Exam 2 review (Abd, CV, Pulm/Thorax) Flashcards
4 Steps of Abdominal Exam?
- Inspect
- Auscultate
- Percuss
- Palpation
Examine tender areas of abdomen first or last?
LAST!
When to auscultate abdomen in order of exam?
BEFORE percussion or palpation!
Auscultate with which side of stethoscope?
Diaphragm
3 types of abdominal pain?
- Visceral
- Parietal
- Referred
What causes Visceral Pain in abdomen?
Distention/Stretching of hollow abd organs
Visceral Pain in abdomen easy or difficult to localize?
Difficult
Quality types of Visceral Pain in abdomen? (Hint: 4 types)
- Gnawing,
- Burning
- Cramping
- Aching
Gnawing, burning, cramping, aching what types of abdominal pain?
Visceral Pain in abdomen
Steady aching pain in abdomen is what type of pain?
Parietal Pain
Parietal Pain in abdomen due to what?
Inflammation
Where is Parietal Pain located?
More precisely located over involved structures
What makes Parietal Pain worse?
Movement, like being in a bouncing ambulance
Which abdominal pain worse- Parietal Pain or Visceral?
Parietal Pain
Examples of abdominal Parietal Pain?
Appendicitis, internal bleeding when fingers withdrawn from palpation
Referred Pain in abdomen comes from where?
Distant sites
Heart ischemia causing epigastric discomfort is an example of what type of pain?
Referred pain
Referred Pain in abdomen localized or diffuse?
Localized
What causes Referred Pain in abdomen?
Dermatomal innervation
4 special tests for appendicitis?
- Heel tap
- Obturator
- Psoas
- Rovsing
HOPR (the chief of police on Stranger Things)
Rovsing’s, Psoas, Obturator, and Heel Tap signs for which abdominal condition?
Appendicitis
Pain in RLQ during left-sided pressure which sign?
Rovsing. Appendicitis.
Describe Rovsings’s Sign. Which condition?
Pain in RLQ during left-sided pressure. Appendicitis.
Pain upon PT raising right thigh against hand pushing against right knee? Which abdominal condition?
Psoas Sign. Appendicitis.
Flex right thigh at hip, knee bent, rotate leg internally at hip is which sign? Which abdominal condition?
Obturator Sign for appendicitis
Positive Obturator Sign?
Right hypogastric pain. Appendicitis.
Obturator Sign’s sensitivity for appendicitis?
Very low sensitivity
What can Digitial Recal Exam in males and Pelvic Exam in females identify in appendicitis?
Atypically located appendix
DRE and Pelvic Exam for appendicitis senitivity?
Low sensitivity
Heel Tap test for which abdominal condition?
Appendicitis
Positive Heel Tap test?
Pain in RLQ after forcefully strike bottom of foot with closed ulnar hand. Appendicitis.
Murphy’s sign for which abdominal condition?
Cholecystitis
Which special test for Cholecystitis?
Murphy’s Sign
Positive Murphy’s Sign when…?
Sharp increase in RUQ tenderness from palpation with deep inspiratory effort. Cholecystitis.
How to do Murphy’s Sign?
Palpate liver at midclavicular line using finger hook technique. Cholecystitis.
What does Crunch Test show in abdomen?
Ventral Hernia
What will Crunch Test results show and not show?
Superficial masses remain palpable, intraabdominal masses not palpable
What type of pain in appendicitis?
Parietal Pain
Where does pain of appendicitis begin and then migrate to?
Begins near umbilicus then migrates to RLQ
Who is less likely to report pain pattern in appendicitis?
Older adults
Position of PT during abdominal percussion?
On back, knees up, feet on exam table, arms at sides (not above head)
What does normal abdominal percussion sound like?
Mostly tympanic, scattered dullness from food and stool.
Normal span of liver percussion on right midclavicular line?
6-12cm
Where is the spleen percussed?
Traube’s Space (lower left anterior left wall)
What are the two types of percussion of the spleen?
- General Percussion
2. Splenic Percussion Sign
Normal sound when percussing the spleen?
Tympany
What is the normal result for General Percussion of the spleen?
Lateral Tympany (normal size spleen)
Where is the Splenic Percusison Sign percussed at? What does the PT have to do?
