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PACS > Exam 2 (wks 4-7) > Flashcards

Exam 2 (wks 4-7) Flashcards

1
Q

Thorax/Lungs

identify the anatomical landmarks of the anterior, posterior, and lateral thorax

A
  • Anterior: Right is mostly upper and middle lobes separated by horizontal fissure at ~ 5th rib in midaxilla to ~4th rib at sternum; Left lower lobe is separated by diagonal fissure from ~5th rib at axilla to ~6th at midclavicular
  • Posterior: Primarily the lower lobe T3 -T10 except apices
  • Right Lateral: Underlies peak of axilla to 7th/8th rib; upper lobe ~5th rib midaxillary and 6th rib anteriorly
  • Left Lateral: Underlies peak of axilla to 7th/8th rib; oblique fissure from 3rd rib medially to 6th rib anteriorly
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2
Q

Thorax/Lungs

define nail clubbing and give examples of what can cause clubbing

A
  • Enlargement of the terminal phalanges of the fingers and/or toes
  • Associated with emphysema, lung cancer, the cyanosis of congenital heart disease, cirrhosis, or cystic fibrosis
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3
Q

Thorax/Lungs

examples that indicate respiratory distress

A
  • barrel chest
  • pursing of the lips
  • flaring of the ala nasi
  • use of accessory muscles
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4
Q

Thorax/Lungs

describe barrel chest

+ 3 examples

A
  • AP diameter approaches or equals the lateral diameter
  • compromised respiration
  • chronic asthma, emphysema, or cystic fibrosis
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5
Q

Thorax/Lungs

define tachypnea

A

Persistent respiratory rate > 20 breaths per minute (in adult)

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6
Q

Thorax/Lungs

causes of tachypnea

3

A
  • examiner watching if not persistent
  • symptom of protective splinting from the pain of a broken rib or pleurisy
  • Massive liver enlargement or abdominal ascites may prevent descent of the diaphragm and produce a similar pattern
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7
Q

Thorax/Lungs

define bradypnea

A

persistent respiratory rate < 12 breaths per minute

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8
Q

Thorax/Lungs

causes of bradypnea

3

A
  • neurologic or electrolyte disturbance, infection
  • a conscious response to protect against the pain of pleurisy or other irritative phenomena
  • excellent level of cardiorespiratory fitness.
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9
Q

Thorax/Lungs

describe dyspnea

A

difficulty and labored breathing w/ SOB

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10
Q

Thorax/Lungs

causes of dyspnea

A
  • pulm or cardiac compromise
  • sedentary lifestyle/obesity
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11
Q

Thorax/Lungs

what is orthopnea

A

SOB that begins or increases when the pt lies down

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12
Q

Thorax/Lungs

how to ask about orthopnea in a clear manner?

A

if they sleep with multiple pillows to elevate themselves

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13
Q

Thorax/Lungs

describe paroxysmal nocturnal dyspnea

A

a sudden onset of shortness of breath after a period of sleep; sitting upright is helpful

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14
Q

Thorax/Lungs

describe hyperpnea

+ 4 causes

A
  • Breathing deeply
  • exercise, anxiety, CNS dz, metabolic dz, ASA posioning
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15
Q

Thorax/Lungs

describe hypopnea

+1 cause

A
  • abnormally shallow respirations
  • pleuritic pain
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16
Q

Thorax/Lungs

describe sighing

A
  • An occasional deep, audible sigh that punctuates an otherwise regular respiratory pattern is associated with emotional distress or an incipient episode of more severe hyperventilation.
  • Sighs also occur in normal respiration.
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17
Q

Thorax/Lungs

describe air trapping

A
  • result of a prolonged but inefficient expiratory effort
  • increased resistance (i.e. chronic bronchitis), decreased elastic recoil of the lung (i.e., emphysema) or a drop in the critical closing pressure of the airway (i.e., asthma)
  • resp rate increases to compensate (more shallow and air trapping increases
  • can lead to lung hyperinflation = barrel chest)
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18
Q

Thorax/Lungs

describe periodic breathing

A
  • regular periodic pattern of breathing w/ intervals of apnea followed by crescendo/decrescendo respiration
  • occurs during sleep, when seriously ill, brain damage, drug overdose
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19
Q

Thorax/Lungs

describe kussmaul breathing

A
  • deep/rapid breathing
  • elevation of JVP w/ inspiration
  • metabolic acidosis w/ respiratory compensation
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20
Q

