Exam 3 Review Flashcards
sternal angle is at rib __
rib 2
inferior wing of scapula is at rib __
rib 7
lung boundaries
superiorly: 3-4 cm above medial end of clavicle
inferiorly:
- midclavicular line: rib 6
- midaxillary line: rib 8
- posterior: T9 and T12
important things at the sternal angle of Louis
- rib 2
- bifurcation of trachea
- carina
- T4
Diaphragm boundaries at end of expiration
anteriorly - rib 5
posteriorly - T9
Barrel chest definition and associated disease(s)
AP diameter >/= lateral diameter
COPD
Flail chest definition
multiple broken ribs –> moves opposite to rest of chest wall with inspiration
Pectus carinatum definition
anterior protrusion of sternum
Pectus excavatum definition and associated disease(s)
depression of sternum
mitral valve prolapse
Kyphoscoliosis definition
abnormal AP diameter and lateral curvature of spine
Normal inspiratory:expiratory ratio
1:2
I:E ratio in asthma or COPD
1:3 or 1:4
Normal adult respiratory rate
10-14/minute
bradypnea
abnormally slow breathing
tachypnea
abnormally fast breathing
apnea
absent breathing
Hypernea/Kussmaul’s breathing definition and associated cause(s)
increased depth
Metabolic acidosis
Biot breathing definition and cause(s)
irregular breathing + periods of apnea
increased intracranial pressure, drug-induced, brain damage
Cheyne-Stokes breathing definition and causes(s)
irregular breathing + periods of increased and decreased rates + apnea
drug-induced, brain damage
Tactile fremitus definition, test, indications
vibration felt on chest wall when patient is speaking
place edge of hand on patient’s chest while they say 99
increased fremitus = increased lung density
decreased fremitus = decreased lung density (fat, air, fluid in chest cavity)
Flat sound description + associated organs
high pitched sound from thick, dense mass
bone or muscle
Dull sound description + associated organs
low amplitude, short duration from solid organ
liver or heart
Resonant sound description + associated organs
high amplitude, low pitched from air-filled tissue
lung
Tympanic sound description + associated organs
high pitched, hollow sound from hollow, air-filled structure
stomach
Hyperresonant sound description + associated organs
low pitched, hollow sound
emphysematous lung
The stethoscope bell is best used for [low/high] pitched sounds
low
The stethoscope diaphragm is best used for [low/high] pitched sounds
high
tracheal breath sounds
harsh, loud, high pitched over trachea
inspiratory = expiratory in length
bronchial breath sounds
loud, high pitched over manubrium
inspiratory < expiratory in length with pause in between
vesicular breath sounds
soft, low pitched over most lung fields
inspiratory > expiratory in length and volume
bronchovesicular breath sounds
mixture of bronchial and vesicular over carina and mainstem bronchi
inspiratory = expiratory in length
Rales/Crackles/Crepitation description, cause, associated disease(s)
short, continuous, nonmusical sound on inspiration (similar to velcro)
caused by opening of collapsed distal airways and alveoli
pulmonary edema, CHF, pulmonary fibrosis, pneumonia, atelectasis
Wheezes description, cause, associated disease(s)
continuous, musical, high pitched sounds during expiration
narrowing of bronchi (swelling, secretion, foreign body, tumor)
asthma, COPD, pulmonary edema, CH (“cardiac asthma”)
Rhonchi description, cause, associated disease(s)
low pitched sound
mucus plugging and poor movement of secretions
bronchitis
Stridor description, cause, associated disease(s)
high pitched, inspiratory, upper airway sound
turbulent airflow in upper airway (airway obstruction from mass or swelling)
tumor, croup, foreign body
Pleural rub description, cause, associated disease(s)
grating sound on inspiration and beginning of expiration (like creaking leather)
roughened or thickened pleura (inflammation, neoplasm, fibrin deposits)
pneumonia, pulmonary infarction
Egophany test and indication
“eee” will be heard as “aaa” through stethoscope
lung consolidation (fluid filled)
Whispered pectoriloquy test and indication
intensification of whispered “one-two-three” can be heard
lung consolidation (fluid filled)
Bronchophony test and indication
“ninety nine” will be transmitted louder
lung consolidation (fluid filled)
proper positions for a breast exam
- arms at sides
- arms overhead
- hands pressed against hips
- torso leaning forward
Cremasteric reflex is absent in patients with ___
testicular torsion
testicular pain causes
renal colic, appendicitis, disease of testis or epididymis (torsion, infection, tumor)
Flank pain causes
kidney hydronephrosis, bladder/ureter distension, referred pain from testicle or labia
low pelvic pain causes
salpingo-oophoritis, cystitis, pregnancy complication, hernia, ovarian torsion, tubo-ovarian abscess
Epigastrium contents
- stomach
- pancreas
- part of liver
- aorta
Suprapubic area contents
- bladder
- uterus
right shoulder pain
- acute cholecystitis
- anything irritating the right hemidiaphragm
testicular pain
- renal colic
- appendicitis
periodic epigastric pain 1 hour after eating
gastric peptic ulcer
periodic epigastric pain 2-3 hours after eating
duodenal peptic ulcer
back pain
- perforated duodenal ulcer
- pancreatic pain
nocturnal pain
duodenal peptic ulcer
pain after eating
abdominal angina triad
tenesmus
a feeling of needing to void the bowel, but unable to defecate
hematochezia
bright red blood per rectum
from colonic tumor, diverticular disease, ulcerative colitis
melena
black, tarry stool
from bleeding in first section of duodenum or upper GI tract
caput medusae
abnormal, dilated periumbilical veins
spider telangiectasias
small patches of prominent, thin veins
Normal bowel sounds occur every ___
5-10 seconds
absence of bowel sounds
no sounds within 2 minutes
borborygmi
low pitched rumbling caused by hyperperistalsis
the normal span of the liver is ___
10 cm or less
percussing for shifting dullness helps detect ___
ascites
rebound tenderness indicates ___
peritoneal irritation (appendicitis, perforated bowel, etc.)
McBurney’s point
area of the abdomen that is 2/3 of the distance between the umbilicus and the right anterior superior iliac spine
Fluid waves test tests for ___
ascites
Rovsing’s sign
test for appendicitis
pushing on patient’s LLQ –> pain at RLQ will be positive
Obturator sign
tests for inflammation, appendicitis, peritoneal irritation
flex and internally rotate hip
Psoas sign
tests for intraabdominal inflammation, appendicitis, or psoas abscess
Murphy’s sign
tests for acute cholecystitis
palpate liver on deep inspiration, feeling for gall bladder; if patient stops inspiration because of pain, test is positive
