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physical exam II > final pt 2 > Flashcards

final pt 2 Flashcards

1
Q

what is JVP

A
  • reflects RA pressure that equals central venous pressure and RV end diastolic volume
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2
Q

normal JVP

A
  • < 3 cm above sternal angle
  • < 8-9 cm in total distance from RA
  • should fall with inspiration
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3
Q

increased JVP

A
  • HF
  • tricuspid stenosis
  • chronic pulm HTN
  • pericardial dz
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4
Q

kussmaul’s sign

A
  • JVP rises with inspiration

- suggests impaired filling of RV

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5
Q

hepatojugular reflex

A
  • pressure applied in RUQ causes JVP to increase
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6
Q

what are the systolic murmurs

A
  • mitral regurg
  • aortic stenosis
  • tricuspid regurg
  • pulm stenosis
  • ASD
  • VSD
  • HOCM
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7
Q

aortic stenosis

A
  • systolic murmur
  • heard best when leans forward
  • can have thrill
  • 2-3 interspace
  • radiates to carotid, down LSB, apex
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8
Q

HOCM

A
  • systolic murmur
  • heard best with squatting and valsalva
  • located in L 3 and 4 interspace
  • radiates down LSB to apex
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9
Q

pulmonic stenosis

A
  • crescendo decrescendo murur
  • systolic
  • located at L 2nd and 3rd interspaces
  • radiates to L shoulder and neck
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10
Q

mitral regurg

A
  • holosystolic murur
  • doesnt change with inspir
  • can have S3
  • located at apex
  • can radiate to L axilla
  • if loud assoc with apical thrill
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11
Q

tricuspid regurg

A
  • holosystolic murmur
  • increases with inspiration
  • lower LSB
  • if RB pressure is high and V is enlarged loudest at apex- may be confused for mitral regurg
  • radiates to R sternum, xiphoid, L midclavicular
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12
Q

ventricular septal defect

A
  • holosystolic
  • located at L 3-5 interspaces
  • wide radiation
  • smaller= louder murmur
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13
Q

aortic regurg

A
  • decrescendo diastolic murmur
  • heard best when leaning foward with exhalation
  • L 2-4 interspaces
  • if loud radiates to apex
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14
Q

mitral stenosis

A
  • diastolic decrescendo
  • opening snap after S2
  • use bell
  • heard best in LLD with hand grips and exhalation
  • usu located in apex without radiation
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15
Q

venous hum

A
  • cont humming murmur
  • loudest in diastole
  • listen with bell
  • located above medial 3rd of clavicles, esp on R
  • best heard in sitting
  • disappears in supine
  • radiates to L 1-2 interspaces
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16
Q

pericardial friction rub

A
  • sounds close to stethoscope
  • best with pt leaning fwd with exhalation
  • heard best in 3rd interspace next to sternum
  • minimal radiation
  • scratchy, scraping, grating quality
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17
Q

PDA

A
  • machine like
  • L 2nd interspace
  • radiates to clavicle
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18
Q

sequence of abdominal exam

A
  • inspect
  • auscultate
  • percuss
  • palpate
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19
Q

tests for ascites

A
  • percuss from central tympany to find dullness
  • shifting dullness
  • fluid wave
  • ballottement
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20
Q

test for shifting dullness

A
  • have pt turn to side
  • percuss and mark borders
  • with ascites tympany shifts to top
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21
Q

test for fluid wave

A
  • assistant press hands on midline
  • top one flank
  • feel opposite flank for impulse
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22
Q

ballottement

A
  • straighten and stiffen fingers
  • make brief jabbing motion
  • will displace fluid
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23
Q

scrotal masses that do not transilluminate

A
  • inguinal hernia
  • varicocele
  • testicular tumor
  • hematoma
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24
Q

femoral hernias

A
  • more common in women

- point of origin below inguinal ligament

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25
Q

indirect hernia

A
  • most common hernial for all ages and sexes
  • point of origin above inguinal ligament
  • can often enter scrotum
  • on exam will touch fingertip
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26
Q

direct hernia

A
  • more common in men > 40
  • point of origin above inguinal ligament close to pubic tubercle
  • on exam will bulge anteriorly and push side of finger forward
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27
Q