Thorax/Lungs

describe biot/ataxic

A
  • irregular respirations which vary in depth and are interrupted by intervals of apnea
  • lacks repitition of periodic respiration
  • severe & persistent increased intracranial pressure
  • same causes as periodic breathing
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21
Q

Thorax/Lungs

AP diameter findings in infants

A

chest of the newborn is generally round, the AP diameter approximating the lateral diameter, and the circumference is roughly equal to that of the head until the child is about 2 years old

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22
Q

Thorax/Lungs

AP chest diameter in older adults

A

The barrel chest that is seen in many older adults results from loss of muscle strength in the thorax and diaphragm, coupled with the loss of lung resiliency. In addition, skeletal changes of aging tend to emphasize the dorsal curve of the thoracic spine, resulting in an increased AP chest diameter. There may also be stiffening and decreased expansion of the chest wall.

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23
Q

Thorax/Lungs

AP chest diameter in pregnant women

A

Anatomic changes that occur in the chest as the lower ribs flare include an increase in the lateral diameter of about 2 cm and an increase in the circumference of 5 to 7 cm. The costal angle progressively increases from about 68.5 degrees to approximately 103.5 degrees in later pregnancy.

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24
Q

Thorax/Lungs

AP chest diameter in healthy adults

A

The AP diameter of the chest is ordinarily less than the lateral diameter – thoracic ratio and is expected to be about 0.70 to 0.75.

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25
Q

Thorax/Lungs

describe the technique to assess thoracic expansion

A

Technique: To evaluate thoracic expansion during respiration, stand behind the patient and place your thumbs along the spinal processes at the level of the tenth rib, with your palms lightly in contact with the posterolateral surfaces. Watch your thumbs diverge during quiet and deep breathing. A loss of symmetry in the movement of the thumbs suggests a problem on one or both sides.

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26
Q

Thorax/Lungs

describe crepitus

A
  • crackly or crinkly sensation
  • can be palpated and heard (gentle, bubbly feeling)
  • incdicates that there is air in the subQ tissue from a rupture somewhere in the respriatory system
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27
Q

Thorax/Lungs

where is fremitus best felt

A

posteriorly and laterally at the level of the bifurcation of the bronchi

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28
Q

Thorax/Lungs

how to test for fremitus

A

have the pt say 99 while you palpate/auscultate

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29
Q

Thorax/Lungs

what does decreased fremitus mean? from what?

A
  • excess air in the lungs
  • emphysema, pleural thickening/effusion, bronchitis
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30
Q

Thorax/Lungs

what does increased fremitus feel like? mean? sign of?

A
  • coarse or rough in feeling
  • presence of fluids or a solid mass within the lungs
  • may be caused by lung consolidation or heavy, but non-obstructive bronchial secretions
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31
Q

Thorax/Lungs

what would hyper resonance come from?

A
  • abnormal sound
  • result of air trapping
  • from emphysema, pneumothorax, asthma
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32
Q

Thorax/Lungs

what can cause dullness or flatness to percussion mean?

A
  • pneumonia
  • atelectasis
  • pleural effusion
  • asthma
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33
Q

Thorax/Lungs

expected findings of diaphragmatic excursion

A
  • higher on the R than the L
  • ~ 7 cm?
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34
Q

Thorax/Lungs

where are bronchial sounds heard

A
  • only over trachea
  • high pitched
  • loud and long expirations
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35
Q

Thorax/Lungs

where are bronchovesicular sounds heard?

A
  • main bronchus area and over upper R posterio rlung field
  • medium pitch
  • expiration equals inspiration
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36
Q

Thorax/Lungs

where are vesicular sounds heard?

A
  • over most lung fields
  • low pitch
  • soft and short expiration
  • louder: thinner people, children
  • quiet: obese/muscular pts
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37
Q

Thorax/Lungs

describe crackles/rales

A

discontinuous, fine crackling, high pitched

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38
Q

Thorax/Lungs

describe rhonchi

A
  • loud, low, coarse sounds (like a snore)
  • heard continuously during inspiration/expiration
  • usually means mucus accumulation (a cough can clear the sound)
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39
Q

Thorax/Lungs

describe wheezing

A
  • muscial noise
  • heard continuously but louder during expiration
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40
Q

describe a pleural friction rub

A
  • dry, rubbing, or grating sound
  • caused by inflammation of pleural surfaces
  • heard during inspiration or expiration
  • loudest over lower lateral anterior surface
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41
Q

