Exam 2 review (Abd, CV, Pulm/Thorax) Flashcards
1
Q
4 Steps of Abdominal Exam?
A
- Inspect
- Auscultate
- Percuss
- Palpation
2
Q
Examine tender areas of abdomen first or last?
A
LAST!
3
Q
When to auscultate abdomen in order of exam?
A
BEFORE percussion or palpation!
4
Q
Auscultate with which side of stethoscope?
A
Diaphragm
5
Q
3 types of abdominal pain?
A
- Visceral
- Parietal
- Referred
6
Q
What causes Visceral Pain in abdomen?
A
Distention/Stretching of hollow abd organs
7
Q
Visceral Pain in abdomen easy or difficult to localize?
A
Difficult
8
Q
Quality types of Visceral Pain in abdomen? (Hint: 4 types)
A
- Gnawing,
- Burning
- Cramping
- Aching
9
Q
Gnawing, burning, cramping, aching what types of abdominal pain?
A
Visceral Pain in abdomen
10
Q
Steady aching pain in abdomen is what type of pain?
A
Parietal Pain
11
Q
Parietal Pain in abdomen due to what?
A
Inflammation
12
Q
Where is Parietal Pain located?
A
More precisely located over involved structures
13
Q
What makes Parietal Pain worse?
A
Movement, like being in a bouncing ambulance
14
Q
Which abdominal pain worse- Parietal Pain or Visceral?
A
Parietal Pain
15
Q
Examples of abdominal Parietal Pain?
A
Appendicitis, internal bleeding when fingers withdrawn from palpation
16
Q
Referred Pain in abdomen comes from where?
A
Distant sites
17
Q
Heart ischemia causing epigastric discomfort is an example of what type of pain?
A
Referred pain
18
Q
Referred Pain in abdomen localized or diffuse?
A
Localized
19
Q
What causes Referred Pain in abdomen?
A
Dermatomal innervation
20
Q
4 special tests for appendicitis?
A
- Heel tap
- Obturator
- Psoas
- Rovsing
HOPR (the chief of police on Stranger Things)
21
Q
Rovsing’s, Psoas, Obturator, and Heel Tap signs for which abdominal condition?
A
Appendicitis
22
Q
Pain in RLQ during left-sided pressure which sign?
A
Rovsing. Appendicitis.
23
Q
Describe Rovsings’s Sign. Which condition?
A
Pain in RLQ during left-sided pressure. Appendicitis.
24
Q
Pain upon PT raising right thigh against hand pushing against right knee? Which abdominal condition?
A
Psoas Sign. Appendicitis.
25
Flex right thigh at hip, knee bent, rotate leg internally at hip is which sign? Which abdominal condition?
Obturator Sign for appendicitis
26
Positive Obturator Sign?
Right hypogastric pain. Appendicitis.
27
Obturator Sign’s sensitivity for appendicitis?
Very low sensitivity
28
What can Digitial Recal Exam in males and Pelvic Exam in females identify in appendicitis?
Atypically located appendix
29
DRE and Pelvic Exam for appendicitis senitivity?
Low sensitivity
30
Heel Tap test for which abdominal condition?
Appendicitis
31
Positive Heel Tap test?
Pain in RLQ after forcefully strike bottom of foot with closed ulnar hand. Appendicitis.
32
Murphy’s sign for which abdominal condition?
Cholecystitis
33
Which special test for Cholecystitis?
Murphy’s Sign
34
Positive Murphy’s Sign when...?
Sharp increase in RUQ tenderness from palpation with deep inspiratory effort. Cholecystitis.
35
How to do Murphy’s Sign?
Palpate liver at midclavicular line using finger hook technique. Cholecystitis.
36
What does Crunch Test show in abdomen?
Ventral Hernia
37
What will Crunch Test results show and not show?
Superficial masses remain palpable, intraabdominal masses not palpable
38
What type of pain in appendicitis?
Parietal Pain
39
Where does pain of appendicitis begin and then migrate to?
Begins near umbilicus then migrates to RLQ
40
Who is less likely to report pain pattern in appendicitis?
Older adults
41
Position of PT during abdominal percussion?
On back, knees up, feet on exam table, arms at sides (not above head)
42
What does normal abdominal percussion sound like?
