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Ab Thorax > Lab > Flashcards

Lab Flashcards

1
Q

order of exam

A
  1. inspection
  2. auscultation
  3. percussion
  4. palpation
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2
Q

auscultate abdominal quadrants in order

A
  1. right lower quadrant
  2. right upper quadrant
  3. left upper quadrant
  4. left lower quadrant
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3
Q

auscultate abdominal arteries in order

A
  1. aorta
  2. renal arteries (bilateral)
  3. iliac arteries (bilateral)
  4. femoral arteries (bilateral)
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4
Q

aorta artery location

A

1/2 distance between xiphoid and umbilicus

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5
Q

renal artery location

A

lateral to aorta, below ribs

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6
Q

iliac arteries location

A

from asis 1/2 way across to midline

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7
Q

femoral arteries location

A

above or below midpoint of inguinal ligament

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8
Q

aorta palpation

A
  1. 2 hands wide apart on upper abdomen on either side of aorta
  2. angle hands towards midline press slowly and deeply into the abdomen to feel edges of aorta
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9
Q

normal bowl sounds rate

A

5-34 per min

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10
Q

abnormal bowl sounds rate

A

no bowl sounds after auscultating for 5 min

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11
Q

normal artery sounds

A

nothing

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12
Q

abnormal artery sounds

A

whooshing = bruits

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13
Q

what does hyperperistalsis indicate (incr. bowel sounds)

A

diarrhea or early obstruction

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14
Q

what absence of bowel sounds indicate

A

late obstruction or generalized peritonitis

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15
Q

bruits is due to what

A

stenosis or obstruction

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16
Q

friction rubs for spleen and liver indicate

A

inflammation of the peritoneal surface and liver capsule

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17
Q

how to listen for bruits in liver and spleen

A

ask pt to hold breath

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18
Q

how to listen for friction rubs in liver and spleen

A

pt breathe slowly and deeply with open mouth

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19
Q

percussion of abdominal quadrants

A

pt supine with knees bent

start with lower rt quadrant then clockwise

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20
Q

percussion of liver
normal midclavicular size
normal midsternal size

A

inhale deeply and hold breath, percuss up then down
percuss over midclavicular line 6-12 cm
percuss over midsternal line 4-8 cm

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21
Q

normal percussion sounds over 4 quadrants

A

tympany

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22
Q

abnormal percussion sounds over 4 quadrants

A

dull

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23
Q

dull tone over midline of lower abs indicate

A

full bladder, pregnant, tumor, fluid/feces

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24
Q

dull tone over gastric area indicate

A

tumor

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25
Q

normal percussion sound of liver

A

dull

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26
Q

shifting dullness significance

A

more than 500ml of fluid is ascites

pt supine: fluid collects around flanks

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27
Q

shifting dullness procedure

A

percussion is tympanic on side far from table

percussion is dull on side neat table

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28
Q

ascites is caused by

A

portal hypertension from cirrhosis, tumor, aids, cancer

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29
Q

percussion of spleen

A

percuss at lowest 10th intercostal anterior to the axillary line
pt exhale, doc percuss all of exhale then pt inhale, doc percuss all of inhale

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30
Q

normal percussion sounds of spleen

A

tympany on exhale

tympany on inhale

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31
Q

abnormal percussion sounds of spleen

A

tympany on exhale

dull on inhale

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32
Q

abnormal finding of spleen percussion means

A

large spleen (splenomegaly)

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33
Q

causes of splenomegaly

A

mononucleosis
malaria
hemolytic anemia
portal hypertension

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34
Q

superficial and deep palpation of abdominal quadrants w/ rebound tenderness

A

stand pt right side

pt supine w/ knees bent

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35
Q

superficial palpation

feel for

A

gently and thoroughly palpate all 4 quadrants
areas of tenderness
nodules/masses

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36
Q

deep palpation

A

pt exhale to palpate more deeply

use smooth circles

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37
Q

rebound tenderness

start where

A

slow pressure in –> quick release

begin in quadrant away from tender area

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38
Q

rebound tenderness means

what sign

A

generalized peritonitis

blumberg sign

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39
Q

involuntary guarding decreases

A

on exhale

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40
Q

involuntary guarding will persist..

suggests what

A

despite relaxation maneuvers

peritonitis

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41
Q

involuntary guarding means

A

peritonitis

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42
Q

abnormal finding of tenderness throughout abdomen along w/ broad like muscular rigidity

