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Physical Diagnosis > Final > Flashcards

Final Flashcards

1
Q

Temperature Difs

A

Rectal>oral>axillary

Tympanic closest to core temp

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2
Q

Temperature Difs

A

Rectal>oral>axillary

Tympanic closest to core temp

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3
Q

Hyperpyrexia

A

> 41.1/106

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4
Q

Hypothermia

A
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5
Q

Smoking and oral temp

A

increase by .2C for 30 mins

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6
Q

Irregular HR should be measured by

A

auscultation at apex for 60s

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7
Q

Bradypnea
Tachypnea
Hyperapnea

A

25 Rapid and SHALLOW= pna, restrictive lung disease

>25 rapid and DEEP-Met acidosis, anxiety

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8
Q

Cheyne Stokes

A

Breathing that alternates every 20-30s between tachypnea and bradypnea

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9
Q

Kussmail breathing

A

metabolic acidosis- fast, slow or normal

varied rate and depth

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10
Q

Trepopnea

A

lateral decubitus tachypnea/dyspnea

Healthy lung better down, right side if CHF,

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11
Q

Platypnea

A

dyspnea worse when sitting, better supine (opp of orthopnea)
due to r to l cardiac shunt, PE or pericardia effusion

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12
Q 
Pulses
Weak
Bounding
Paradoxus
Alterans
A

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

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13
Q

Auscultatory gap

A

Korotkoff sound disappears between systolic and diastolic

increased atherosclerosis and venous congestion

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14
Q

Bilatera UE BP differences

A

aortic dissection

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15
Q

Pulse pressure- narrow vs wide

A

narrow= low CO, aortic stenosis,chf(rt)

Wide: aortic insufficiency, stiff arteries

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16
Q 
Fevers
Sustained
intermittent
remittent
hectic
relapsing
resistant
A

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.

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17
Q

O2 saturation misreading
false desat
false saturation
unable to read

A

false desat- venous pulsation (right heart disease, tricuspid regurg)
False sat- met/carboxy hemoglobinemia
unable to read- poor perfusion (vascular disease/hypotension)

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18
Q

Orthostatic criteria

A

Systolic decrease by >20 or diastolic >10

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19
Q

BP cuff too small/large

A

too small= higher reading

too large- lower reading

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20
Q

5th vital sign

A

patient pain level

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21
Q

Hyperpyrexia

A

> 41.1/106

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22
Q

Hypothermia

A
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23
Q

Smoking and oral temp

A

increase by .2C for 30 mins

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24
Q

Irregular HR should be measured by

A

auscultation at apex for 60s

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25
Q

Opthalmic exam:

  • optic disk - what is it
  • cup:disk ratio
  • Vessel diameter ratio
A

convergence of arteries and veins
cup:disk= 1:3
Artery: vein= 2:3
artery reflect light more than veins

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26
Q

leukokoria

A

white reflex

cataracts, retinal detachment, chorioretinitis, retinoblastoma

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27
Q

Kussmail breathing

A

metabolic acidosis- fast, slow or normal

varied rate and depth

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28
Q

Trepopnea

A

lateral decubitus tachypnea/dyspnea

Healthy lung better down, right side if CHF,

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29
Q

Platypnea

A

dyspnea worse when sitting, better supine (opp of orthopnea)
due to r to l cardiac shunt, PE or pericardia effusion

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30
Q 
Pulses
Weak
Bounding
Paradoxus
Alterans
A

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

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31
Q

Lips

  • swollen
  • painful vesicles that crust
  • firm lesion that might ulcerate
  • irregular/plaque nodule
  • red spot
  • brown spots
  • scaling/fissures at corner of mouth
A
  • 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
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32
Q

Bilatera UE BP differences

A

aortic dissection

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33
Q

Tracheal deviation

A

Atelectasis pulls trachea

pneumothorax, pleural effusion-pushes trachea

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34
Q 
Fevers
Sustained
intermittent
remittent
hectic
relapsing
resistant
A

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.