Mostly tympanic, scattered dullness from food and stool.
43
Normal span of liver percussion on right midclavicular line?
6-12cm
44
Where is the spleen percussed?
Traube’s Space (lower left anterior left wall)
45
What are the two types of percussion of the spleen?
1. General Percussion
| 2. Splenic Percussion Sign
46
Normal sound when percussing the spleen?
Tympany
47
What is the normal result for General Percussion of the spleen?
Lateral Tympany (normal size spleen)
48
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
49
What does a dull sound mean when doing the Splenic Percussion Sign?
Splenomegaly (enlarged spleen)
50
Where does the spleen expand to when enlarged?
Expands anteriorly, downward, and medially
51
Can you palpate a spleen which is normal and not enlarged?
Usually not
52
What are the two types of palpation of the abdomen? Which comes first?
Light palpation then deep palpation
53
What are the 2 normal sounds when auscultating the abdomen?
Clicks and gurgles
54
How many clicks per minute should be heard when auscultating abdomen?
5-34/min
55
What does bulging abdominal flanks suggest?
Ascites
56
What is Bororygmi?
Prolonged gurgles d/t hyperperistalsis. Stomach growling.
57
What 2 things can caused increased bowel sounds?
1. Diarrhea
| 2. Early intestinal obstruction
58
What 2 things can cause decreased bowel sounds?
1. Adynamic ileus
| 2. Peritonitis
59
How long to listen to bowel sounds for if decreased
More than 2 minutes
60
What does a high pitch tinkle bowel sound indicate?
Intestinal fluid and air under tension in dialated bowel
61
What does a bowel sound of rush of high pitch plus cramps indicate?
Intestinal obstruction
62
What can altered bowel sounds suggest?
Diarrhea, intestinal obstructions, paralytic ileus, peritonitis
63
What sort of disease does an abdonimal bruit suggest?
Occlusive vascular disease
64
What does a bruit with both systolic and diastolic components suggest?
Atherosclerosis
65
What does a hepatic bruit suggest? (2 possible things)
Cirrhosis or hepatic carcinoma
66
What does bruit in epigastrum, RUQ, or LUQ + both systolic and diastolic components indicate?
Renal artery stenosis
67
What does an abdominal Friction Rub sound like?
Grating sound with respiratory variation
68
Where to auscultate for abdominal Friction Rub?
Over liver and spleen
69
What does an abdominal Friction Rub indicate?
Inflammation of peritoneal surface of organ
70
A hepatic friction rub + systolic bruit indicate?
Liver carcinoma
71
Describe sound of abdominal Venous Hum
Soft humming noise with both systolic and diastolic components
72
What does abdominal Venous Hum indicate?
Increased collateral circulation between portal and systemic systems (like hepatic cirrhosis)
73
Define Hyperaesthesia
Pain out of proportion
74
Hyperaesthesia is an indicator of what?
Peritoneal inflammation
75
What is Rebound Tenderness?
Hurts more when letting go from palpation
76
Rebound Tenderness is an indicator of what?
Peritoneal inflammation
77
What might the spleen do in mono, sickle cell, or hemolytic anemia?
Enlarge “splenomegaly”
78
Bladder shouldn’t be wider than what?
3cm
79
Anorexia followed by periumbilical pain then migration to the right side of the abdomen with pain preceding vomiting?
Appendicitis
80
Pain in RLQ suggests what?
Peritonitis
81
A sudden increase in pain and cessation of inhalation suggests...?
Cholecystitis
82
What position to examine Anterior Thorax?
Supine
83
What position to examine Posterior Thorax?
Sitting. Arms folded, hands resting on opposite shoulders to increase access to lung fields.
84
Normal respirations in adult?
14-20 breaths/min, quiet and regular.
85
Define tachypnea?
More than 25 breaths/min
86
Define Fremitus
Palpable vibrations transmitted thorugh bronchopulmonary tree to chest wall while speaking
87
Where is fremitus more prominent?
Interscapular area
88
Fremitus is easier to detect over which lung?
Right lung
89
Where does fremitus disappear?
Below diaphragm
90
Is fremitus a precise technique?
No. It’s imprecise but directs your attention.
91
How to detect fremitus?
Ball or ulnar surface of hand as patient said “99”
92
Where to place hands during tactile fremitus?