A

generalized peritonitis

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43
Q

pain and tenderness w/ muscles spasm

A

peritoneal inflammation

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44
Q

blumberg sign is synonymous with

A

rebound tenderness

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45
Q

blumberg sign is when

A

pain is increased on rapid withdrawl of pressure

area of tenderness is likely location of peritoneal inflammation

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46
Q

roving sign and what it suggests

A

press on LLQ: increased tnederness in LRQ

suggests appendicitis

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47
Q

liver palpation method

A

hand under pt right rib
pt inhale and hold
smooth circular motion

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48
Q

liver cirrhosis signs

A

not tender, firm hard, regular or irregular margin

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49
Q

liver hepatitis signs

A

tender, soft, smooth margin

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50
Q

liver cancer signs

A

might be tender, hard texture, irregular margin

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51
Q

normal liver signs

A

non tender, soft, smooth margin

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52
Q

galbladder palpation method

A

feeds hands under ribcage on pt’s exhale

hold the hand in region of the galbladder as pt inhale

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53
Q

abnormal finding for gallbladder palpation

A

pt. abruptly stops inhaling due to pain

murphys sign: cholecystitis

54
Q

spleen palpation method

A

face directly across umbilicus
reach lt hand across pt place under pt lt ribcage
press in after pt exhale

55
Q

normal palpation signs of spleen

A

non palpable

56
Q

abnormal palpation signs of spleen

A

palpable

2 1/2 - 3x normal size

57
Q

normal kidney palpation

if palpable w/ entrapment method, suggests

A

not palpable

enlarged kidney: tumor, hydronephrosis, polycystic kidney

58
Q

kidney entrapment method

A
  1. stand on side of kidney
  2. hand on top of pt and 1 hand underneath just below lowest rib
  3. pt exhale
  4. push hands together and hold while pt inhale
59
Q

murphy’s punch location

A

over costovertebral angle
pt sitting
one hand over kidney other hand punch kidney

60
Q

murphy’s punch indicates

A

pain

pyelonephritis

61
Q

percussion of post thorax procedure

A

pt arms crossed

percuss r-l, r-l

62
Q

diaphragmatic excursion

A 
pt arms crossed 
pt inhales and hold 
percuss 
mark diaphragm 
pt exhale
percuss 
mark diaphragm
63
Q

location of rt diaphragm

A

t10 at exhale

t12 at inhale

64
Q

right diaphragm is

A

higher than the left

65
Q

distance between marks of diaphragmatic excursion

A

same size bilaterally

3-6 cm between two marks on each side (2-3 finger widths)

66
Q

normal percussion tone over lungs

A

resonant

67
Q

abnormal percussion tone over lungs

A

tympanic, dull, hyper resonance, flat

68
Q

tympanic tone over lungs

A

TB

69
Q

dull tone over lungs

A

pneumonia

70
Q

hyper resonance tone over lung

A

emphysema

71
Q

flat tone over lung

A

massive pleural effusion

72
Q

normal percussion tone over diaphragm

A

dull

73
Q

palpate post thorax method

A

palpate for masses and tenderness

pt seated w/ arm crossed when palpating scapula

74
Q

what pt says during palpation of post thorax for bronchophony

A

99 in slow voice each time hand touch back

75
Q

palpation of 99 of post thorax for

A

tactile fremitus (vibration)

76
Q

increased vibration during palpation of post thorax

A

increased density

pneumonia

77
Q

decreased vibration during palpation of post thorax

A

decreased density

emphysema

78
Q

respiratory expansion performed where

A

t10

79
Q

respiratory expansion process

A
  1. pt arm down at side
  2. grasp around rib cage make sure plenty of skin btw thumb
  3. move fingers with ribs while pt inhales deeply
  4. observe distance over 3 breaths
80
Q

normal respiratory expansion distance

A

1-2 inches of expansion

81
Q

abnormal respiratory expansion

A

decreased expansion

82
Q

unilateral abnormal respiratory expansion

A

problem w/ lungs
problem w/ diaphragm
pneumothorax
lobar pneumonia

83
Q

bilateral abnormal respiratory expansion

A

ankylosing spondylitis

84
Q

auscultate diaphragm instruction

A

pt breath slowly, deeply, quietly open mouth

85
Q

what to listen for when auscultating diaphragm

A
  1. breath sounds
  2. any adventitious sounds
  3. if abnormalities are heard, listen to pt spoken or whispered voice (transmitted voice sounds)
86
Q

bronchophony during diaphragm ascultation

A

pt say 99

sound is louder, clearer and more distinct than normal

87
Q

pectoriloquy during diaphragm ascultation

A

whisper 99
sound is louder, clearer and more distinct than normal
suggest consolidation