hydrocele

A
  • nontender
  • fluid filled mass within tunica vaginalis
  • transilluminates
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28
Q

cryptorchidism

A
  • testis is atrophied

- lies outside scrotum in inguinal canal, abdomen, or near pubic tubercle

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29
Q

small testis

A
  • adults: length < 3.5 cm
  • small firm testes < 2 cm suggests klinefelter
  • small testis often suggests atrophy
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30
Q

causes of testicular atrophy

A
  • cirrhosis
  • myotonic dystrophy
  • use of estrogen
  • hypopituitarism
  • can follow orchitis
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31
Q

acute orchitis

A
  • testes is inflamed, tender, painful, swollen
  • hard to distinguish from epididymis
  • scrotum may be reddened
  • seen in mumps or other viral infx
  • unilat
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32
Q

testicular tumor

A
  • painless nodule

- as enlarges feels heavier than normal

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33
Q

spermatocele and cyst of epididymis

A
  • painless movable cystic mass
  • just above testis
  • both transilluminate
  • spermatocele has sperm, cyst does not
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34
Q

acute epididymitis

A
  • indurated, swollen, tender epididymis
  • hard to distinguish from testis
  • scrotum may be reddened and vas deferens inflamed
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35
Q

tuberculosis epidymitis

A
  • chronic inflam of Tb -> firm enlargement of epididymis, +/- tender thickening/ beading of vas deferens
36
Q

varicocele of spermatic courd

A
  • often on L side
  • soft bag of worms
  • disappears in supine
37
Q

torsion of spermatic cord

A
  • acutely painful, tender, swollen testicle
  • often retracted up into scrotum
  • cremasteric reflex absent
38
Q

prostate anatomy

A
  • lies against anterior rectal wall
  • 2.5 cm long
  • normally feel lateral lobes and median sulcus
39
Q

phimosis

A
  • tight prepuce that cannot be retracted over glans
40
Q

paraphimosis

A
  • tight prepuce that once retracted cannot be returned
  • causes edema
  • medical emergency
41
Q

balanitis

A
  • inflammation of glans penis
42
Q

breast anatomy

A
  • overlies pec major and serratus anterior
  • tail of spence extends into anterior axillary fold
  • extends from clavicle/ 2nd rib to 6th rib, sternum across midaxillary line
43
Q

cystocele

A
  • bulge of upper 2/3 of anterior vaginal wall

- d/t weakened ant supporting tissues

44
Q

urethral caruncle

A
  • small red benign tumor
  • post urethral meatus in females
  • postmenopausal women
  • usu asymptomatic
45
Q

bartholin gland infx

A
  • acutely appears tense, hot, very tender abscess
  • chronically nontender cyst that may be large or small
  • d/t trauma, gonococci, anaerobes
46
Q

cystourethraocyele

A
  • entire vaginal wall, together with bladder and urethra prod bulge
  • +/- groove defines boarder between urethrocele and cystocele
47
Q

prolapse of urethral mucosa

A
  • forms swollen red ring around urethral meatus

- often occurs in kids before menarche or after menopause

48
Q

rectocele

A
  • herniation of rectum into post wall of vagina

- d/t weakness or cleft in endopelvic fascia

49
Q

female breast provocative maneuvers

A
  • arms at side
  • arms above head
  • hands pressed on hips
  • leaning fwd with arms extended
50
Q

shoulder dislocation

A
  • disarticulation
  • usu anterior
  • to reduce muscles must be relaxed- can try versed
  • best maneuver- fried
51
Q

shoulder subluxation

A
  • temporary and partial
  • can reduce on its own
  • joint instability
  • may report shoulder rolls out of socket
52
Q

shoulder dislocationsx

A
  • popping noise
  • poor ROM
  • A LOT of pain
53
Q

apprehension sign

A
  • knee placed in 30 degrees of flexion
  • lateral pressure applied
  • medial instability results in pt apprehension
54
Q

primary wound closure

A
  • within 6-12 hours of injury
  • wound edges are neatly approximated
  • rapid return to function
  • good cosmetic outcome
55
Q