Symmetric sides of posterior thorax
93
How many spots to for anterior and posterior tactile fremitus?
Anterior=3 regions symmetric
| Posterior=4 regions symmetric
94
What does an Asymmetric Decrease in Fremitus indicate? (Hint: 3 possible)
Unilateral pleural effusion, pnemothoax, or neoplasm
95
What does an Asymmetric Increase in Fremitus indicate?
Unilateral pneumonia
96
Vesicular, Bronchovesicular, Bronchial, and Tracheal are examples of what?
Breath sounds
97
Which is the normal breath sound?
Vesicular
98
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
99
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.
100
Describe Bronchial breath sound (pitch, where heard, when heard)
High pitch, loud, harsh. Over manubrium. Expiratory sound lasts longer than inspiratory.
101
Describe Tracheal breath sound (pitch, where heard, when heard)
Loud and harsh sounds. Heard over trachea. Inspiratory and expiratory sounds almost equal.
102
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.
103
Most important finding in breath sounds?
Presence of breath sounds!
104
Where do Bronchovesicular breath sounds occur?
Over 1st and 2nd ICS, and between scapula
105
Where do Bronchial breath sounds occur?
Over manubrium
106
Define “Adventitious Lung Sounds”
Added sounds over normal
107
Crackles, fine crackles, coarse crackles, wheezes, ronchi, and stridor are examples of what?
Aventitiuous lung sounds
108
Crackles aka?
Rales
109
Crackles are known as ____ in time
“Dots in time”
110
Crackles sound? Musical or not?
Discontinuous, non-musical popping sound
111
What does the sound of crackles represent in the lungs?
Small distal airways pop open during inspiration
112
Biphasic crackles may indicate what?
Pneumonia
113
Early inspiratory crackles may indicate?
COPD
114
Late inspiratory crackes may indicate?
Pulmonary fibrosis
115
Pulmonary Fibrosis and Interstitial Lung disease associated with which crackles?
Fine Crackles
116
Pitch and duration of Fine Crackles?
Soft and high pitch. Short duration.
117
Pitch and duration of Coarse Crackles?
Low frequency, longer duration than fine
118
Sound of Coarse Crackles? Where heard?
Popping sound. Heard over any lung region.
119
COPD, asthma, bronchiectasis, pneumonia, and HF associated with which crackles?
Coarse crackles
120
Pitch and sound of Wheezes? Musical?
Relative high pitch. Continuous musical sound.
121
What does wheezing suggest in airways?
Suggests narrowed airways
122
What is happening in lungs during Wheezing?
Bronchial airway narrowed to point of closure.
123
Are wheezes localized or heard through lungs?
Can be either. Localized d/t foreign body, mucous plug, or tumor or throughout lungs.
124
Do wheezes disappear with cough?
No
125
Wheezes are typical in which respiratory disease?
Asthma
126
Pitch of Ronchi?
Relatively low-pitch
127
What does Ronchi suggest in large airways?
Suggests secretions in large airways
128
Do ronchi disappear with cough?
Yes
129
Pitch and sound of Stridor?
Continuous, high-pitch musical sound
130
What happening in respiratory tract during Stridor?
Narrowing of upper respiratory tract
131
Where is Stridor best heard and in which phase of breathing?
Over neck during inspiration
132
Stridor due to what in airway?
Airway obstruction
133
Which lung sounds are non-musical, dots in time?
Crackles
134
Pleural Rub pitch and sound?
Discontinuous, low-frequency, grating sound
135
Pleural Rub heard in which 2 regions of the lungs?
1. Axilla
| 2. Base of lungs
136
Which pleura inflammed and roughened in Pleural Rub?
Inflammation and roughening of visceral pleural and it slides against parietal pleura
137
Mediastinal Crunch is a series of what sound and synchronous with what?
Series of precordial crackles synchronous with heart beat (not respiration)
138
Mediastinal Crunch d/t entry of what into the mediastinum?
Air entry into mediastinum causing mediastinal emphysema “pneumomediastinum”
139
Where is pain in Mediastinal Crunch? Quality of pain?
Severe central chest pain
140
Normal lung percussion sound?
Resonant
141
A hyperresonant lung percussion sound due to what two things?