88
Q

egophony during diaphragm ascultation

A

say EE
sound is heard as AY w/ nasal quality
sound heard over meniscus of pleural effusion

89
Q

inspiratory sounds of vesicular breath

A

last 3x longer than expiratory

no pause between inhale and exhale

90
Q

expiratory sound intensity of vesicular breath

A

soft

91
Q

pitch sound of vesicular breath

A

low

92
Q

location where vesicular breath heard

A

everywhere (majority of lung field)

93
Q

inspiratory sounds of bronchovesicular breath

A

equal to expiratory sounds

no pause between inhale and exhale

94
Q

bronchovesicular breath intensity of expiratory sound

A

intermediate (not high or low)

95
Q

bronchovesicular pitch of expiratory sound

A

intermediate

96
Q

bronchovesicular locations heard

A

between scapula and ant 1st and 2nd interspace

97
Q

abnormal breath sounds

A

harsh vesicular breath
diminished vesicular breath
bronchovesicular breath sounds

98
Q

harsh vesicular breath sounds are heard where

A

in children, thin walled individuals and after exercise

99
Q

diminished vesicular breath sounds

A

heard in elderly, thick walled individuals and emphysema

100
Q

bronchovesicular breath sounds are heard with what

A

pulmonary edema

101
Q

auscultate heart with

A

diaphragm and bell with patient seated

102
Q

aortic side and intercostal

A

right 2nd intercostal

103
Q

pulmonic side and intercostal

A

left 2nd intercostal

104
Q

erbs point side and intercostal

A

left 3rd intercostal

105
Q

tricuspid side and intercostal

A

left 4th and 5th intercostal

106
Q

mitral side and intercostal

A

left 5th intercostal 7-10 cm from midsternal

107
Q

mitral maneuver

A

pt on side laying

use bell to auscultate mitral valve under 5th intercostal

108
Q

what is mitral maneuver for

A

detect s3, s4, mitral stenosis or low pitched murmur

109
Q

what causes murmurs

A

regurgitation or stenosis

110
Q

splitting of s2 is heard where

A

heard during inhalation but gone on exhalation

listen for split s2 sound at 2nd intercostal space

111
Q

normal s1 sound (diaphragm)

A

lub

closing of mitral and tricuspid valves

112
Q

normal s2 sound (diaphragm)

A

dub
closing of aortic and pulmonic valves
beginning of diastole

113
Q

abnormal s3 sound (bell)

A

early diastole (right after S2)
ventricular gallop
normal: in children and preggo
CHF or mitral regurgitation

114
Q

abnormal s4 sound (bell)

A

late diastole
atrial gallop
hyperthyroidism, hypertension
exception: heard in well trained athlete

115
Q

aortic maneuver procedure

A

pt seated leaning forward
use diaphragm
exhale and hold
auscultate PETTM (not aortic)

116
Q

vital signs

A 
height
weight
temp (98.7)
hr (60-110)
respiration (14-20)
117
Q

bp pressure drop

A

2-3 mmhg/sec

118
Q

high blood pressure

A

> 140/90 mmHg

119
Q

prehypertension

A

120-139/80-89 mmHg

120
Q

normal bp

A

120/80

121
Q

optimal pressure

A

110-119/60-79

122
Q

hypotension

A

<100/60

123
Q

hypertension is determined by

A

3 readings of >140/90

124
Q

auscultatory gap

A

period of silence while taking BP but systolic pressure is higher

125
Q

auscultatory gap is found in

A

ppl w/ hypertension

126
Q

palpate peripheral vasculature of head neck, ue and abdomen

A

temporal, carotid, brachial, ulnar, radial, aorta

then auscultate carotid while pt holds breath

127
Q

assess for what in peripheral vasculature palp

A

rate, rhythm, amplitude, and contour

128
Q

abnormal peripheral vasculature palp

A

redness of skin, pallor, cyanosis, trophic skin changes (shiny, thin hair loss, edema) stasis dermatitis

129
Q

arterial occlusion signs

A

pallor, cool/cold skin

decrease or absent pulse

130
Q

venous stasis

A

normal pulse, no pallor, normal temp, pitting edema, stasis dermatitis

131
Q

peripheral palp of abdomen and lower extremities

A

aorta, femora, popliteal, posterior tibial (just distal to malleoli), dorsal pedis (lateral to big toe)

132
Q

high pitched intermittent rushes during abdominal auscultation

A

partial obstruction

Ab Thorax (1 decks)

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