Thorax/Lungs

describe a mediastinal crunch (hamman sign)

A
  • found w/ mediastinal emphsema
  • variety of sounds (loud crackles, clicking, gurgling) over the precordium
  • synchronous w/ heartbeat
  • easiest to hear when pt leans to the L (L lateral decubitus)
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42
Q

Thorax/Lungs

pathophy of diminution of breath sounds

A
  • fluid or pus accumulating in the pleural space, secretions, or a foreign body obstructs the bronchi
  • breathing is shallow from splinting due to pain
  • the lungs can overinflate from severe obstruction
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43
Q

Thorax/Lungs

disorders that can cause dimunition of breath sounds

A
  • COPD
  • emphysema
  • pleurisy
  • pneumonia
  • bronchiolitis
  • hemothorax
  • lung abscess
  • pleural effusion
  • pneumothorax
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44
Q

Thorax/Lungs

describe how to do PE for bronchophony

A
  • have pt speak 1, 2, 3 repeatedly
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45
Q

Thorax/Lungs

what might increased clarity mean for bronchophony?

A
  • consolidated lungs
  • carried by liquid
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46
Q

Thorax/Lungs

what is whispered pectoriloquy?

A
  • pt whispers 1, 2, 3
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47
Q

Thorax/Lungs

what is egophony test?

A
  • whisper e
  • should hear as e, but could hear as a
  • fluid filled, compressed lung
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48
Q

Thorax/Lungs

inspiration to expiration ratio for:
* airway obstruction
* stridor

A
  • airway obstruction: I/E > 2:1
  • stridor: I/E > 3:1
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49
Q

Thorax/Lungs

normal lung/thorax findings on inspection

A

symmetrical movement on expansion, absence of retrations

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50
Q

Thorax/Lungs

normal findings for palpation

A
  • midline trachea, mobile, no tugging
  • symmetric, unaccentuated tactile fremitus
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51
Q

Thorax/Lungs

normal findings for percussion

A
  • range of 3 to 5 cm for diaphragmatic excursion
  • resonant and symmetric percussion notes
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52
Q

Thorax/Lungs

normal findings on auscultation

A
  • absence of adventitious sounds, vesicular breath sounds
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53
Q

Cardiac/Peripheral Vascular

describe S1

A
  • when systole begins
  • ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed which prevents backflow
  • LUB
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54
Q

Cardiac/Peripheral Vascular

describe S2

A
  • when the ventricles are almost empty, the pressure falls below that of the aorta and pulmonary arteries causing the pulm and aortic valves to close
  • DUB
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55
Q

Cardiac/Peripheral Vascular

describe S3

A
  • as the ventricular pressure falls below atrial pressure, the mitral and tricuspid valves open to allow ventricular refilling
  • ventricular diastole
  • not always heard
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56
Q

Cardiac/Peripheral Vascular

describe S4

A
  • the atria contract to ensure ejection of remaining blood
  • not always heard
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57
Q

Cardiac/Peripheral Vascular

Explain how the relationship between the duration of the systolic and diastolic phases changes at higher heart rates

A
  • As heart rate increases, systole and diastole become more similar in length
  • With slower heart rate, diastole is longer than systole
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58
Q

Cardiac/Peripheral Vascular

define pulse pressure

A

difference between the upper and lower (systolic and diastolic) numbers of your blood pressure. This number can be an indicator of health problems before you develop symptoms

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59
Q

Cardiac/Peripheral Vascular

describe expected CV system changes that occur during pregnancy

A
  • pt’s blood volume increases 40-50%
  • increased plasma volume
  • heart works harded to accomodate increased HR and stroke volume
  • CO increases 30-40%
  • LV increases in thickness and mass
  • heart is shifted toward a horizontal position to make room for baby
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60
Q

Cardiac/Peripheral Vascular

CV changes post partum

A
  • returns to normal levels 3-4 wks after delivery
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61
Q

Cardiac/Peripheral Vascular

describe CV changes in geriatric pts

A
  • heart size may decrease unless HTN or heart disease
  • valves may begin to harden
  • stroke volume decreases, CO declines
  • LV and endocardium thicken
  • myocardium becomes more rigid
  • tachycardia not tolerated
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62
Q

Cardiac/Peripheral Vascular

describe the “a wave” of jugular pulsation

A

the upward a wave, the first and most prominent component, is the result of a brief backflow of blood to the vena cava during right atrial contraction. This peaks slightly before the first heart sound (S1).