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35
Q

O2 saturation misreading
false desat
false saturation
unable to read

A

false desat- venous pulsation (right heart disease, tricuspid regurg)
False sat- met/carboxy hemoglobinemia
unable to read- poor perfusion (vascular disease/hypotension)

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36
Q

Orthostatic criteria

A

Systolic decrease by >20 or diastolic >10

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37
Q

BP cuff too small/large

A

too small= higher reading

too large- lower reading

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38
Q

palmar crease palor

A

anemia

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39
Q

BMI

A

kg/m2
25-30= overweight
Obese>30
Morbidly obese>40

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40
Q

Waist to hip ratio- normal is:

A

women .85 or less

Men 1 or less

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41
Q

Normal pupil diameter

A

R&L within .4mm
10yrs-7mm
40yrs-6mm
80-4mm

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42
Q

anisocoria

A

unequal pupil size

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43
Q

hippus

A

“restless” pupils, in young people, during illumination

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44
Q

Opthalmic exam:

  • optic disk
  • cup:disk ration
  • Vessel diameter ration
A

convergence of arteries and veins
cup:disk= 1:3
Artery: vein= 2:3
artery reflect light more than veins

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45
Q

leukokoria

A

white reflex

catarcts, retinal detachment, chorioretinitis, retinoblastoma

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46
Q

optic disk cupping

A

glaucoma

47
Q

swollen disk/vessels

A

venous stasis from papilledema

48
Q

Accurate JVP when

A

measure patient’s RIGHT side during expiration.

>3cm (total 8cm from RA) of sternal angle is abnormal

49
Q

Falsely small/large thyroid

A

Normal size

50
Q

Lips

  • swollen
  • painful vesicles that crust
  • firm lesion that might ulcerate
  • irregular/plaque nodule
  • red spot
  • brown spots
  • scaling/fissures at corner of mouth
A
  • 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
51
Q

eye auscultation

A

bruit can indicate intracranial aneurysm

52
Q

Tracheal deviation

A

towards atelectasis

away from pna, effusions

53
Q

Carotid pulse

  • delayed upstroke
  • bounding upstroke
  • bruit
A

-delayed upstroke- carotid setnosis
-bounding upstroke- aortic insuf
bruit- atherosclerotic narrowing

54
Q

Pretibial myxedema

A

raised pink/brown plaques over skin= hyperthyroidism

55
Q

Spider angioma- also might see

A

hepatocellular disease, vit b def, pregnancy

palmar erythema has same etiology

56
Q

caput medusae

A

hepatocellular disease

57
Q

palmar crease palor

A

anemia

58
Q

Delphian node

Sentinel node

A

Delphian node; single enlarged node above thyroid isthmus= thyroid cancer
Sentinel: supraclavicular-abd or thoracic malignancy

59
Q

Normal hearing range

A
60
Q

Waldeyers ring

A

lymph: palatine, lingual and adenoid tonsils

61
Q

Total teeth

A

32

62
Q

proximal nail fold

A

1/4 of nail bed

63
Q

allergic rhinitis-

viral rhinitis

A

swollen pale= allergic

swollen red= viral

64
Q

smooth tongue, papilla loss

A

vita B/ Fe deficiency

65
Q

Pembertons Sign

A

goiter at thoracic inlet= goiter with dyspnea, dysphagia, cough, hoarseness (esp with arms raised)

66
Q

Substernal goiter

A

= tracheal deviation

67
Q

myxedema

A

non pitting puffiness- can be sign of hypothyroidism

68
Q

Normal chest shape

A

AP: lateral diameter .7-.75

69
Q

Barrel chest

Normal vs abnormal

A

Normal: old/infants
Abnormal: COPD

70
Q

Flail Chest

A

Rib fracture

Inward on inspiration, outward with expiration

71
Q

Pectus excavatum

A

funnel chest- depression of lower part of sternum

72
Q

Pectus carinatum

A

Pigeon chest

anterior sternum

73
Q

Asynchronous breathing

A

Caused by obstruction, COPD,
Expiration: usually inward abdominal movement
Instead expriration causes inward then outward movement

74
Q

Resp alterans

A

inspiration has abdominal movement, expiration has thoracic movement

75
Q

paradoxical abd movement

A

due to bilateral diaphragm weakness

abdomen move in and chest move out (loss of synchrony)

76
Q

Where to put hole/tube

  1. tension pneumothorax
  2. chest tube
A
  1. 2nd intercostal space= tension pneumothorax