Lowest interspace at anterior axillary line (ALL) while PT is deeply inhaling
What does a dull sound mean when doing the Splenic Percussion Sign?
Splenomegaly (enlarged spleen)
Where does the spleen expand to when enlarged?
Expands anteriorly, downward, and medially
Can you palpate a spleen which is normal and not enlarged?
Usually not
What are the two types of palpation of the abdomen? Which comes first?
Light palpation then deep palpation
What are the 2 normal sounds when auscultating the abdomen?
Clicks and gurgles
How many clicks per minute should be heard when auscultating abdomen?
5-34/min
What does bulging abdominal flanks suggest?
Ascites
What is Bororygmi?
Prolonged gurgles d/t hyperperistalsis. Stomach growling.
What 2 things can caused increased bowel sounds?
- Diarrhea
2. Early intestinal obstruction
What 2 things can cause decreased bowel sounds?
- Adynamic ileus
2. Peritonitis
How long to listen to bowel sounds for if decreased
More than 2 minutes
What does a high pitch tinkle bowel sound indicate?
Intestinal fluid and air under tension in dialated bowel
What does a bowel sound of rush of high pitch plus cramps indicate?
Intestinal obstruction
What can altered bowel sounds suggest?
Diarrhea, intestinal obstructions, paralytic ileus, peritonitis
What sort of disease does an abdonimal bruit suggest?
Occlusive vascular disease
What does a bruit with both systolic and diastolic components suggest?
Atherosclerosis
What does a hepatic bruit suggest? (2 possible things)
Cirrhosis or hepatic carcinoma
What does bruit in epigastrum, RUQ, or LUQ + both systolic and diastolic components indicate?
Renal artery stenosis
What does an abdominal Friction Rub sound like?
Grating sound with respiratory variation
Where to auscultate for abdominal Friction Rub?
Over liver and spleen
What does an abdominal Friction Rub indicate?
Inflammation of peritoneal surface of organ
A hepatic friction rub + systolic bruit indicate?
Liver carcinoma
Describe sound of abdominal Venous Hum
Soft humming noise with both systolic and diastolic components
What does abdominal Venous Hum indicate?
Increased collateral circulation between portal and systemic systems (like hepatic cirrhosis)
Define Hyperaesthesia
Pain out of proportion
Hyperaesthesia is an indicator of what?
Peritoneal inflammation
What is Rebound Tenderness?
Hurts more when letting go from palpation
Rebound Tenderness is an indicator of what?
Peritoneal inflammation
What might the spleen do in mono, sickle cell, or hemolytic anemia?
Enlarge “splenomegaly”
Bladder shouldn’t be wider than what?
3cm
Anorexia followed by periumbilical pain then migration to the right side of the abdomen with pain preceding vomiting?
Appendicitis
Pain in RLQ suggests what?
Peritonitis
A sudden increase in pain and cessation of inhalation suggests…?
Cholecystitis
What position to examine Anterior Thorax?
Supine
What position to examine Posterior Thorax?
Sitting. Arms folded, hands resting on opposite shoulders to increase access to lung fields.
Normal respirations in adult?
14-20 breaths/min, quiet and regular.
Define tachypnea?
More than 25 breaths/min
Define Fremitus
Palpable vibrations transmitted thorugh bronchopulmonary tree to chest wall while speaking
Where is fremitus more prominent?
Interscapular area
Fremitus is easier to detect over which lung?
Right lung
Where does fremitus disappear?
Below diaphragm
Is fremitus a precise technique?
No. It’s imprecise but directs your attention.
How to detect fremitus?
Ball or ulnar surface of hand as patient said “99”
Where to place hands during tactile fremitus?
Symmetric sides of posterior thorax
How many spots to for anterior and posterior tactile fremitus?
Anterior=3 regions symmetric
Posterior=4 regions symmetric
What does an Asymmetric Decrease in Fremitus indicate? (Hint: 3 possible)
Unilateral pleural effusion, pnemothoax, or neoplasm
What does an Asymmetric Increase in Fremitus indicate?
Unilateral pneumonia
Vesicular, Bronchovesicular, Bronchial, and Tracheal are examples of what?