delayed primary closure

A
  • used in situations where primary closure is inappropriate- i.e. infx, contamination
  • allows for secondary healing to occur before closure- 48-96 hours
56
Q

phases of wound healing

A
  • hemostasis
  • inflammation
  • proliferation
  • remodeling
57
Q

hemostasis phase of wound healing

A
  • immed after wound healing
  • platelet plug forms and vasoconstriction occurs
  • thrombus dev to seal wound
58
Q

inflammation phase of wound healing

A
  • 2-3 d after injury

- WBC remove necrotic tissue and control infx

59
Q

proliferation phase of wound healing

A
  • begins on day 2/3 after injury
  • lasts 2-4 weeks
  • fibroblasts proliferate in wound -> structural proteins
  • new capillaries form and epithelial cells migrate across top of wound- granulation tissue
60
Q

remodeling phase of wound healing

A
  • new capillaries atrophy
  • collagen changes from type III to type I
  • myofibroblasts cause scar contracture
  • forces acting on wound shape remodeling process- best if force is uniaxial
61
Q

suture removal for scalp

A
  • 6-8 days
62
Q

suture removal for face

A
  • 4-5 days
63
Q

suture removal for turnk

A
  • 8-10 days
64
Q

suture removal for extremities and hands

A
  • 8-10 days
65
Q

suture removal feet

A
  • 12-14 days
66
Q

absorbable sutures

A
  • dissolved by enzymes or hydrolysis
  • tend to prod more pronounced scar
  • often used under the skin
  • plain cat gut
  • chromic gut
  • monocryl
  • vicryl
  • polydioxanone
  • panacryl
67
Q

nonabsorbable sutures

A
  • remain in place until removed
  • less tissue reactive so not as much scarring
  • best on skin
  • ethilon
  • prolene
  • nurolon
  • permhand silk
  • stainless steel
68
Q

staples

A
  • used for linear lacerations with edges that are well aligned
  • avoid in cosmetic areas or if pt needs CT/ MRI
  • scalp
69
Q

dermabond

A
  • skin adhesive
  • can be used on face, extremities, torso
  • use with SQ sutures if in area of high tension
  • dont use over joints, if infx or in mucosal area
70
Q

steristrips

A
  • used for superficial linear clean edges
  • no damage to nerves or vessels
  • can be reinforcement for sutures
  • dont use over joints or areas that get wet
71
Q

1% lidocaine

A
  • blocks pain stimuli

- leaves pressure and touch intact

72
Q

2% lidocaine

A
  • blocks all awareness of stimuli including pressure and touch
73
Q

what is the max dose of lidocaine

A
  • 4 mg/kg
74
Q

where should you not use epi

A
  • digits
  • nose
  • ears
  • penis
75
Q

plaster for splinting

A
  • takes 2-8 min to set

- more time to mold than orthoglass

76
Q

orthoglass for splinting

A
  • lighter
  • longer wear
  • more expensive
  • less molding time
77
Q

steps for splinting

A
  • stockinette without folds
  • webril- 50% overlap
  • extend padding slightly past area of splinting
  • measure/ cut plaster or orthoglass
  • dip in room temp* water
  • apply
  • place webril over plaste (prevents sticking to ace)
  • ace bandage
  • mold
  • a lot of webril to bony prominances
78
Q

how should you wrap for splinting

A
  • distal to proximal
79
Q

what are some explanations for small head circumference

A
  • abnormal brain dev

- premature fusing of skull- craniosynostosis

80
Q

history for altered mental status and possible SC injury

A
  • “A MUST”
  • A: AMS
  • M: mechanism
  • U: underlying conditions
  • S: sx
  • T: timing
81
Q

significant missed SC injuries

A
  • C1-C2 injuries
  • missed on cross table lateral xray
  • odontoid or open mouth view recommended
82
Q

how do you confirm tube placement

A
  • NOT with CXR
  • watch tube pass through cords
  • look for chest rise symmetrically
  • listen over epigastric aea
83
Q

what hand do you use to intubate

A
  • L hand
84
Q

straight blade for intubation

A
  • miller
85
Q

curved blade for intubation

A
  • mcintosh

physical exam II (5 decks)

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