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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
normal percussion sound of liver
dull
26
shifting dullness significance
more than 500ml of fluid is ascites | pt supine: fluid collects around flanks
27
shifting dullness procedure
percussion is tympanic on side far from table | percussion is dull on side neat table
28
ascites is caused by
portal hypertension from cirrhosis, tumor, aids, cancer
29
percussion of spleen
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
30
normal percussion sounds of spleen
tympany on exhale | tympany on inhale
31
abnormal percussion sounds of spleen
tympany on exhale | dull on inhale
32
abnormal finding of spleen percussion means
large spleen (splenomegaly)
33
causes of splenomegaly
mononucleosis malaria hemolytic anemia portal hypertension
34
superficial and deep palpation of abdominal quadrants w/ rebound tenderness
stand pt right side | pt supine w/ knees bent
35
superficial palpation | feel for
gently and thoroughly palpate all 4 quadrants areas of tenderness nodules/masses
36
deep palpation
pt exhale to palpate more deeply | use smooth circles
37
rebound tenderness | start where
slow pressure in --> quick release | begin in quadrant away from tender area
38
rebound tenderness means | what sign
generalized peritonitis | blumberg sign
39
involuntary guarding decreases
on exhale
40
involuntary guarding will persist.. | suggests what
despite relaxation maneuvers | peritonitis
41
involuntary guarding means
peritonitis
42
abnormal finding of tenderness throughout abdomen along w/ broad like muscular rigidity
generalized peritonitis
43
pain and tenderness w/ muscles spasm
peritoneal inflammation
44
blumberg sign is synonymous with
rebound tenderness
45
blumberg sign is when
pain is increased on rapid withdrawl of pressure | area of tenderness is likely location of peritoneal inflammation
46
roving sign and what it suggests
press on LLQ: increased tnederness in LRQ | suggests appendicitis
47
liver palpation method
hand under pt right rib pt inhale and hold smooth circular motion
48
liver cirrhosis signs
not tender, firm hard, regular or irregular margin
49
liver hepatitis signs
tender, soft, smooth margin
50
liver cancer signs
might be tender, hard texture, irregular margin
51
normal liver signs
non tender, soft, smooth margin
52
galbladder palpation method
feeds hands under ribcage on pt's exhale | hold the hand in region of the galbladder as pt inhale
53
abnormal finding for gallbladder palpation
pt. abruptly stops inhaling due to pain | murphys sign: cholecystitis
54
spleen palpation method
face directly across umbilicus reach lt hand across pt place under pt lt ribcage press in after pt exhale
55
normal palpation signs of spleen
non palpable
56
abnormal palpation signs of spleen
palpable | 2 1/2 - 3x normal size
57
normal kidney palpation | if palpable w/ entrapment method, suggests
not palpable | enlarged kidney: tumor, hydronephrosis, polycystic kidney
58
kidney entrapment method
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
murphy's punch location
over costovertebral angle pt sitting one hand over kidney other hand punch kidney
60
murphy's punch indicates
pain | pyelonephritis
61
percussion of post thorax procedure
pt arms crossed | percuss r-l, r-l
62
diaphragmatic excursion
``` pt arms crossed pt inhales and hold percuss mark diaphragm pt exhale percuss mark diaphragm ```
63
location of rt diaphragm
t10 at exhale | t12 at inhale
64
right diaphragm is
higher than the left
65
distance between marks of diaphragmatic excursion
same size bilaterally | 3-6 cm between two marks on each side (2-3 finger widths)
66
normal percussion tone over lungs
resonant
67
abnormal percussion tone over lungs
tympanic, dull, hyper resonance, flat
68
tympanic tone over lungs
TB
69
dull tone over lungs
pneumonia
70
hyper resonance tone over lung
emphysema
71
flat tone over lung
massive pleural effusion
72
normal percussion tone over diaphragm
dull
73
palpate post thorax method
palpate for masses and tenderness | pt seated w/ arm crossed when palpating scapula
74
what pt says during palpation of post thorax for bronchophony
99 in slow voice each time hand touch back
75
palpation of 99 of post thorax for
tactile fremitus (vibration)
76
increased vibration during palpation of post thorax
increased density | pneumonia
77
decreased vibration during palpation of post thorax
decreased density | emphysema
78
respiratory expansion performed where
t10
79
respiratory expansion process
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