Breath sounds
Which is the normal breath sound?
Vesicular
Describe Vesicular breath sound (pitch, where heard, when heard)
Soft/low pitch, over most of both lungs, heart through inspiration and 1/3 of expiration
Describe Bronchovesicular breath sound (pitch, where heard, when heard)
Intermediate pitch sound. Over 1st and 2nd ICS, and between scapula. Inspiratory and expiratory sounds almost equal.
Describe Bronchial breath sound (pitch, where heard, when heard)
High pitch, loud, harsh. Over manubrium. Expiratory sound lasts longer than inspiratory.
Describe Tracheal breath sound (pitch, where heard, when heard)
Loud and harsh sounds. Heard over trachea. Inspiratory and expiratory sounds almost equal.
What to suspect if Bronchial and Bronchovesicular breath sounds heard in locations distant from where expected?
Suspect air-filled lung replaced by fluid filled or solid lung tissue. AKA consolidation.
Most important finding in breath sounds?
Presence of breath sounds!
Where do Bronchovesicular breath sounds occur?
Over 1st and 2nd ICS, and between scapula
Where do Bronchial breath sounds occur?
Over manubrium
Define “Adventitious Lung Sounds”
Added sounds over normal
Crackles, fine crackles, coarse crackles, wheezes, ronchi, and stridor are examples of what?
Aventitiuous lung sounds
Crackles aka?
Rales
Crackles are known as ____ in time
“Dots in time”
Crackles sound? Musical or not?
Discontinuous, non-musical popping sound
What does the sound of crackles represent in the lungs?
Small distal airways pop open during inspiration
Biphasic crackles may indicate what?
Pneumonia
Early inspiratory crackles may indicate?
COPD
Late inspiratory crackes may indicate?
Pulmonary fibrosis
Pulmonary Fibrosis and Interstitial Lung disease associated with which crackles?
Fine Crackles
Pitch and duration of Fine Crackles?
Soft and high pitch. Short duration.
Pitch and duration of Coarse Crackles?
Low frequency, longer duration than fine
Sound of Coarse Crackles? Where heard?
Popping sound. Heard over any lung region.
COPD, asthma, bronchiectasis, pneumonia, and HF associated with which crackles?
Coarse crackles
Pitch and sound of Wheezes? Musical?
Relative high pitch. Continuous musical sound.
What does wheezing suggest in airways?
Suggests narrowed airways
What is happening in lungs during Wheezing?
Bronchial airway narrowed to point of closure.
Are wheezes localized or heard through lungs?
Can be either. Localized d/t foreign body, mucous plug, or tumor or throughout lungs.
Do wheezes disappear with cough?
No
Wheezes are typical in which respiratory disease?
Asthma
Pitch of Ronchi?
Relatively low-pitch
What does Ronchi suggest in large airways?
Suggests secretions in large airways
Do ronchi disappear with cough?
Yes
Pitch and sound of Stridor?
Continuous, high-pitch musical sound
What happening in respiratory tract during Stridor?
Narrowing of upper respiratory tract
Where is Stridor best heard and in which phase of breathing?
Over neck during inspiration
Stridor due to what in airway?
Airway obstruction
Which lung sounds are non-musical, dots in time?
Crackles
Pleural Rub pitch and sound?
Discontinuous, low-frequency, grating sound
Pleural Rub heard in which 2 regions of the lungs?
- Axilla
2. Base of lungs
Which pleura inflammed and roughened in Pleural Rub?
Inflammation and roughening of visceral pleural and it slides against parietal pleura
Mediastinal Crunch is a series of what sound and synchronous with what?
Series of precordial crackles synchronous with heart beat (not respiration)
Mediastinal Crunch d/t entry of what into the mediastinum?
Air entry into mediastinum causing mediastinal emphysema “pneumomediastinum”
Where is pain in Mediastinal Crunch? Quality of pain?
Severe central chest pain
Normal lung percussion sound?
Resonant
A hyperresonant lung percussion sound due to what two things?
- Long standing asthma
2. Very long duration pneumothorax
How many percussion spots on anterior and posterior thorax?
Anterior Thorax=6
Posterior Thorax=7
What sort of pattern to use when percussion thorax?