2. 4th- chest tube

77
Q

Tactile fremitus

non pathologic absence

A

non patho- women, high pitch/soft voice, thick chest wall

78
Q

grunting

A

resp muscle fatigue, untreated pna

79
Q

expiratory wheeze

inspiratory wheeze

A

exp: low airway obstruction
Insp: stridor, upper airway obstruction

80
Q

Costal paradox=

A

hoovers sign = thoracic expansion is opposite (hands come together
COPD, weak diaphragms (basically chest can’t expand any more)

81
Q

Tactile fremitus- pathologic
Increased
Decreased

A

Increased= consolidation, ie PNA

Decreaed: Space between chest wall and lung= effusion, pneumothorax, COPD, neoplasm

82
Q

Percussion sounds

flat, dull, resonant, tympanic

A

flat-bone, muscle
dull- liver
resonant- lung
tympanic- abd (bowel gas)

83
Q

Normal range of diaphragm

A

percussion- 3-6cm
radiograph 5-7cm
lung disease=

84
Q

Vesicular breath sounds

Bronchial breath sounds

A

Vesicular- lower pitch, inspiratory, over most of lungs

Bronchial= higher pitch, expiratory, harsh, loud. Over trachea and apex of RT lung

85
Q 
Wheezes
Crackles
Rales
Rhonchi
Rubs
A 
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
86
Q

Crackles loudest in

A

lower chest

87
Q

Clavicle rise

A

> 5mm= COPD

88
Q

Flat/dull percussion of lung

A

consolidation (pna), pleural effusion, atelectasis, diaphragm paralysis

89
Q

Hyperresonant percussion of lung

A

pneumothorax, COPD, emphysema, -increased air

90
Q

Tympanic percussion of lung

A

large pneumothorax - increased air

91
Q

Breath sounds increased/decreased/bronchial

A

Increased=pna
Decreased= pleural effusion, pneumothorax, COPD, asthma
Bronchial: pna

92
Q

Wheeze

A

high pitch exp
lower airway obstruction
asthma, chronic bronchitis, left heart failure

93
Q

Crackle
lower lung
early
late

A

lower lung= interstitial fibrosis, left heart failure
late inspiratory- consolidation, interstitial fibrosis
early insp= asthma, chronic bronchitis

94
Q

Interstitial fibrosis

A

fine late inspiratory crackle

95
Q

Pleural rub

A

pleural effusion, pna, malignancy

96
Q

Rhonchi

A

chronic bronchitis

97
Q

Vocal resonance and diseases

A

pna, effusion= egophony, whispered, bronchophony

98
Q

absent vocal resonancy

A

atelectasis

99
Q

stridor

A

exp wheeze, loud in neck

100
Q

Hyperkinetic pulsation

A

“thrust”= ASD, pectus excavatum, fever

or thin walled chest, ventricular aneurysm

101
Q

Sustained pulsation

A

“heave or lift”- abnormal RV from pulm htn, ASD, enlarged left atrium, vent aneurysm, LVH, cardiomyopathy aortic stenosis/regurg

102
Q

palpable p2

A

possible pulm htn (if patient has mitral stenosis)

103
Q

abnormal apical impulse- def

normal chnage

A

> 2.5cm diameter

displaced to left in pregnancy

104
Q

Diaphragm vs bell

A 
Diaphragm= high pitch
bell= low pitch
105
Q

S1 vs S2 (normal

A

S2- louder, higher pitched. possible split 20-30ms normal

106
Q

S3=

A

early diastole

107
Q

S4

A

late diastole

108
Q

diffuse PMI

A

CHF, R/L Ventricular hypertrophy

109
Q

hyperkinetic/increased diameter/duration/amplitude

A

LV failure, CHF, ventricular aneurysm

110
Q

retraction of PMI

A

restrictive pericarditis, tricusp regurg

111
Q

double cardiac impulse

A

ventricular aneurysm

112
Q

vent aneurysm

A

Diffuse, hyperkinetic, sustain, or double PMI

113
Q

patients with emphysema may have cardiac percussion

A

errors exaggerated

114
Q

palpation from aortic/pulm stenosis

A

2nd intercostal space thrills

Physical Diagnosis (1 decks)

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