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H&P > H&P Final Exam: Respiratory + Abdomen > Flashcards

H&P Final Exam: Respiratory + Abdomen Flashcards

1
Q

Define Dyspnea

A

Non-painful but uncomfortable awareness of breathing that is inappropriate for the level of exertion.

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2
Q

What is PND?

A

Paroxysmal nocturnal dyspnea

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3
Q

What are common associated symptoms with SOB?

A

Hemoptysis
Cough
N/V
DOE
PND
Orthopnea
Diaphoresis
Palpitations
CP

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4
Q

What should you always ask in regards to a cough?

A

Productive or non-productive

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5
Q

What are the 5 As?

A

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

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6
Q

What are the smoking cessation aids?

A

Nicotine patches
Lozenges
Wellbutrin

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7
Q

How are interspaces numbered?

A

By the rib above.

AKA

interspace 1 is below rib 1.

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8
Q

On palpation, are costal cartilages and ribs distinguishable?

A

No!

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9
Q

Where can I find the tip of rib 11? 12?

A

Laterally for 11.

Posteriorly for 12.

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10
Q

How do I describe abnormalities on the chest?

A

2D

Vertical axis (ribs and intercostal spaces)

Around circumference of the chest

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11
Q

Where are the 2 locations for a needle insertion for a tension pneumothorax?

A

2th ICS on the midclavicular

5th ICS on the anterior/mid-axillary

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12
Q

Where are the locations for a chest tube insertion?

A

4th or 5th Anterior/mid-axillary

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13
Q

Where is the inferior border for an endotracheal tube on CXR?

A

T4

Note:
Also the point where the trachea bifurcates posteriorly.

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14
Q

What landmark is used to locate C7 posteriorly?

A

Protrusion of the vertebral column with a flexed neck.

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15
Q

Do I count interspaces going up or down posteriorly?

A

Going up, starting from the 12th rib.

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16
Q

Where is the scapular line?

A

A vertical line from the inferior angle of the scapula.

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17
Q

Where is a thoracentesis performed?

A

Above 9th rib.
Scapular line (between the spine and posterior mid-axillary)

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18
Q

How high is the apex of a lung?

A

2-4cm above the proximal 1/3 of each clavicle.

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19
Q

How low is the inferior border of the lungs?

A

6th rib midclavicular

8th rib mid-axillary

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20
Q

How low is the inferior border of the lungs posteriorly?

A

T10 spinous process with normal inspiration.

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21
Q

Where does the trachea bifurcate anteriorly and posteriorly?

A

Sternal angle anteriorly.

T4 spinous process posteriorly.

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22
Q

Which of the lung pleura have nerve endings?

A

Parietal

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23
Q

What are the muscles of inspiration?

A

Diaphragm + External intercostals.

Forced adds SCM and scalenes

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24
Q

What are the muscles of expiration?

A

None

Forced adds intercostals, neck, and abdominal muscles.

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25
Q

What is a normal RR for an adult?

A

14-20 breaths per minute

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26
Q

What is a clubbed finger?

A

Nail angle with finger is >180

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27
Q

When is supraclavicular retraction present?

A

Extreme difficulty inspiring

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28
Q

What is the order of a thorax exam?

A

Inspect
Palpate
Percuss
Auscultate

Note:
Think of the skills order

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29
Q

What condition has an AP ratio of 1:1?

A

Barrel chest

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30
Q

What is a sinus tract?

A

It is a channel our body creates to rid ourselves of infections on our back

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31
Q

Where do I place my thumbs to measure chest expansion?

A

10th ribs

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32
Q

What does increased tactile fremitus indicate?

A

Consolidation
Mass
Pneumonia

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33
Q

What does decreased tactile fremitus indicate?

A

Collapsed lung
Loss of lung parenchyma
Fluid (pleural effusion)
Air (pneumothorax)
Infiltrating tumor
Pulmonary fibrosis

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34
Q

What can percussion not detect?

A

Deep-seated lesions

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35
Q

What is the purpose of percussion?

A

Determining if a mass is air-filled, fluid-filled, or solid

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36
Q

Describe a healthy lung sound upon percussion?

A

Loud intensity
Low pitch
Long duration

Resonant

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37
Q

What kind of percussions have high pitches?

A

Thighs (flat)

Air bubbles (tympany)

38
Q

What do you call the finger on the body during percussion?

A

Pleximeter finger

39
Q

What do you call the finger hitting the joint?

A

Plexor finger

40
Q

Do I hit with the tip or pad of my plexor finger?

A

Tip

41
Q

What is diaphragmatic excursion used for?

A

Checking of atelectasis

Pleural effusions

42
Q

What is the range of a normal diaphragmatic excursion?

A

3-5.5cm

43
Q

When do I hear vesicular lung sounds? Describe them.

A

Most lung fields.
Soft and low-pitched
Heard during inspiration and first 1/3rd of expiration.

44
Q

When do I hear bronchovesicular lung sounds? Describe them.

A

1st/2nd anterior interspaces
Between scapular posteriorly

Intermediate pitch and intensity.

Equal in inspiration and expiration.

45
Q

When do I hear bronchial lung sounds? Describe them.

A

Manubrium, trachea, and mainstem bronchi.

Harsh, loud, and high pitch

Longer expiratory

46
Q

When do I hear tracheal lung sounds? Describe them.

A

Loud, harsh sounds.