Ladder pattern to compare symmetry
Normal AP diameter of thorax?
1:2.
Can be 1:1 in aging.
Pigeon Chest aka
Pectus Carinatum
Sternal Angle at which rib?
2nd rib
Interspace of ribs named for?
Named for rib above
Where to insert needle for pneumothorax decompression?
2nd ICS
Where to insert chest tube for pneumothorax?
4th ICS
Landmark for Thoracentesis?
T7-T8
Which ribs are floating?
11th and 12th. No anterior attachments.
How many lobes in right lung?
- Upper, middle, lower.
How many lobes in left lung?
- Upper and lower.
Which fissure does the left lung not have which the right lung does have?
Horizontal “minor” fissure, divides middle and lower lobes.
Auscultate lung sounds with which part of stethoscope?
Diaphragm
What is principal muscle of inspiration
Diaphragm
Is normal breathing audible?
Barely audible near open mouth
What is a consolidation?
Airless lung tissue
What does prolonged expiratory phase represent?
Obstructive respiratory disease
What is the Pleximeter Finger?
Rests of surface, struck using the plexor finger
How to make percussion louder?
Increase pressure with Pleximeter Finger
Which finger strikes Pleximeter Finger?
Plexor Finger
Strike the pleximeter finger using which part of the plexor finger?
Tip, not finger pad.
Resonant percussion lung sounds represent what?
Normal sounds, chronic bronchitis, early L side HF
Dull percussion lung sounds represent what? (3 things)
- Consolidation=airless lung tissue
- Atelectasis (lobar consolidation)
- Pleural effusion
Hyperresonant percussion lung sounds represent what 3 conditions?
- Asthma
- COPD
- Pneumothorax
Increased Egophony, Bronchophony, and Whistered Pectoriloquy can mean what has formed in the lungs?
Consolidation
Flat percussion note can be heard where? Duration?
Thigh. Short duraiton.
Liver percussion note? Duration?
Dull . Medium duraiton.
Tympanic percussion note can be heard where? Duration?
Gastric air bibble, puffed out cheek. Very long duration.
Increased transmission of voice sounds (as above) suggests what?
Air-filled lung has become airless (alsoknown as consolidation).
Chronic Bronchitis percussion sound?
Resonant
Left-sided heart failure percussion sound?
Resonant
Consolidation percussion sound?
Dull
Atelectasis (lobar consolidation) percussion sound?
Dull
Pneumothorax percussion sound?
Hyperresonant
COPD percussion sound?
Hyperresonant
Asthma percussion sound?
Resonant to hyperresonant
COPD percussion sound?
Hyperresonant
Which chamber of the heart occupies most of the anterior cardiac surface?
Right Ventricle
The Inferior Border of the Right Ventricle lies below the junction of ____ and ____
Sternum and Xiphoid Process
What two parts of the heart form a wedge-like structure behind and to the left of the sternum?
Right Ventricle + Pulmonary Artery
The Right Ventricle and Pulmonary Artery join to form what at the level of the sternal angle?
Base of the Heart
Superior aspect of the heart at the Right and Left 2nd ICS adjacent to the sternum?
Base of the Heart
Which heart chamber is behind and to the left of the Right Ventricle?
Left Ventricle
What is the tapered inferior tip of the Left Ventricle called?
Cardiac Apex
The Cardiac Apex produces what impulse?
Apical Impulse
What is the Apical Impulse called during palpation of the precordium?
Point of Maximum Impulse (PMI)
Is the PMI always palpable?
No! Even in healthy PTs it’s not palpable.
PMI makes up which border of the heart?
Left border
Which ICS is the left border of the heart (made from the PMI) found?
5th ICS
What is a normal PMI diameter in a supine patient?
1-2.5cm. About as large as a quarter.
If PMI >2.5cm what does it mean?
LVH
LVH will have a PMI above what?
> 2.5cm
What can cause a PMI >2.5cm? (2 things)
HTN or aortic stenosis
Where will the PMI be most prominent in RVH?
Xiphoid or Epigastric area
What can cause RVH?
COPD
Where do the Great Vessels of the heart lay?
Above heart
What are the 4 Great Vessels of the heart?