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63
Q

Cardiac/Peripheral Vascular

describe the “c wave” of jugular pulsation

A

the upward c wave is a transmitted impulse from the vigorous backward push produced by closure of the tricuspid valve during right ventricular systole.

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64
Q

Cardiac/Peripheral Vascular

describe the “v wave” of jugular pulsation

A

the upward v wave is caused by the increasing volume and concomitant increasing pressure in the right atrium. It occurs after the c wave, late in ventricular systole.

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65
Q

Cardiac/Peripheral Vascular

describe the “x slope” of jugular pulsation

A

the downward x slope is caused by passive atrial filling. This ends with the initiation of the v wave.

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66
Q

Cardiac/Peripheral Vascular

describe the “y slope” of jugular pulsation

A

the y slope following the v wave reflects the open tricuspid valve and the rapid filling of the right ventricle.

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67
Q

Cardiac/Peripheral Vascular

describe where the PMI is located

A
  • In most adults the apical impulse is visible at about the midclavicular line in the fifth left intercostal space, but it is easily obscured by obesity, large breasts, or muscularity.
  • It should be seen in only one intercostal space if the heart is healthy
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68
Q

Cardiac/Peripheral Vascular

what might a readily visible and palpable PMI indicate

A

problem related to intensity

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69
Q

Cardiac/Peripheral Vascular

what might an absent apical impulse + faint heart sounds indicate?

A

extracardiac problem like pleural or pericardial fluid

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70
Q

Cardiac/Peripheral Vascular

how to characterize an apical pulse that is vigorous or long

A

heave or lift

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71
Q

Cardiac/Peripheral Vascular

a lift along the LSB could be caused by?

A

RVH

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72
Q

Cardiac/Peripheral Vascular

an apical pulse that is more forceful and widely distributed, fills systole, or is displaced laterally may indicate?

A

LVH

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73
Q

Cardiac/Peripheral Vascular

displacement of the PMI to the right may suggest?

A
  • dextrocardia
  • diaphragmatic hernia
  • distended stomach
  • pulm abnormality
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74
Q

Cardiac/Peripheral Vascular

define parasternal heave/life/thrust

A
  • precordial impulse that may be felt (palpated) in pts with cardiac or respiratory disease
  • precordial impulses are visible or palpable pulsations which originate on the heart of great vessels
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75
Q

Cardiac/Peripheral Vascular

when is a thrill present?

A

grade IV murmur or higher

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76
Q

Cardiac/Peripheral Vascular

what is a thrill?

A

palpable murmur

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77
Q

Cardiac/Peripheral Vascular

where to auscultate the aortic valve area

A

2nd RICS at the RSB

78
Q

Cardiac/Peripheral Vascular

where to auscultate the pulmonic valve

A

2nd LICS at the LSB

79
Q

Cardiac/Peripheral Vascular

where to auscultate the second pulmonic area

A

3rd LICS at the LSB

80
Q

Cardiac/Peripheral Vascular

where to auscultate the tricuspid area

A

4th LICS at the LLSB

81
Q

Cardiac/Peripheral Vascular

where to auscultate the mitral area

A

apex of heart in the 5th LICS at the midclavicular line

82
Q

Cardiac/Peripheral Vascular

where is S1 best heard

A
  • toward apex
  • S1 is louder on the L than the R
  • lower in pitch, longer than S2
83
Q

Cardiac/Peripheral Vascular

where is S2 best heard

A
  • aortic and pulmonic areas
  • higher pitched, shorter duration than S1
84
Q

Cardiac/Peripheral Vascular

define splitting

A
  • when the aortic/pulmonic or the mitral/tricuspid valves do not close simultaneously
85
Q

Cardiac/Peripheral Vascular

when might S3 be audible

A
  • causes a gallop
  • sounds like “ ken-TUCK-y “
  • best heard in the L lateral decubitus position
86
Q

Cardiac/Peripheral Vascular

when might S4 be audible

A
  • intense, pre-systolic gallop
  • older pts, due to increased resistance to ventricular filling
  • sounds like “ TEN-nes-ses”
87
Q

Cardiac/Peripheral Vascular

which sounds are best heard w/ a diaphragm?

A

S1 and S2

88
Q

Cardiac/Peripheral Vascular

which sounds are best head via bell

A

S3 and S4

89
Q

Cardiac/Peripheral Vascular

what position is S1 best heard in?

A

any position

90
Q

Cardiac/Peripheral Vascular

what position is S2 best heard in?