1. Long standing asthma
| 2. Very long duration pneumothorax
142
How many percussion spots on anterior and posterior thorax?
Anterior Thorax=6
| Posterior Thorax=7
143
What sort of pattern to use when percussion thorax?
Ladder pattern to compare symmetry
144
Normal AP diameter of thorax?
1:2.
| Can be 1:1 in aging.
145
Pigeon Chest aka
Pectus Carinatum
146
Sternal Angle at which rib?
2nd rib
147
Interspace of ribs named for?
Named for rib above
148
Where to insert needle for pneumothorax decompression?
2nd ICS
149
Where to insert chest tube for pneumothorax?
4th ICS
150
Landmark for Thoracentesis?
T7-T8
151
Which ribs are floating?
11th and 12th. No anterior attachments.
152
How many lobes in right lung?
3. Upper, middle, lower.
153
How many lobes in left lung?
2. Upper and lower.
154
Which fissure does the left lung not have which the right lung does have?
Horizontal “minor” fissure, divides middle and lower lobes.
155
Auscultate lung sounds with which part of stethoscope?
Diaphragm
156
What is principal muscle of inspiration
Diaphragm
157
Is normal breathing audible?
Barely audible near open mouth
158
What is a consolidation?
Airless lung tissue
159
What does prolonged expiratory phase represent?
Obstructive respiratory disease
160
What is the Pleximeter Finger?
Rests of surface, struck using the plexor finger
161
How to make percussion louder?
Increase pressure with Pleximeter Finger
162
Which finger strikes Pleximeter Finger?
Plexor Finger
163
Strike the pleximeter finger using which part of the plexor finger?
Tip, not finger pad.
164
Resonant percussion lung sounds represent what?
Normal sounds, chronic bronchitis, early L side HF
165
Dull percussion lung sounds represent what? (3 things)
1. Consolidation=airless lung tissue
2. Atelectasis (lobar consolidation)
3. Pleural effusion
166
Hyperresonant percussion lung sounds represent what 3 conditions?
1. Asthma
2. COPD
3. Pneumothorax
167
Increased Egophony, Bronchophony, and Whistered Pectoriloquy can mean what has formed in the lungs?
Consolidation
168
Flat percussion note can be heard where? Duration?
Thigh. Short duraiton.
169
Liver percussion note? Duration?
Dull . Medium duraiton.
170
Tympanic percussion note can be heard where? Duration?
Gastric air bibble, puffed out cheek. Very long duration.
171
Increased transmission of voice sounds (as above) suggests what?
Air-filled lung has become airless (alsoknown as consolidation).
172
Chronic Bronchitis percussion sound?
Resonant
173
Left-sided heart failure percussion sound?
Resonant
174
Consolidation percussion sound?
Dull
175
Atelectasis (lobar consolidation) percussion sound?
Dull
176
Pneumothorax percussion sound?
Hyperresonant
177
COPD percussion sound?
Hyperresonant
178
Asthma percussion sound?
Resonant to hyperresonant
179
COPD percussion sound?
Hyperresonant
180
Which chamber of the heart occupies most of the anterior cardiac surface?
Right Ventricle
181
The Inferior Border of the Right Ventricle lies below the junction of ____ and ____
Sternum and Xiphoid Process
182
What two parts of the heart form a wedge-like structure behind and to the left of the sternum?
Right Ventricle + Pulmonary Artery
183
The Right Ventricle and Pulmonary Artery join to form what at the level of the sternal angle?
Base of the Heart
184
Superior aspect of the heart at the Right and Left 2nd ICS adjacent to the sternum?
Base of the Heart
185
Which heart chamber is behind and to the left of the Right Ventricle?
Left Ventricle
186
What is the tapered inferior tip of the Left Ventricle called?
Cardiac Apex
187
The Cardiac Apex produces what impulse?
Apical Impulse
188
What is the Apical Impulse called during palpation of the precordium?
Point of Maximum Impulse (PMI)
189
Is the PMI always palpable?
No! Even in healthy PTs it’s not palpable.
190
PMI makes up which border of the heart?
Left border
191
Which ICS is the left border of the heart (made from the PMI) found?
5th ICS
192
What is a normal PMI diameter in a supine patient?