normal respiratory expansion distance
1-2 inches of expansion
81
abnormal respiratory expansion
decreased expansion
82
unilateral abnormal respiratory expansion
problem w/ lungs problem w/ diaphragm pneumothorax lobar pneumonia
83
bilateral abnormal respiratory expansion
ankylosing spondylitis
84
auscultate diaphragm instruction
pt breath slowly, deeply, quietly open mouth
85
what to listen for when auscultating diaphragm
1. breath sounds 2. any adventitious sounds 3. if abnormalities are heard, listen to pt spoken or whispered voice (transmitted voice sounds)
86
bronchophony during diaphragm ascultation
pt say 99 | sound is louder, clearer and more distinct than normal
87
pectoriloquy during diaphragm ascultation
whisper 99 sound is louder, clearer and more distinct than normal suggest consolidation
88
egophony during diaphragm ascultation
say EE sound is heard as AY w/ nasal quality sound heard over meniscus of pleural effusion
89
inspiratory sounds of vesicular breath
last 3x longer than expiratory | no pause between inhale and exhale
90
expiratory sound intensity of vesicular breath
soft
91
pitch sound of vesicular breath
low
92
location where vesicular breath heard
everywhere (majority of lung field)
93
inspiratory sounds of bronchovesicular breath
equal to expiratory sounds | no pause between inhale and exhale
94
bronchovesicular breath intensity of expiratory sound
intermediate (not high or low)
95
bronchovesicular pitch of expiratory sound
intermediate
96
bronchovesicular locations heard
between scapula and ant 1st and 2nd interspace
97
abnormal breath sounds
harsh vesicular breath diminished vesicular breath bronchovesicular breath sounds
98
harsh vesicular breath sounds are heard where
in children, thin walled individuals and after exercise
99
diminished vesicular breath sounds
heard in elderly, thick walled individuals and emphysema
100
bronchovesicular breath sounds are heard with what
pulmonary edema
101
auscultate heart with
diaphragm and bell with patient seated
102
aortic side and intercostal
right 2nd intercostal
103
pulmonic side and intercostal
left 2nd intercostal
104
erbs point side and intercostal
left 3rd intercostal
105
tricuspid side and intercostal
left 4th and 5th intercostal
106
mitral side and intercostal
left 5th intercostal 7-10 cm from midsternal
107
mitral maneuver
pt on side laying | use bell to auscultate mitral valve under 5th intercostal
108
what is mitral maneuver for
detect s3, s4, mitral stenosis or low pitched murmur
109
what causes murmurs
regurgitation or stenosis
110
splitting of s2 is heard where
heard during inhalation but gone on exhalation | listen for split s2 sound at 2nd intercostal space
111
normal s1 sound (diaphragm)
lub | closing of mitral and tricuspid valves
112
normal s2 sound (diaphragm)
dub closing of aortic and pulmonic valves beginning of diastole
113
abnormal s3 sound (bell)
early diastole (right after S2) ventricular gallop normal: in children and preggo CHF or mitral regurgitation
114
abnormal s4 sound (bell)
late diastole atrial gallop hyperthyroidism, hypertension exception: heard in well trained athlete
115
aortic maneuver procedure
pt seated leaning forward use diaphragm exhale and hold auscultate PETTM (not aortic)
116
vital signs
``` height weight temp (98.7) hr (60-110) respiration (14-20) ```
117
bp pressure drop
2-3 mmhg/sec
118
high blood pressure
>140/90 mmHg
119
prehypertension
120-139/80-89 mmHg
120
normal bp
120/80
121
optimal pressure
110-119/60-79
122
hypotension
<100/60
123
hypertension is determined by
3 readings of >140/90
124
auscultatory gap
period of silence while taking BP but systolic pressure is higher
125
auscultatory gap is found in
ppl w/ hypertension
126
palpate peripheral vasculature of head neck, ue and abdomen
temporal, carotid, brachial, ulnar, radial, aorta | then auscultate carotid while pt holds breath
127
assess for what in peripheral vasculature palp
rate, rhythm, amplitude, and contour
128
abnormal peripheral vasculature palp
redness of skin, pallor, cyanosis, trophic skin changes (shiny, thin hair loss, edema) stasis dermatitis
129
arterial occlusion signs
pallor, cool/cold skin | decrease or absent pulse
130
venous stasis
normal pulse, no pallor, normal temp, pitting edema, stasis dermatitis
131
peripheral palp of abdomen and lower extremities
aorta, femora, popliteal, posterior tibial (just distal to malleoli), dorsal pedis (lateral to big toe)
132
high pitched intermittent rushes during abdominal auscultation
partial obstruction

Ab Thorax (1 decks)

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