A

sitting/supine

91
Q

Cardiac/Peripheral Vascular

what position is S3 best heard in?

A

supine or left lateral

92
Q

Cardiac/Peripheral Vascular

what positions are most likely to allow you to hear all sounds?

A

supine or left lateral

93
Q

Cardiac/Peripheral Vascular

what position best allows you to hear a summation gallop?

A

supine or L lateral

94
Q

Cardiac/Peripheral Vascular

what position best allows you to hear ejection sounds

A

sitting or supine

95
Q

Cardiac/Peripheral Vascular

what position best allows you to hear a systolic click?

A

sitting or supine

96
Q

Cardiac/Peripheral Vascular

what position best allows you to hear an opening snap

A

any position

97
Q

Cardiac/Peripheral Vascular

describe grade I murmur

A

barely audible even in a quiet room

98
Q

Cardiac/Peripheral Vascular

describe a grade II murmur

A

quiet but clearly audible

99
Q

Cardiac/Peripheral Vascular

describe a grade III murmur

A

moderately loud

100
Q

Cardiac/Peripheral Vascular

describe a grade IV murmur

A

loud, associated w/ a thrill

101
Q

Cardiac/Peripheral Vascular

describe a grade V murmur

A

very loud, thrill easily palpable

102
Q

Cardiac/Peripheral Vascular

describe a grade VI murmur

A

very loud, audible w/out stethoscope

103
Q

Cardiac/Peripheral Vascular

describe innocent murmurs

A

They are usually grade I or II, usually midsystolic, without radiation, medium pitch, blowing, brief, and often accompanied by splitting of S 2 . They are often located in the second left intercostal space near the left sternal border. Such murmurs heard in a recumbent position may disappear when the patient sits or stands because of the tendency of the blood to pool.

104
Q

Cardiac/Peripheral Vascular

describe S3 and S4 gallops

A

due to increase blood w/in the ventricles

105
Q

Cardiac/Peripheral Vascular

describe a summation gallop

A

combined presence of S3 and S4 due to tachycardia

106
Q

Cardiac/Peripheral Vascular

describe a quadruple gallop

A

when S3 and S4 are both heard separately

107
Q

Cardiac/Peripheral Vascular

describe an aortic/pulmonic early systolic click

A
  • ejection click
  • high pitched sounds that occur at the moment of maximal opening of the aortic or pulmonary valves
  • heard just after the first heart sound
108
Q

Cardiac/Peripheral Vascular

describe mid to late mitral valve systolic clicks

A
  • systolic sounds occuring at AV valves in prolapse of mitral/tricuspid valves
  • due to myxomatous degeneration of valve
109
Q

Cardiac/Peripheral Vascular

describe mitral valve opening snap

A
  • occurs because of increased L atrial pressure
110
Q

Cardiac/Peripheral Vascular

describe a pericardial friction rub

A
  • grating, to and fro sound
111
Q

Cardiac/Peripheral Vascular

describe pulse grades

A
  • 0: absent, not palpable
  • 1: diminished, barely palpable
  • 2: expected
  • 3: full, increased
  • 4: bounding, aneurysmal
112
Q

Cardiac/Peripheral Vascular

how to identify varcose veins

A

Inspect the legs for superficial varicosities when the patient is standing. With varicosities, the veins appear dilated and often tortuous. If varicose veins are suspected, have the patient stand on his or her toes 10 times in succession. Palpate the legs to feel the venous distention. When the venous system is competent, the distention of the veins disappears in a few seconds. If the distention of the veins is sustained for a longer time, suspect venous insufficiency.

113
Q

Cardiac/Peripheral Vascular

what is Homan’s sign

A

pain in calf w/ dorsiflexion of foot

114
Q

Cardiac/Peripheral Vascular

describe generalized edema

A
  • massive and generalized (anasarca).
  • It is caused by a variety of clinical conditions like heart failure, renal failure, liver failure, or problems with the lymphatic system
115
Q

Cardiac/Peripheral Vascular

describe localized edema

A
  • Typically, this involves one organ or part of the body.
  • Clinically important examples of localized edema are brain edema, lung edema, or accumulation of fluid in the thoracic cavity (hydrothorax) or abdominal cavity (ascites).
116
Q

Cardiac/Peripheral Vascular

describe pitting edema

A
  • swollen part of your body has a dimple (or pit) after you press it for a few seconds.
  • From CHF, liver dz, kidney dz, DVT, preg
117
Q