1-2.5cm. About as large as a quarter.
193
If PMI >2.5cm what does it mean?
LVH
194
LVH will have a PMI above what?
>2.5cm
195
What can cause a PMI >2.5cm? (2 things)
HTN or aortic stenosis
196
Where will the PMI be most prominent in RVH?
Xiphoid or Epigastric area
197
What can cause RVH?
COPD
198
Where do the Great Vessels of the heart lay?
Above heart
199
What are the 4 Great Vessels of the heart?
1. Venae Cava
2. Pulmonary Artery
3. Pulmonary Vein
4. Aorta
200
The Aorta curves up from which ventricle?
LV
201
What does the Pulmonary Artery quickly bifurcate into?
R and L branches. From RV to lungs.
202
The Venae Vaca is on which border of the heart?
Medial border
203
Systole is between which S sounds?
S1 to S2
204
Diastole is between which S sounds?
S2 to S1
205
Which valves slam shut in Systole (S1 to S2)?
Mitral and Tricuspid valves slam shut
206
Pitch of Systole (S1 to S2)? Changes with inspriation?
High pitch. Softer on inspiration.
207
Where to listen/where is loudest place for Systole (S1 to S2)? Which part of stethoscope?
Listed at Apex with diaphragm
208
Blood ejected from where in Diastole (S2 to S1)? Which valves slam shut?
Blood ejected from L.V.
| Aortic and pulmonic valves slam shut.
209
Where to listen/where is loudest place for Diastole (S2 to S1)? Which part of stethoscope?
Listen at base of heart with diaphragm.
210
Pitch of Diastole (S2 to S1)?
High pitch
211
S3 aka?
“Kentucky”
212
S4 aka?
“Tennessee”
213
Listen to S3 and S4 with which part of stethoscope? Why?
Bell. More sensitive to lower pitch sounds
214
Which chamber is galloping in S3?
Ventricular gallop
215
Which chamber is galloping in S4?
Atrial gallop
216
Pitch of S3? Change with inspiration?
Low pitch. Increases with inspiration.
217
Where to listen for S3? Which part of stethoscope?
Apex with bell.
218
What is rapidly filling with S3?
Rapid ventricular filling
219
Pitch of S4? Change with inspiration?
Low pitch, increase with inspiration.
220
PT position listening to S3?
Supine on L lateral
221
PT position listening to S4?
Supine or left semilateral.
222
Where to listen for S4? Which part of stethoscope?
Apex with bell.
223
Describe ejection in S4
Forceful atrial ejection into distended ventricle
224
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.
225
Acronym for 5 cardiac areas?
```
All=Aortic area
PAs=Pulmonic area
Easily=Erb’s point
Take=Tricuspid area
Money=Mitral area
```
226
Location of Aortic Area?
Right 2nd ICS
227
Location of Pulmonic Area
Left 2nd ICS
228
Location of Erb’s Point?
Left 3rd ICS at left sternal border
229
Location of Tricuspid Area?
Left 4th ICS at sternal border
230
Location of Mitral Area?
Left 5th midclavicular line
231
What is a cardiac murmur attributed to?
Turbulent blood blood.
232
What are cardiac murmurs diagnostic of?
Valvular heart disease
233
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.
234
Do diastolic murmurs usually represent valvular heart disease?
Yes! Diastolic murmurs usually represent valvular heart disease.
235
Most common kind of heart murmur?
Midsystolic ejection murmurs are the most common kind of heart murmur.
236
What is an innocent murmur?
Without any detectable physiologic or structural abnormality
237
What is a physiologic murmur due to?
Physiologic changes in body metabolism
238
What is a pathologic murmur?
Arising from structural abnormalities in the heart or great vessels.
239
How many grades of murmurs are there?
6
240
Describe Grade 1 Murmur
Very faint, not heard in all positions
241
Describe Grade 2 Murmur
Quiet, heart immediately with stethoscope on chest
242
Describe Grade 3 Murmur
Moderately loud
243
Describe Grade 4 Murmur
Loud with palpable thrill
244
Describe Grade 5 Murmur
Very loud with thrill. May be heard with stethoscope partly off chest.
245
Describe Grade 6 Murmur
Very loud with thrill. May be heard with stethoscope entirely off chest.