- Venae Cava
- Pulmonary Artery
- Pulmonary Vein
- Aorta
The Aorta curves up from which ventricle?
LV
What does the Pulmonary Artery quickly bifurcate into?
R and L branches. From RV to lungs.
The Venae Vaca is on which border of the heart?
Medial border
Systole is between which S sounds?
S1 to S2
Diastole is between which S sounds?
S2 to S1
Which valves slam shut in Systole (S1 to S2)?
Mitral and Tricuspid valves slam shut
Pitch of Systole (S1 to S2)? Changes with inspriation?
High pitch. Softer on inspiration.
Where to listen/where is loudest place for Systole (S1 to S2)? Which part of stethoscope?
Listed at Apex with diaphragm
Blood ejected from where in Diastole (S2 to S1)? Which valves slam shut?
Blood ejected from L.V.
Aortic and pulmonic valves slam shut.
Where to listen/where is loudest place for Diastole (S2 to S1)? Which part of stethoscope?
Listen at base of heart with diaphragm.
Pitch of Diastole (S2 to S1)?
High pitch
S3 aka?
“Kentucky”
S4 aka?
“Tennessee”
Listen to S3 and S4 with which part of stethoscope? Why?
Bell. More sensitive to lower pitch sounds
Which chamber is galloping in S3?
Ventricular gallop
Which chamber is galloping in S4?
Atrial gallop
Pitch of S3? Change with inspiration?
Low pitch. Increases with inspiration.
Where to listen for S3? Which part of stethoscope?
Apex with bell.
What is rapidly filling with S3?
Rapid ventricular filling
Pitch of S4? Change with inspiration?
Low pitch, increase with inspiration.
PT position listening to S3?
Supine on L lateral
PT position listening to S4?
Supine or left semilateral.
Where to listen for S4? Which part of stethoscope?
Apex with bell.
Describe ejection in S4
Forceful atrial ejection into distended ventricle
How to listen to 5 cardiac areas?
Listen from apex-to-base or base-to-apex. Inch from area to area listening for a change in tone.
Acronym for 5 cardiac areas?
All=Aortic area PAs=Pulmonic area Easily=Erb’s point Take=Tricuspid area Money=Mitral area
Location of Aortic Area?
Right 2nd ICS
Location of Pulmonic Area
Left 2nd ICS
Location of Erb’s Point?
Left 3rd ICS at left sternal border
Location of Tricuspid Area?
Left 4th ICS at sternal border
Location of Mitral Area?
Left 5th midclavicular line
What is a cardiac murmur attributed to?
Turbulent blood blood.
What are cardiac murmurs diagnostic of?
Valvular heart disease
Are systolic murmurs always d/t valve disease?
No! Systolic murmurs point to valvular disease but can be physiologic flow murmurs arising from normal heart valves.
Do diastolic murmurs usually represent valvular heart disease?
Yes! Diastolic murmurs usually represent valvular heart disease.
Most common kind of heart murmur?
Midsystolic ejection murmurs are the most common kind of heart murmur.
What is an innocent murmur?
Without any detectable physiologic or structural abnormality
What is a physiologic murmur due to?
Physiologic changes in body metabolism
What is a pathologic murmur?
Arising from structural abnormalities in the heart or great vessels.
How many grades of murmurs are there?
6
Describe Grade 1 Murmur
Very faint, not heard in all positions
Describe Grade 2 Murmur
Quiet, heart immediately with stethoscope on chest
Describe Grade 3 Murmur
Moderately loud
Describe Grade 4 Murmur
Loud with palpable thrill
Describe Grade 5 Murmur
Very loud with thrill. May be heard with stethoscope partly off chest.
Describe Grade 6 Murmur
Very loud with thrill. May be heard with stethoscope entirely off chest.
Define Thrill
Vibration sensation felt on ball of hand due to underlying turbulent blood flow
Define Heave/Lift
Sustained impulses that rhythmically lift fingers on chest. D/T enlarged atrium or ventricle.
Memory tool for systolic murmurs?
MR. AS TRies PSeudonums , ASD, VSD, HOCM MR=mitral regurg AS=aortic stenosis TR=tricuspid regurg PS=pulmonic stenosis
What will an innocent or physiologic murmur do upon sitting?