47
Q

Which adventitious lung sound is discontinuous?

A

Crackles/Rales

48
Q

What adventitious lung sound is continuous?

A

Wheezes and rhonchi

49
Q

Describe crackles/rales.

A

Intermittent non-musical, like dots in time.

50
Q

Describe Rhonchi.

A

Low-pitched, snoring sounds (suggestive of secretions in large airway)

51
Q

What is stridor?

A

A wheeze heard mostly on INSPIRATION.

52
Q

What does stridor indicate?

A

Partial obstruction of larynx/trachea, requires immediate intervention.

53
Q

What is a pleural rub? What does it sound like?

A

Rubbing of the pleura against each other.

Sounds like creaking/grating/leathery sounds.

54
Q

How do I test bronchophony?

A

99

If it is loud and clear, then it is abnormal and is bronchophony.

Heard in general lung consolidation.

55
Q

How do I test egophony?

A

Say eeeee

If it sounds like ayy instead, then it is E-to-A change egophony.

Heard in pleural effusion and lobar consolidation.

56
Q

How do I test pectoriloquy?

A

whisper 99 or 1-2-3

If it is heard distinctly, it is whispered pectoriloquy.

Heard in consolidation and fibrosis.

57
Q

What is pectus excavatum?

A

Congential chest wall deformity that looks like a depression in the chest.

Note:
Like an excavator scooped out some chest

58
Q

What is pectus carinatum?

A

Congenital chest wall deformity that causes a bird-like chest protrusion.

59
Q

Where do you generally hear decreased/absent fremitus anteriorly?

A

Precordium

60
Q

Where are the largest breath sounds heard anteriorly?

A

Upper anterior lung fields.

61
Q

Define dysphagia and odynophagia.

A

Dysphagia = trouble swallowing

Odynophagia = painful swallowing

62
Q

What are the 3 pain types of abdominal pain?

A

Visceral
Parietal
Referred

63
Q

Which abdominal pain type is most easily localized?

A

Parietal

64
Q

What are the two types of bloody stool?

A

Hematochezia (Bloody)

Melena (Dark & tarry)

65
Q

What can cause heartburn/acid reflux/regurgitation?

A

ALARM?

Dysphagia
Odynophagia
Recurrent vomiting
Evidence of GI bleed
Weight loss
Anemia
Risk factors for gastric cancer

66
Q

What are the alcohol abuse criteria for women and men?

A

Women:
>= 3 drinks per occasion
>= 7 drinks per week

Men:
>= 4 drinks per occasion
>= 14 drinks per week

67
Q

What is the order of an abdominal exam?

A

Inspection
Auscultation
Percussion
Palpation

Note:
Think of the abdomen exam order.

68
Q

What are striae?

A

Stretch marks

69
Q

What is ascites?

A

Fluid in the peritoneal cavity most commonly caused by liver disease.

Protuberant abdomen with bulging flanks

70
Q

Define borborygmi

A

Rumbling/gurgling sound caused by movement of intestinal gas

71
Q

What is ileus?

A

Intestinal obstruction due to lack of peristalsis.

72
Q

Where in the stomach is a gastric air bubble?

A

Fundus of the stomach.

Nestled under the left hemidiaphragm.

73
Q

What is the normal range for midsternal percussion of the liver?

A

4-8 cm

74
Q

What is the normal range for mid-clavicular percussion of the liver?

A

6-12 cm

75
Q

What is the space where the spleen is percussed?

A

Traube’s space, along the costal margin

76
Q

What does a spleen sound like when enlarged?

A

Dull

77
Q

What indicates a positive splenic percussion sign?

A

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.

78
Q

Where is the liver generally palpable?

A

Upon inspiration, it should be 3 cm below the R costal margin in the midclavicular line.

79
Q

What kind of patients do you use a “hooking” technique?

A

Obese patients when palpating the liver.

80
Q

Which kidney is generally not very palpable?

A

Left kidney

81
Q

What is CVA tenderness?

A

It will be due to renal capsule inflammation.

Costovertebral angle tenderness.

82
Q

What obscures a deep abdominal mass?

A

Abdominal muscle contracture.

83
Q

What is rebound tenderness indicative of?

A

Peritonitis

84
Q

What indicates positive rebound tenderness?

A

Positive if withdrawal produces pain

85
Q

What is the difference between guarding and rigidity?

A

Guarding is voluntary

Rigidity is an involuntary reflex

86
Q

What does a positive fluid wave indicate?

A

Ascites

87
Q

What can RUQ pain usually indicate?

A

Cholecystitis

88
Q

What is Murphy’s sign?

A

Cholecystitis check.

Deep breath while Hand is under the R costal margin.

A wincing in breathing = positive.

89
Q

What is McBurney’s point? When do I do it?

A

RLQ pain that suggest appendicitis.

1/3 down from ASIS to umbilicus

Involuntary guarding and rebound tenderness will be present.

90
Q

What is Rovsing’s sign?

A

RLQ pain when the LLQ is palpated.

91
Q

What is a psoas sign? When do I do it?

A

Pain on passive extension of R thigh.

Checks for a retrocecal appendix that is inflamed.

92
Q

What is an obturator sign? When do I do it?

A

Internal rotation of hip with a flexed hip and knee.
Stretches internal obturator near the appendix.
If it amplifies RLQ pain, it is positive.

H&P (10 decks)

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