246
Define Thrill
Vibration sensation felt on ball of hand due to underlying turbulent blood flow
247
Define Heave/Lift
Sustained impulses that rhythmically lift fingers on chest. D/T enlarged atrium or ventricle.
248
Memory tool for systolic murmurs?
```
MR. AS TRies PSeudonums , ASD, VSD, HOCM
MR=mitral regurg
AS=aortic stenosis
TR=tricuspid regurg
PS=pulmonic stenosis
```
249
What will an innocent or physiologic murmur do upon sitting?
Decrease or disapepar
250
What position to augment/accentuate the sound of Aortic Stenosis?
Sit and lean forward
251
What position to augment/accentuate the sound of HOCM?
Stand
252
What will squating or valsalva do to HOCM sound?
Squat=Decrease sound
| Valsalva=Louder sound
253
How to augment/accentuate the sound of Tricuspid Regurg?
Inspiration
254
How to augment/accentuate the sound of Aortic Regurg?
Sit, lean forward, hold breath after exhale
255
How to augment/accentuate the sound of Mitral Stenosis?
Mild exercise (handgrips) with exhalation
256
What does Jugular Venous Pressure reflect?
Right Atrium pressure
257
What does Right Atrium pressure in turn equal? (hint: 2)
1. Centrous venous pressure
| 2. RV end-diastolic pressure
258
Best vein/place to estimate JVP?
Right internal jugular vein
259
What looking for on surface of neck for JVP measurment?
Transmitted pulsations from right internal jugular vein
260
What is the dominant movement of the JVP?
Inward!
261
What can the dominant movement of the JVP on the neck be confused with?
Outward Carotid movement
262
To find highest point of int jugular pulsation (aka meniscus) raise bed to what degree?
60 degrees
263
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.
264
Normal Jugular Venous Pressure distance?
≤9cm
265
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.
266
A very low JVP can mean what?
Hypovolemia
267
If PT is hypovolemic do what with head of bed for JVP measurment?
Lower head of bed
268
If PT is hypervolemic do what with head of bed for JVP measurment?
Raise head of bed
269
JVP levels above 9 cm reflect?
Increased right atrial volume
270
A-wave corresponds to what?
Atrial contraction
271
Absent A-waves mean what? (hint 2 things)
1. Afib
| 2. Junctional/ventricular rhythms
272
Afib or junctional/ventricular rhythms do what to A-waves?
Absent
273
X-descent corresponds to what?
Atrial relaxation
274
C-wave represents to what?
Bulging of tricuspid valve during systolic contraction
275
Which wave represents bulging of tricuspid valve during systolic contraction?
C wave
276
V-wave reflects what?
Increased atrial pressure as venous return increases after systole
277
Which wave reflects increased atrial pressure as venous return increases after systole
V-wave
278
V-wave is prominent with which valvular heart dz?
Severe tricuspid regurg
279
Severe tricuspid regurg causes which wave to be prominent?
V-wave
280
What does the Y-descent represent?
Reduced pressure observed with tricuspid valve opening and atrial emptying during systole
281
Which descent is represented by reduced pressure observed with tricuspid valve opening and atrial emptying during systole
Y-descent
282
Does JVP normally rise of fall with inspiration?
Falls with inspiration
283
What does JVP do with Kussmal’s Sign?
Kussmaul's sign is the observation of a JVP that rises with inspiration.
284
What does Kussmal’s Sign suggest to right ventricle? Due to what? (Hint: 2 things)
Impaired filling of the right ventricle. Due to:
1. Fluid in the pericardial space, or
2. Poorly compliant myocardium or pericardium.
285
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.
286
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
287
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
288
Carotid pulse used to detect what 2 conditions?
1. Stenosis
| 2. Aortic valve insufficiency
289
PT at what angle when assessing carotid pulse?
30 degrees
290
Where to palate right carotid artery?
Lower 1/3 of neck
291
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.
292
4 types of carotid pulse amplitudes?
1. Thready
2. Weak
3. Strong
4. Bounding
293
What does the amplitude of the carotid pulse correlate with?
Pulse pressure
294
What makes up the contour of the carotid pulse wave?
Speed of upstroke, duration of summit, and speed of downstroke
295
Describe the normal carotid speed of upstroke
Brisk
296
What S sounds does the carotid upstroke follow and preceed?