Decrease or disapepar
What position to augment/accentuate the sound of Aortic Stenosis?
Sit and lean forward
What position to augment/accentuate the sound of HOCM?
Stand
What will squating or valsalva do to HOCM sound?
Squat=Decrease sound
Valsalva=Louder sound
How to augment/accentuate the sound of Tricuspid Regurg?
Inspiration
How to augment/accentuate the sound of Aortic Regurg?
Sit, lean forward, hold breath after exhale
How to augment/accentuate the sound of Mitral Stenosis?
Mild exercise (handgrips) with exhalation
What does Jugular Venous Pressure reflect?
Right Atrium pressure
What does Right Atrium pressure in turn equal? (hint: 2)
- Centrous venous pressure
2. RV end-diastolic pressure
Best vein/place to estimate JVP?
Right internal jugular vein
What looking for on surface of neck for JVP measurment?
Transmitted pulsations from right internal jugular vein
What is the dominant movement of the JVP?
Inward!
What can the dominant movement of the JVP on the neck be confused with?
Outward Carotid movement
To find highest point of int jugular pulsation (aka meniscus) raise bed to what degree?
60 degrees
Once find meniscus of int jugular do what?
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.
Normal Jugular Venous Pressure distance?
≤9cm
If JVP is >9cm what does it mean about the right atrial volume?
Increased right atrial volume.
HF, tricuspid valve dz, pulm stenosis, pericardial dz, etc.
A very low JVP can mean what?
Hypovolemia
If PT is hypovolemic do what with head of bed for JVP measurment?
Lower head of bed
If PT is hypervolemic do what with head of bed for JVP measurment?
Raise head of bed
JVP levels above 9 cm reflect?
Increased right atrial volume
A-wave corresponds to what?
Atrial contraction
Absent A-waves mean what? (hint 2 things)
- Afib
2. Junctional/ventricular rhythms
Afib or junctional/ventricular rhythms do what to A-waves?
Absent
X-descent corresponds to what?
Atrial relaxation
C-wave represents to what?
Bulging of tricuspid valve during systolic contraction
Which wave represents bulging of tricuspid valve during systolic contraction?
C wave
V-wave reflects what?
Increased atrial pressure as venous return increases after systole
Which wave reflects increased atrial pressure as venous return increases after systole
V-wave
V-wave is prominent with which valvular heart dz?
Severe tricuspid regurg
Severe tricuspid regurg causes which wave to be prominent?
V-wave
What does the Y-descent represent?
Reduced pressure observed with tricuspid valve opening and atrial emptying during systole
Which descent is represented by reduced pressure observed with tricuspid valve opening and atrial emptying during systole
Y-descent
Does JVP normally rise of fall with inspiration?
Falls with inspiration
What does JVP do with Kussmal’s Sign?
Kussmaul’s sign is the observation of a JVP that rises with inspiration.
What does Kussmal’s Sign suggest to right ventricle? Due to what? (Hint: 2 things)
Impaired filling of the right ventricle. Due to:
- Fluid in the pericardial space, or
- Poorly compliant myocardium or pericardium.
Firm pressure applied to the abdomen’s RUQ will do what to blood return to heart? What is this reflex called?
Hepato-Jugular Reflex. Increase blood volume return to Right Atrium.
What will the Hepato-Jugular Reflex do in a patient with normal cardiac function?
Increased volume of blood return is accommodated and only a transient change in the intensity of the JVP is observed
What will the Hepato-Jugular Reflex do in a patient with impaired right cardiac function?
Progressive rise in CVP and, subsequently, increased JVP waveform intensity
Carotid pulse used to detect what 2 conditions?
- Stenosis
2. Aortic valve insufficiency
PT at what angle when assessing carotid pulse?
30 degrees
Where to palate right carotid artery?
Lower 1/3 of neck
Where is carotid sinus? What to do with it?
Upper 1/3 of neck. Avoid it or you can slow down the heart (reflex bradycardia) or drop in BP.
4 types of carotid pulse amplitudes?
- Thready
- Weak
- Strong
- Bounding
What does the amplitude of the carotid pulse correlate with?