Cardiac/Peripheral Vascular

describe non pitting edema

A
  • If you press your finger to a swollen area, it will usually bounce right back.
  • From venous insufficiency, angioedema, myxedema
118
Q

Cardiac/Peripheral Vascular

classify edema

A
  • Trace: does not meet criteria to classify as 1+
  • 1+: Slight pitting, no visible distortion, disappears rapidly, 2mm
  • 2+: A somewhat deeper pit than in 1+, but again no readily detectable distortion; disappears in 10–15 seconds, 4mm
  • 3+: Noticeably deep pit that may last more than a minute; dependent extremity looks fuller and swollen, 6 mm
  • 4+: Very deep pit that lasts as long as 2–5 minutes; dependent extremity is grossly distorted, 8 mm”
119
Q

Cardiac/Peripheral Vascular

where is the carotid artery located

A

deep to the SCM, superiorly anterior to SCM, medial to IJV, and deep to sternohyoid and sternothyroid muscles.

120
Q

Cardiac/Peripheral Vascular

where is the IJV located?

A

just lateral to CA

121
Q

Cardiac/Peripheral Vascular

where is the EJV located?

A

superficial to SCM

122
Q

Abdomen

Discuss the pattern of abdominal organ innervation and correlate to visceral and somatic abdominal pain sensation

A

The abdominal viscera are innervated, as all viscera are, by the autonomic nervous system. The parasympathetic innervation is delivered by the vagus primarily, with help from the pelvic splanchnic nerves. The sympathetic innervation comes primarily from the thoracic splanchnic nerves, greater, lesser, and least, with help from the upper lumbar splanchnic nerves.

123
Q

Abdomen

what is within the RLQ

A
  • appendix
  • cecum
  • inferior ascending colon
124
Q

Abdomen

what lies within the RUQ

A
  • liver
  • gall bladder
  • hepatic flexure
  • superior ascending colon
  • right transverse colon
125
Q

Abdomen

what lies within LUQ

A
  • L transverse colon
  • stomach
  • pancreas
  • spleen
  • superior descending colon
  • splenic flexure
126
Q

Abdomen

what is contained within the LLQ

A
  • inferior descending colon
  • sigmoid colon
  • rectum
127
Q

Abdomen

order of PE and why it’s important

A
  1. inspection
  2. auscultation
  3. percussion
  4. palpation

Always perform auscultation of the abdomen before percussion and palpation because these maneuvers may alter the frequency and intensity of bowel sound

128
Q

Abdomen

what is Cullen Sign

A
  • blue-ish periumbilical discoloration (eccymoisis)
  • suggests intra-abdominal bleeding
129
Q

Abdomen

normal striae vs Cushing’s striae

A
  • normal: pink, red
  • Cushing’s: purple
130
Q

Abdomen

what type of appearance suggests ascites?

A

glistening/taunt

131
Q

Abdomen

what is Sister Mary Joseph’s sign?

A
  • pearl like, enlarged, painful umbilical nodule
  • suggests metastasis
132
Q

Abdomen

what is Gray-Turner Sign

A

eccyhmosis on flank

133
Q

Abdomen

how deep is light palpation? deep palpation?

A
  • 1 cm
  • 4-5 cm
134
Q

Abdomen

what features can commonly be felt as masses?

A
  • kidneys
  • aorta
  • fecal mass (cecum/sigmoid)
  • uterus
  • bladder
  • sacral promontory
135
Q

Abdomen

what to use to differentiate enlarged spleen vs enlarged kidney?

A
  • percussion
  • spleen: dull
  • kidney: resonant
136
Q

Abdomen

indirect percussion for kidney tenderness

A

smacking their back
* kidney stones, pyelonephritis

137
Q

Abdomen

what does lateral pulsation suggest when palpating the aorta?

A

aortic aneurysm

138
Q

Abdomen

differentiate flat, rounded, and scaphoid stomachs

A
  • falt: well-muscled, athletic adults (flat)
  • round: common in kids, obese adults
  • scaphoid: thin adults
139
Q

Abdomen

what could cause generalized symmetric abd distension

A

obesity, enlarged organs, bloat

140
Q

Abdomen

what could cause distention from the umbilicus to the symphysis

A
  • ovarian tumor
  • pregnancy
  • uterine fibroids
  • distended bladder
141
Q

Abdomen

what could cause distention above the umbilicus?