Following S1 almost immediately, proceeds S2
297
DEscribe duration of carotid summit?
Smooth
298
Describe speed of carotid downstroke relative to the upstroke
Less abrupt than upstroke
299
What does Aortic Stenosis do to the carotid upstroke?
Delays it
300
Describe a carotid thrill
Vibration, like purring cat
301
Can thrills in aortic stenosis can be transmitted to the carotid arteries?
Yes they sure can, batman
302
Descrube a carotid bruit
Turbulent swishing sound whie PT holding breath
303
Which artery pulsations are used to time the cardiac cycle?
carotid
304
Carotid pulsations are aligned with ___________ _______?
Ventricular systole
305
If there is a carotid bruit or thrill which artery to use instead to time the cardiac cycle?
Brachial artery
306
What does the Allen Test compare?
Patency of ulnar and radial arteries.
307
What does the Allen Test ensure?
Patency of ulnar artery before puncturing radial artery for blood draw
308
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
309
Allen Test negative when?
Palmar flushing within 3-5 seconds when ulnar artery decompressed
310
Allen Test positive when?
Palmar pallor d/t ulnar artery occlusion
311
What is the cause of a Pericardial Friction Rub?
Pericarditis
312
What is inflammed in Pericardial Friction Rub?
Inflammation of visceral and partietal pericardium
313
Sound of Pericardial Friction Rub? Heard where?
High pitch, coard grating sound.
| Heard in Left 3 ICS.
314
What position PT in to hear Pericardial Friction Rub?
Sitting, learning forward, forced expiration, and breath held. Left 3 ICS.
315
Pericardial Friction Rub has components of what?
Both systole and diastole
316
What happens ventricules during a Gallop Rhythm?
Rapid rate of ventricular filling
317
Which heart phase does Gallop Rhythm occur in? (Hint: systole or diastole)
Diastole only!
318
What are the two Gallop Rhythm?
S3=ventricular gallop
| S4=atrial gallop
319
What is “galloping” in S3?
Ventricular gallop. Rapid filling of the ventricles.
320
What is “galloping” in S4?
Atrial gallop. Forceful ejection of blood from artium into ventricles.
321
What is a Summation Gallop?
S3 and S4 merge into one loud extra heart sound during a rapid heart rate
322
Murmur + Thrill=?
Cardiac Pathology
323
Which chest ICSs to palpate?
3, 4, 5, 6 ICS
324
Palpate chest from ____ _______ ________ ____ toward _______.
From left anterior axillary line toward sternum
325
Normal palpation sound of chest wall?
Resonand
326
Abnormal palpation sound of chest wall?
Dull
327
Where will the first dull note be when palpating chest wall?
Sternum
328
“Vibrating sensation felt on ball of hand due to underlying turbulent blood flow.”
Thrill. Felt during chest wall palpation.
329
“Sustained impulses that rhythmycally lift fingers on chest due to enlarged atrium or ventricle.”
Heave/Lift.
330
Thrill felt with which murmur grades?
4, 5, and 6
331
Where is PMI palpated?
5th ICS
332
PMI aka
Apical Impulse
333
What happens to fingers in Primary Raynaud’s Phenomenon?
Episodic reversible vasoconstriction in fingers and toes.
334
What triggers Primary Raynaud’s Phenomenon?
Cold temperate
335
Is the cause known for Primary Raynaud’s Phenomenon?
No discernable cause.
336
Where is pain/numbness/tingling in Primary Raynaud’s Phenomenon?
Distal portions of ≥1 fingers
337
What are signs/symptoms of Secondary Raynaud’s Phenomenon related to?
Autoimmune diseases
338
What is Peripheral Artery Disease due to?
Atherosclerotic obstruction of peripheral arteries during exertional claudication
339
What is Claudication?
Muscle pain that gets better with rest
340
Where is claudication in Peripheral Artery Disease?
Calf muscles
341
What are the 2 causes of Acute Arterial Occlusion?
1. Embolism
| 2. Thrombosis
342
Where is pain in Acute Arterial Occlusion?
Distal pain, usually in foot and leg
343
Which cardiac region to listen for splitting of S2?
Pulmonic. Left 2 ICS at sternal border.
