Final- Look Over Midterm Flashcards
Where do you perform a needle decompression?
2nd ICS just superior to 3rd ICS at the midclavicular line
Where do you insert a chest tube?
4th ICS at mid axillary or anterior axillary line
Where should the trachea be positioned? What is a cause of displacement?
Should be at midline
Lateral displacement due to tension pneumothorax
What are some conditions in which fingernail clubbing occurs?
Heart disease, lung disease/cancer, cystic fibrosis
What is tactile fremitus?
Palpable vibrations transmitted through bronchopulmonary tree to chest wall as someone speaks
What are some causes of decreased tactile fremitus?
COPD, pleural effusion, pneumothorax
What are some causes of increased tactile fremitus?
Pneumonia
How do you percuss for lower respiratory exam?
Percuss in a ladder pattern from upper left down the back
What does dullness replace resonance with percussion?
When fluid or soft tissue replaces air filled lungs
Causes- pneumonia or pleural accumulation of substances
When will you hear hyperresonance with percussion of lower resp exam?
With COPD and asthma
What is diaphragmatic excursion? What is a normal finding?
Finding the difference in the level of dullness during expiration and inspiration
SHould be 3-5 cm
What are the 4 normal breathing sounds heart with auscultation?
Vesicular
Bronchovesicular
Bronchial
Tracheal
Where do you hear vesicular breath sounds?
Heart with inspiration over most of the lungs
Where do you hear bronchovesicular breath sounds?
Heard in inspiration and expiration in the 1st and 2nd ICS anteriorly
Where do you hear bronchial breath sounds?
Heard during expiration over manubrium
Where do you hear tracheal breath sounds?
Over the trachea
What are some adventitious breath sounds?
Crackles/rales
Wheezes- associated with COPD and asthma
Rhonchi
Stridor- wheeze during inspiration, tracheal obstruction, treat ASAP
What is bronchophony?
When listening to lungs have patient say 99
Will sound loud and clear
What is egophony?
Have patient make EEE sound
Will sound less like EEE and more like AYYY
What is whispered pectoriloquy?
Have patient whisper 99 and it will sound louder and clearer than expected
What is the order for PE of lower resp?
Inspect, palpate, percuss, auscultate
What are the 5 fingers of normal heart exam?
History, physical, ECG, x-ray, lab tests
What are the 4 locations of auscultation for heart sounds?
Aortic Valve- 2nd ICS on R SB
Pulmonary Valve- 2nd ICS on L SB
Tricuspid Valve- 4th ICS on L SB
Mitral Valve- 5th ICS at L mid-clavicular line
What are the 4 heart sounds?
S1- heard when AV valves close
S2- heart when SL valves close
S3- heart after rapid filling of atria due to rapid deceleration
S4- heart when atria contract against stiff ventricles
How do you grade a murmur?
1-3- increasing vol WITHOUT THRILL
4-6- increasing vol WITH THRILL
6- can hear with stethoscope off chest
When inspecting the chest are 3 abnormalities?
Pectus carinatum- pigeon chest
Pectus excavatum- funnel chest
Barrel chest- COPD increased A/P diameter
How do you access point of maximal impulse?
Have patient left lateral recumbent
Palpate at left 4th ICS at midclavicular line just inferior to nipple
How do you great peripheral pulses?
0- absent 1- faint 2- normal 3- strong 4- bounding
Where can you test for edema?
Anterior tibia
Dorsum of foot
Posterior to medial malleolus
How do you grade edema?
0- absent 1- barely detectable 2- 10-15 seconds 3- more than a minute 4- more than 2 minutes
How do you measure JVP? What is considered normal? What is a common cause of elevated JVP?
Have patient lie supine to allow veins to enlarge, then raise to 45 degrees, measure from JV to suprasternal notch then add 5
Normal is 0-9
Elevated JVP is associated with elevated RV diastolic pressure
What is the cause of the A wave of JVP?
Caused by RA contraction
Increased with stenosis, PE, and pulmonary hypertension
What is the cause of the C wave of JVP?
Caused by AV valves closing which reflects pressure back into the jugular
What is the V wave of JVP?
Represents passive atrial filling which increase atrial pressure which reflects into jugular vein
