Final Flashcards
Temperature Difs
Rectal>oral>axillary
Tympanic closest to core temp
Temperature Difs
Rectal>oral>axillary
Tympanic closest to core temp
Hyperpyrexia
> 41.1/106
Hypothermia
Smoking and oral temp
increase by .2C for 30 mins
Irregular HR should be measured by
auscultation at apex for 60s
Bradypnea
Tachypnea
Hyperapnea
25 Rapid and SHALLOW= pna, restrictive lung disease
>25 rapid and DEEP-Met acidosis, anxiety
Cheyne Stokes
Breathing that alternates every 20-30s between tachypnea and bradypnea
Kussmail breathing
metabolic acidosis- fast, slow or normal
varied rate and depth
Trepopnea
lateral decubitus tachypnea/dyspnea
Healthy lung better down, right side if CHF,
Platypnea
dyspnea worse when sitting, better supine (opp of orthopnea)
due to r to l cardiac shunt, PE or pericardia effusion
Pulses Weak Bounding Paradoxus Alterans
Weak- hypovolemia, aortic stenosis, increased peripheral resistance (CHF, cold)
Bounding- increased stroke volume/decreased resistance. Fever, anemia, hyperthyroidism, agint, aortic insufficiency,
Pulsus paradoxus- Drop in systolic BP>10 during inspiration from cardiac tamponade or constrictive pericarditis
Pulsus alterans- pulses have different amplitude -caused by LV systolic impairment
Auscultatory gap
Korotkoff sound disappears between systolic and diastolic
increased atherosclerosis and venous congestion
Bilatera UE BP differences
aortic dissection
Pulse pressure- narrow vs wide
narrow= low CO, aortic stenosis,chf(rt)
Wide: aortic insufficiency, stiff arteries
Fevers Sustained intermittent remittent hectic relapsing resistant
sustained- lobar pna
intermittent- malaria
remittent (varies but never returns to normal)- typhoid
hectic- chronic TB, pyogenic abscess
Relapsing- prior infection, hodgkin, borrelia,
resistant- misdiagnosed infection, resistant organism.
O2 saturation misreading
false desat
false saturation
unable to read
false desat- venous pulsation (right heart disease, tricuspid regurg)
False sat- met/carboxy hemoglobinemia
unable to read- poor perfusion (vascular disease/hypotension)
Orthostatic criteria
Systolic decrease by >20 or diastolic >10
BP cuff too small/large
too small= higher reading
too large- lower reading
5th vital sign
patient pain level
Hyperpyrexia
> 41.1/106
Hypothermia
Smoking and oral temp
increase by .2C for 30 mins
Irregular HR should be measured by
auscultation at apex for 60s
Opthalmic exam:
- optic disk - what is it
- cup:disk ratio
- Vessel diameter ratio
convergence of arteries and veins
cup:disk= 1:3
Artery: vein= 2:3
artery reflect light more than veins
leukokoria
white reflex
cataracts, retinal detachment, chorioretinitis, retinoblastoma
Kussmail breathing
metabolic acidosis- fast, slow or normal
varied rate and depth
Trepopnea
lateral decubitus tachypnea/dyspnea
Healthy lung better down, right side if CHF,
Platypnea
dyspnea worse when sitting, better supine (opp of orthopnea)
due to r to l cardiac shunt, PE or pericardia effusion
Pulses Weak Bounding Paradoxus Alterans
Weak- hypovolemia, aortic stenosis, increased peripheral resistance (CHF, cold)
Bounding- increased stroke volume/decreased resistance. Fever, anemia, hyperthyroidism, agint, aortic insufficiency,
Pulsus paradoxus- Drop in systolic BP>10 during inspiration from cardiac tamponade or constrictive pericarditis
Pulsus alterans- different amplitude from LV systolic impairment
Lips
- swollen
- painful vesicles that crust
- firm lesion that might ulcerate
- irregular/plaque nodule
- red spot
- brown spots
- scaling/fissures at corner of mouth
- swollen= angioedema
- painful vesicles that crust- HSV1
- firm lesion that might ulcerate- Syphilitic chancre
- irregular/plaque nodule=cancer
- red spot-hereditary telangiectasia (nasal/Gi bleeding)
- brown spots-Peutz Jeghers syndrome (intestinal polyps)
- scaling/fissures at corner of mouth- angular cheilitis= riboflavin def
Bilatera UE BP differences
aortic dissection
Tracheal deviation
Atelectasis pulls trachea
pneumothorax, pleural effusion-pushes trachea
Fevers Sustained intermittent remittent hectic relapsing resistant
sustained- lobar pna
intermittent- malaria
remittent (varies but never returns to normal)- typhoid
hectic- chronic TB, pyogenic abscess
Relapsing- prior infection, hodgkin, borrelia,
resistant- misdiagnosed infection, resistant organism.