Pulse pressure
What makes up the contour of the carotid pulse wave?
Speed of upstroke, duration of summit, and speed of downstroke
Describe the normal carotid speed of upstroke
Brisk
What S sounds does the carotid upstroke follow and preceed?
Following S1 almost immediately, proceeds S2
DEscribe duration of carotid summit?
Smooth
Describe speed of carotid downstroke relative to the upstroke
Less abrupt than upstroke
What does Aortic Stenosis do to the carotid upstroke?
Delays it
Describe a carotid thrill
Vibration, like purring cat
Can thrills in aortic stenosis can be transmitted to the carotid arteries?
Yes they sure can, batman
Descrube a carotid bruit
Turbulent swishing sound whie PT holding breath
Which artery pulsations are used to time the cardiac cycle?
carotid
Carotid pulsations are aligned with ___________ _______?
Ventricular systole
If there is a carotid bruit or thrill which artery to use instead to time the cardiac cycle?
Brachial artery
What does the Allen Test compare?
Patency of ulnar and radial arteries.
What does the Allen Test ensure?
Patency of ulnar artery before puncturing radial artery for blood draw
How to do Allen Test?
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
Allen Test negative when?
Palmar flushing within 3-5 seconds when ulnar artery decompressed
Allen Test positive when?
Palmar pallor d/t ulnar artery occlusion
What is the cause of a Pericardial Friction Rub?
Pericarditis
What is inflammed in Pericardial Friction Rub?
Inflammation of visceral and partietal pericardium
Sound of Pericardial Friction Rub? Heard where?
High pitch, coard grating sound.
Heard in Left 3 ICS.
What position PT in to hear Pericardial Friction Rub?
Sitting, learning forward, forced expiration, and breath held. Left 3 ICS.
Pericardial Friction Rub has components of what?
Both systole and diastole
What happens ventricules during a Gallop Rhythm?
Rapid rate of ventricular filling
Which heart phase does Gallop Rhythm occur in? (Hint: systole or diastole)
Diastole only!
What are the two Gallop Rhythm?
S3=ventricular gallop
S4=atrial gallop
What is “galloping” in S3?
Ventricular gallop. Rapid filling of the ventricles.
What is “galloping” in S4?
Atrial gallop. Forceful ejection of blood from artium into ventricles.
What is a Summation Gallop?
S3 and S4 merge into one loud extra heart sound during a rapid heart rate
Murmur + Thrill=?
Cardiac Pathology
Which chest ICSs to palpate?
3, 4, 5, 6 ICS
Palpate chest from ____ _______ ________ ____ toward _______.
From left anterior axillary line toward sternum
Normal palpation sound of chest wall?
Resonand
Abnormal palpation sound of chest wall?
Dull
Where will the first dull note be when palpating chest wall?
Sternum
“Vibrating sensation felt on ball of hand due to underlying turbulent blood flow.”
Thrill. Felt during chest wall palpation.
“Sustained impulses that rhythmycally lift fingers on chest due to enlarged atrium or ventricle.”
Heave/Lift.
Thrill felt with which murmur grades?
4, 5, and 6
Where is PMI palpated?
5th ICS
PMI aka
Apical Impulse
What happens to fingers in Primary Raynaud’s Phenomenon?
Episodic reversible vasoconstriction in fingers and toes.
What triggers Primary Raynaud’s Phenomenon?
Cold temperate
Is the cause known for Primary Raynaud’s Phenomenon?
No discernable cause.
Where is pain/numbness/tingling in Primary Raynaud’s Phenomenon?
Distal portions of ≥1 fingers
What are signs/symptoms of Secondary Raynaud’s Phenomenon related to?
Autoimmune diseases
What is Peripheral Artery Disease due to?
Atherosclerotic obstruction of peripheral arteries during exertional claudication
What is Claudication?
Muscle pain that gets better with rest
Where is claudication in Peripheral Artery Disease?
Calf muscles
What are the 2 causes of Acute Arterial Occlusion?
- Embolism
2. Thrombosis
Where is pain in Acute Arterial Occlusion?
Distal pain, usually in foot and leg
Which cardiac region to listen for splitting of S2?
Pulmonic. Left 2 ICS at sternal border.