A
  • tumor
  • pancreatic cyst
  • gastric dilation
142
Q

Abdomen

what could cause asymmetric distention or protrustion

A
  • hernia
  • tumor
  • cyst
  • bowel obstruction
  • hepato/spleno megaly
143
Q

Abdomen

what is visible surface motion from peristalsis indicative of?

A
  • maybe they’re just skinny
  • but also intestinal obstruction
144
Q

Abdomen

how to properly inspect for abd masses

A
  • take a big, deep breath and hold it
  • pushes organs together
145
Q

Abdomen

where is an epigastric hernia located?

A

upper abdomen at midline

146
Q

Abdomen

where is an incisional hernia located

A

previous incisional site

147
Q

Abdomen

where is an umbilical hernia located

A

at the navel

148
Q

Abdomen

where is a direct inguinal hernia located

A

near the opening of the inguinal canal (basically on McBurney’s point it looks like)

149
Q

Abdomen

where is an indirect inguinal hernia located?

A

at the opening of the inguinal canal (close to femoral canal but more medial)

150
Q

Abdomen

where is a femoral hernia located?

A

in the femoral canal

151
Q

Abdomen

what is an abdominal wall hernia

A

opening or area of weakness which allows abd contents to protrude out of

152
Q

Abdomen

describe:
* non-reducible hernia
* incarcerated hernia
* strangulated hernia

A
  • cannot be reduced, but has blood flow
  • no blood flow
  • muscle clamps down on the protrusion of the SI cutting off clood flow
153
Q

Abdomen

what is diastasis recti?

A
  • enlargement/widening of the linea alba
  • occurs in pregnancy
154
Q

Abdomen

what is borborygmi

A

stomach growling

155
Q

Abdomen

norm bowel sound range

A

5-35 per min

156
Q

Abdomen

what can cause increased bowl sounds? decreased?

A
  • increased: gastroenteritis, early intestinal obstruction, hunger
  • decreases: paralytic ileuss, peritonitis
157
Q

Abdomen

what would a mechanical bowel obstruction sound like?

A
  • high pitched tinkling sounds
  • suggestive of intestional fluid and air under pressure
158
Q

Abdomen

describe sounds of abdomen when percussing

A
  • most of stomach is tympanic to percussion
  • full bladder could be dull
  • kidneys are resonant
  • spleen/live dull
159
Q

Abdomen

normal liver span by percussion

A

6 to 12 cm, on mid clavicular line

160
Q

Abdomen

how to determine if resistance on abd palpation is voluntary or involuntary

A

Place a pillow under the patient’s knees and ask the patient to breathe slowly through the mouth as you feel for relaxation of the rectus abdominis muscles on expiration. If the tenseness remains, it is probably an involuntary response to localized or generalized rigidity.

161
Q

Abdomen

overcoming ticklishness

A

have pt self palpate with your hands over top, slowly bring your hands down onto stomach

162
Q

Abdomen

where can deep palpation evoke tenderness in healthy persons?

A
  • cecum
  • sigmoid colon
  • aorta
  • midline near xiphoid process
163
Q

Abdomen

how to determine on PE if abd pass is superficial or intra abdominal

A

raise head when supine
* superficial: will remain visible, on abd wall
* intra abd: will disappear

164
Q

Abdomen

what does liver edge feel like to palpation

A

firm, smooth, even, non-tender

165
Q

Abdomen

findings associated with palpating gallbladder

A
  • healthy gallbladder is not palpable
  • palpable + tender = cholecystitis
  • non-tender + palpable = common bile duct obstruction
166
Q

Abdomen

normal aorta size

A

1.5 to 3 cm

167
Q

Abdomen

how does ascites sound to percussion

A

dull

168
Q

Abdomen

how does a distended bladder feel/sound

A
  • smooth, round, tense mass
  • lower percussion note than air filled intestines
169
Q

Abdomen

describe “fluid wave” technique

A

With the patient supine, ask him or her or another person to press the edge of the hand and forearm firmly along the vertical midline of the abdomen. This positioning helps stop the transmission of a wave through adipose tissue. Place your hands on each side of the abdomen and strike one side sharply with your fingertips. Feel for the impulse of a fluid wave with the fingertips of your other hand. An easily detected fluid wave suggests ascites.

170
Q

Abdomen

describe shifting dullness PE technique

A

After identifying the borders between tympany and dullness, have the patient lie on one side and again percuss for tympany and dullness and mark the borders. In the patient without ascites, the borders will remain relatively constant. With ascites, the border of dullness shifts to the dependent side (approaches the midline) as the fluid resettles with gravity.