O2 saturation misreading
false desat
false saturation
unable to read
false desat- venous pulsation (right heart disease, tricuspid regurg)
False sat- met/carboxy hemoglobinemia
unable to read- poor perfusion (vascular disease/hypotension)
Orthostatic criteria
Systolic decrease by >20 or diastolic >10
BP cuff too small/large
too small= higher reading
too large- lower reading
palmar crease palor
anemia
BMI
kg/m2
25-30= overweight
Obese>30
Morbidly obese>40
Waist to hip ratio- normal is:
women .85 or less
Men 1 or less
Normal pupil diameter
R&L within .4mm
10yrs-7mm
40yrs-6mm
80-4mm
anisocoria
unequal pupil size
hippus
“restless” pupils, in young people, during illumination
Opthalmic exam:
- optic disk
- cup:disk ration
- Vessel diameter ration
convergence of arteries and veins
cup:disk= 1:3
Artery: vein= 2:3
artery reflect light more than veins
leukokoria
white reflex
catarcts, retinal detachment, chorioretinitis, retinoblastoma
optic disk cupping
glaucoma
swollen disk/vessels
venous stasis from papilledema
Accurate JVP when
measure patient’s RIGHT side during expiration.
>3cm (total 8cm from RA) of sternal angle is abnormal
Falsely small/large thyroid
Normal size
Lips
- swollen
- painful vesicles that crust
- firm lesion that might ulcerate
- irregular/plaque nodule
- red spot
- brown spots
- scaling/fissures at corner of mouth
- swollen= angioedema
- painful vesicles that crust- HSV1
- firm lesion that might ulcerate- Syphilitic chancre
- irregular/plaque nodule=cancer
- red spot-hereditary telangiectasia (nasal/Gi bleeding)
- brown spots-Peutz Jeghers syndrome (intestinal polyps)
- scaling/fissures at corner of mouth- angular cheilitis= riboflavin def
eye auscultation
bruit can indicate intracranial aneurysm
Tracheal deviation
towards atelectasis
away from pna, effusions
Carotid pulse
- delayed upstroke
- bounding upstroke
- bruit
-delayed upstroke- carotid setnosis
-bounding upstroke- aortic insuf
bruit- atherosclerotic narrowing
Pretibial myxedema
raised pink/brown plaques over skin= hyperthyroidism
Spider angioma- also might see
hepatocellular disease, vit b def, pregnancy
palmar erythema has same etiology
caput medusae
hepatocellular disease
palmar crease palor
anemia
Delphian node
Sentinel node
Delphian node; single enlarged node above thyroid isthmus= thyroid cancer
Sentinel: supraclavicular-abd or thoracic malignancy
Normal hearing range
Waldeyers ring
lymph: palatine, lingual and adenoid tonsils
Total teeth
32
proximal nail fold
1/4 of nail bed
allergic rhinitis-
viral rhinitis
swollen pale= allergic
swollen red= viral
smooth tongue, papilla loss
vita B/ Fe deficiency
Pembertons Sign
goiter at thoracic inlet= goiter with dyspnea, dysphagia, cough, hoarseness (esp with arms raised)
Substernal goiter
= tracheal deviation
myxedema
non pitting puffiness- can be sign of hypothyroidism
Normal chest shape
AP: lateral diameter .7-.75
Barrel chest
Normal vs abnormal
Normal: old/infants
Abnormal: COPD
Flail Chest
Rib fracture
Inward on inspiration, outward with expiration
Pectus excavatum
funnel chest- depression of lower part of sternum
Pectus carinatum
Pigeon chest
anterior sternum
Asynchronous breathing
Caused by obstruction, COPD,
Expiration: usually inward abdominal movement
Instead expriration causes inward then outward movement
Resp alterans
inspiration has abdominal movement, expiration has thoracic movement
