H&P Final Exam: Respiratory + Abdomen Flashcards
Define Dyspnea
Non-painful but uncomfortable awareness of breathing that is inappropriate for the level of exertion.
What is PND?
Paroxysmal nocturnal dyspnea
What are common associated symptoms with SOB?
Hemoptysis
Cough
N/V
DOE
PND
Orthopnea
Diaphoresis
Palpitations
CP
What should you always ask in regards to a cough?
Productive or non-productive
What are the 5 As?
Tobacco/Vape cessation
Ask about tobacco use
Advise to quit through clear, personalized messages
Assess willingness to quit
Assist to quit
Arrange followup and support
What are the smoking cessation aids?
Nicotine patches
Lozenges
Wellbutrin
How are interspaces numbered?
By the rib above.
AKA
interspace 1 is below rib 1.
On palpation, are costal cartilages and ribs distinguishable?
No!
Where can I find the tip of rib 11? 12?
Laterally for 11.
Posteriorly for 12.
How do I describe abnormalities on the chest?
2D
Vertical axis (ribs and intercostal spaces)
Around circumference of the chest
Where are the 2 locations for a needle insertion for a tension pneumothorax?
2th ICS on the midclavicular
5th ICS on the anterior/mid-axillary
Where are the locations for a chest tube insertion?
4th or 5th Anterior/mid-axillary
Where is the inferior border for an endotracheal tube on CXR?
T4
Note:
Also the point where the trachea bifurcates posteriorly.
What landmark is used to locate C7 posteriorly?
Protrusion of the vertebral column with a flexed neck.
Do I count interspaces going up or down posteriorly?
Going up, starting from the 12th rib.
Where is the scapular line?
A vertical line from the inferior angle of the scapula.
Where is a thoracentesis performed?
Above 9th rib.
Scapular line (between the spine and posterior mid-axillary)
How high is the apex of a lung?
2-4cm above the proximal 1/3 of each clavicle.
How low is the inferior border of the lungs?
6th rib midclavicular
8th rib mid-axillary
How low is the inferior border of the lungs posteriorly?
T10 spinous process with normal inspiration.
Where does the trachea bifurcate anteriorly and posteriorly?
Sternal angle anteriorly.
T4 spinous process posteriorly.
Which of the lung pleura have nerve endings?
Parietal
What are the muscles of inspiration?
Diaphragm + External intercostals.
Forced adds SCM and scalenes
What are the muscles of expiration?
None
Forced adds intercostals, neck, and abdominal muscles.
What is a normal RR for an adult?
14-20 breaths per minute
What is a clubbed finger?
Nail angle with finger is >180
When is supraclavicular retraction present?
Extreme difficulty inspiring
What is the order of a thorax exam?
Inspect
Palpate
Percuss
Auscultate
Note:
Think of the skills order
What condition has an AP ratio of 1:1?
Barrel chest
What is a sinus tract?
It is a channel our body creates to rid ourselves of infections on our back
Where do I place my thumbs to measure chest expansion?
10th ribs
What does increased tactile fremitus indicate?
Consolidation
Mass
Pneumonia
What does decreased tactile fremitus indicate?
Collapsed lung
Loss of lung parenchyma
Fluid (pleural effusion)
Air (pneumothorax)
Infiltrating tumor
Pulmonary fibrosis
What can percussion not detect?
Deep-seated lesions
What is the purpose of percussion?
Determining if a mass is air-filled, fluid-filled, or solid
Describe a healthy lung sound upon percussion?
Loud intensity
Low pitch
Long duration
Resonant
What kind of percussions have high pitches?
Thighs (flat)
Air bubbles (tympany)
What do you call the finger on the body during percussion?
Pleximeter finger
What do you call the finger hitting the joint?
Plexor finger
Do I hit with the tip or pad of my plexor finger?
Tip
What is diaphragmatic excursion used for?
Checking of atelectasis
Pleural effusions
What is the range of a normal diaphragmatic excursion?
3-5.5cm
When do I hear vesicular lung sounds? Describe them.
Most lung fields.
Soft and low-pitched
Heard during inspiration and first 1/3rd of expiration.
When do I hear bronchovesicular lung sounds? Describe them.
1st/2nd anterior interspaces
Between scapular posteriorly
Intermediate pitch and intensity.
Equal in inspiration and expiration.
When do I hear bronchial lung sounds? Describe them.
Manubrium, trachea, and mainstem bronchi.
Harsh, loud, and high pitch
Longer expiratory
When do I hear tracheal lung sounds? Describe them.
Loud, harsh sounds.
Which adventitious lung sound is discontinuous?
Crackles/Rales
What adventitious lung sound is continuous?
