

What is Peripheral Artery Disease due to?

A

Atherosclerotic obstruction of peripheral arteries during exertional claudication

339
Q

What is Claudication?

A

Muscle pain that gets better with rest

340
Q

Where is claudication in Peripheral Artery Disease?

A

Calf muscles

341
Q

What are the 2 causes of Acute Arterial Occlusion?

A
  1. Embolism

2. Thrombosis

342
Q

Where is pain in Acute Arterial Occlusion?

A

Distal pain, usually in foot and leg

343
Q

Which cardiac region to listen for splitting of S2?

A

Pulmonic. Left 2 ICS at sternal border.

Physical Exam I (8 decks)

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