paradoxical abd movement
due to bilateral diaphragm weakness
abdomen move in and chest move out (loss of synchrony)
Where to put hole/tube
- tension pneumothorax
- chest tube
- 2nd intercostal space= tension pneumothorax
2. 4th- chest tube
Tactile fremitus
non pathologic absence
non patho- women, high pitch/soft voice, thick chest wall
grunting
resp muscle fatigue, untreated pna
expiratory wheeze
inspiratory wheeze
exp: low airway obstruction
Insp: stridor, upper airway obstruction
Costal paradox=
hoovers sign = thoracic expansion is opposite (hands come together
COPD, weak diaphragms (basically chest can’t expand any more)
Tactile fremitus- pathologic
Increased
Decreased
Increased= consolidation, ie PNA
Decreaed: Space between chest wall and lung= effusion, pneumothorax, COPD, neoplasm
Percussion sounds
flat, dull, resonant, tympanic
flat-bone, muscle
dull- liver
resonant- lung
tympanic- abd (bowel gas)
Normal range of diaphragm
percussion- 3-6cm
radiograph 5-7cm
lung disease=
Vesicular breath sounds
Bronchial breath sounds
Vesicular- lower pitch, inspiratory, over most of lungs
Bronchial= higher pitch, expiratory, harsh, loud. Over trachea and apex of RT lung
Wheezes Crackles Rales Rhonchi Rubs
Wheeze=high pitch Crackle- non musical sound ---fine- high pitch= interstitial fibrosis ---coarse- low pitch Rales=aka crackles Rhonchi= low pitch snore Rub- continuous low pitch crackle
Crackles loudest in
lower chest
Clavicle rise
> 5mm= COPD
Flat/dull percussion of lung
consolidation (pna), pleural effusion, atelectasis, diaphragm paralysis
Hyperresonant percussion of lung
pneumothorax, COPD, emphysema, -increased air
Tympanic percussion of lung
large pneumothorax - increased air
Breath sounds increased/decreased/bronchial
Increased=pna
Decreased= pleural effusion, pneumothorax, COPD, asthma
Bronchial: pna
Wheeze
high pitch exp
lower airway obstruction
asthma, chronic bronchitis, left heart failure
Crackle
lower lung
early
late
lower lung= interstitial fibrosis, left heart failure
late inspiratory- consolidation, interstitial fibrosis
early insp= asthma, chronic bronchitis
Interstitial fibrosis
fine late inspiratory crackle
Pleural rub
pleural effusion, pna, malignancy
Rhonchi
chronic bronchitis
Vocal resonance and diseases
pna, effusion= egophony, whispered, bronchophony
absent vocal resonancy
atelectasis
stridor
exp wheeze, loud in neck
Hyperkinetic pulsation
“thrust”= ASD, pectus excavatum, fever
or thin walled chest, ventricular aneurysm
Sustained pulsation
“heave or lift”- abnormal RV from pulm htn, ASD, enlarged left atrium, vent aneurysm, LVH, cardiomyopathy aortic stenosis/regurg
palpable p2
possible pulm htn (if patient has mitral stenosis)
abnormal apical impulse- def
normal chnage
> 2.5cm diameter
displaced to left in pregnancy
Diaphragm vs bell
Diaphragm= high pitch bell= low pitch
S1 vs S2 (normal
S2- louder, higher pitched. possible split 20-30ms normal
S3=
early diastole
S4
late diastole
diffuse PMI
CHF, R/L Ventricular hypertrophy
hyperkinetic/increased diameter/duration/amplitude
LV failure, CHF, ventricular aneurysm
retraction of PMI
restrictive pericarditis, tricusp regurg
double cardiac impulse
ventricular aneurysm
vent aneurysm
Diffuse, hyperkinetic, sustain, or double PMI
patients with emphysema may have cardiac percussion
errors exaggerated
palpation from aortic/pulm stenosis
2nd intercostal space thrills