Wheezes and rhonchi
Describe crackles/rales.
Intermittent non-musical, like dots in time.
Describe Rhonchi.
Low-pitched, snoring sounds (suggestive of secretions in large airway)
What is stridor?
A wheeze heard mostly on INSPIRATION.
What does stridor indicate?
Partial obstruction of larynx/trachea, requires immediate intervention.
What is a pleural rub? What does it sound like?
Rubbing of the pleura against each other.
Sounds like creaking/grating/leathery sounds.
How do I test bronchophony?
99
If it is loud and clear, then it is abnormal and is bronchophony.
Heard in general lung consolidation.
How do I test egophony?
Say eeeee
If it sounds like ayy instead, then it is E-to-A change egophony.
Heard in pleural effusion and lobar consolidation.
How do I test pectoriloquy?
whisper 99 or 1-2-3
If it is heard distinctly, it is whispered pectoriloquy.
Heard in consolidation and fibrosis.
What is pectus excavatum?
Congential chest wall deformity that looks like a depression in the chest.
Note:
Like an excavator scooped out some chest
What is pectus carinatum?
Congenital chest wall deformity that causes a bird-like chest protrusion.
Where do you generally hear decreased/absent fremitus anteriorly?
Precordium
Where are the largest breath sounds heard anteriorly?
Upper anterior lung fields.
Define dysphagia and odynophagia.
Dysphagia = trouble swallowing
Odynophagia = painful swallowing
What are the 3 pain types of abdominal pain?
Visceral
Parietal
Referred
Which abdominal pain type is most easily localized?
Parietal
What are the two types of bloody stool?
Hematochezia (Bloody)
Melena (Dark & tarry)
What can cause heartburn/acid reflux/regurgitation?
ALARM?
Dysphagia
Odynophagia
Recurrent vomiting
Evidence of GI bleed
Weight loss
Anemia
Risk factors for gastric cancer
What are the alcohol abuse criteria for women and men?
Women:
>= 3 drinks per occasion
>= 7 drinks per week
Men:
>= 4 drinks per occasion
>= 14 drinks per week
What is the order of an abdominal exam?
Inspection
Auscultation
Percussion
Palpation
Note:
Think of the abdomen exam order.
What are striae?
Stretch marks
What is ascites?
Fluid in the peritoneal cavity most commonly caused by liver disease.
Protuberant abdomen with bulging flanks
Define borborygmi
Rumbling/gurgling sound caused by movement of intestinal gas
What is ileus?
Intestinal obstruction due to lack of peristalsis.
Where in the stomach is a gastric air bubble?
Fundus of the stomach.
Nestled under the left hemidiaphragm.
What is the normal range for midsternal percussion of the liver?
4-8 cm
What is the normal range for mid-clavicular percussion of the liver?
6-12 cm
What is the space where the spleen is percussed?
Traube’s space, along the costal margin
What does a spleen sound like when enlarged?
Dull
What indicates a positive splenic percussion sign?
Change from tympany to dullness when sound begins tympanic in the lowest Left anterior axillary interspace.
Upon a deep breath and 2nd percussion, it changes to dull.
Indicates need for palpation of spleen.
Where is the liver generally palpable?
Upon inspiration, it should be 3 cm below the R costal margin in the midclavicular line.
What kind of patients do you use a “hooking” technique?
Obese patients when palpating the liver.
Which kidney is generally not very palpable?
Left kidney
What is CVA tenderness?
It will be due to renal capsule inflammation.
Costovertebral angle tenderness.
What obscures a deep abdominal mass?
Abdominal muscle contracture.
What is rebound tenderness indicative of?
Peritonitis
What indicates positive rebound tenderness?
Positive if withdrawal produces pain
What is the difference between guarding and rigidity?
Guarding is voluntary
Rigidity is an involuntary reflex
What does a positive fluid wave indicate?
Ascites
What can RUQ pain usually indicate?
Cholecystitis
What is Murphy’s sign?
Cholecystitis check.
Deep breath while Hand is under the R costal margin.
A wincing in breathing = positive.
What is McBurney’s point? When do I do it?
RLQ pain that suggest appendicitis.
1/3 down from ASIS to umbilicus
Involuntary guarding and rebound tenderness will be present.
What is Rovsing’s sign?
RLQ pain when the LLQ is palpated.
What is a psoas sign? When do I do it?
Pain on passive extension of R thigh.
Checks for a retrocecal appendix that is inflamed.
What is an obturator sign? When do I do it?
Internal rotation of hip with a flexed hip and knee.
Stretches internal obturator near the appendix.
If it amplifies RLQ pain, it is positive.