171
Q

Abdomen

describe puddle sign PE technique

A

Patient lies prone for 5 minutes, Patient then rises onto elbows and knees, Apply stethoscope diaphragm to most dependent Abdomen, Examiner repeatedly flicks near flank with finger, Continue to flick at same spot on Abdomen, Move stethoscope across Abdomen away from examiner, Sound loudness increases at farther edge of puddle, Sound transmission does not change when patient sits

172
Q

Abdomen

define:
* Blumberg Sign
* McBurnery Sign
* Rovsing Sign

A
  • B: rebound pain at site of palpation (anywhere)
  • M: rebound tenderness in RLQ suggestive of appendicitis
  • R: RLQ pain upon palpation of the LLQ
173
Q

Abdomen

differentiate:
* iliopsoas sign
* obturator sign

A
  • I: R hip flexion against resistance causes RLQ pain
  • O: rotation of R hip causes pain in hypogastric area
174
Q

Abdomen

what is Kehr sign?

A

abd pain radiating to L shoulder; indicates splenic rupture, renal calculi, ectopic preg

175
Q

Abdomen

what is murphy’s sign

A

abrupt stop of inspiration upon palpation of gall bladder due to pain

176
Q

Abdomen

what is courvoisier’s sign?

A

distal CBD obstruction with a palpably enlarged but non-tender GB (carcinoma in head of pancreas)

177
Q

Breasts/Axilla

anatomical borders of the breast

A
  • Lateral: latissimus dorsi
  • Inferior: inframammary ridge
  • Superior: second rib
  • Medial: sternum
178
Q

Breasts/Axilla

which muscles form floor of breast?

A
  • pec major/minor
  • serratus anterior
  • latissimus dorsi
  • subscapularis
  • external oblique
  • rectus abdominis
179
Q

Breasts/Axilla

what are lactiferous ducts

A

drain milk from lobe onto surface of nipple

180
Q

Breasts/Axilla

what are montgomery tubercles

A

bumps on nipple from sebaceous glands around it

181
Q

Breasts/Axilla

lymphatic drainage pathways of the axilla

A
  • the anterior axillary (pectoral) nodes are located along the lower border of the pectoralis major, inside the lateral axillary fold.
  • The midaxillary (central) nodes are high in the axilla close to the ribs.
  • The posterior axillary (subscapular) nodes lie along the lateral border of the scapula and deep in the posterior axillary fold
  • The lateral axillary (brachial) nodes can be felt along the upper humerus.
182
Q

Breast/Axilla

what are supernumery nipples found along?

A

milk line

183
Q

Breast/Axilla

changes that occur during pregnancy

A
  • lactiferous ducts proliferate
  • alveoli increase in size & number (boobs increase in size)
  • breasts become softer & looser
  • colostrum is the first milk of pregnancy
  • aerola become darker and bigger
184
Q

Breast/Axilla

what changes to breast are indicative of an underlying malignancy?

A
  • unilateral venous pattern
  • recent unilateral inversion of previously everted nipple
  • nipple discharge
  • painless lump
  • palpable mass that is unilateral
  • dimpled breast
  • peau d’orange, thickened skin appearance
185
Q

Lymph

describe lymph drainage

A

lymph capillaries –> afferent lymph vessels –> lymph nodes –> efferent lymph vessels –> lymph trunk –> collecting duct –> L subclavian vein

186
Q

Lymph

what is Virchow’s lymph node?

A

supraclavicular areas, probing deeply in the angle formed by the clavicle and the sternocleidomastoid muscle
if enlarged, sign of gastric cancer

187
Q

Lymph

describe matted lymph nodes

A

group of fused lymph nodes may be a sign of cancer or infection

188
Q

Lymph

describe shotty lymph nodes

A

clusters of small lymph nodes < 1 cm in children

189
Q

Lymph

what are hard, enlarged, non-tender, non-mobile lymph nodes a sign of?

A

malignancy

190
Q

Lymph

what are tender, mobile, firm, indurated lymph nodes a sign of?

A

inflammation

191
Q

Breast/Axilla

Tanner charts for breast development
* it is unusual for menses to begin before what stage?
* by what stage have most began menses?
* what stage is a breast bud?
* time from breast bud to first period?

A
  • Stage III
  • Stage IV
  • Stage II
  • 2 yrs
192
Q

Lymph

what is cellulitic streaking indicative of?

A

infection traveling through lymph

PACS (5 decks)

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