PD 2 Flashcards
preload
initial stretching of cardiac myocytes prior to contraction
afterload
“load” that heart must eject blood against, closely related to aortic pressure
systole
vent. cont. resulting in forceful flow of blood into system and pulm circ
diastole
between 2 contractions - relaxation - allowing vent to fill w blood
S1 heart sound
closure of mitral and tricuspid (AV) valves
S2 heart sound
closure of aortic & pulmonic valves
S3 gallop heart sound
at the end of ventricular filling, if the vol of blood being transferred is abnormally large (mitral regurg), the blood “sloshing” up against vent. walls causes S3 sound
S4 gallop heart sound
late stage diastole is marked by atrial contraction. if vent. is stiff and noncompliant, will cause “atrial kick” pushing the remaining blood into the vent.
murmur
abnormal turbulent flow of blood when a valve is stenotic or damaged.
bruit
unexpected, audible swishing sound or murmur over an artery or vascular organ (low pitched, best heart w bell of steth.)
point of max. impulse (PMI)
beat of L vent. during systole. usually generated by the apex. May be produced by enlarged or hypertrophied RV, a dilated aorta or plum. artery, or LV wall motion abnormality
thrill
palpable murmur - signifies turbulent blood flow, associated w congenital and valvular abnormalities
heave/lift
Heave/Lift: are sustained palpable movements of localized areas of the precordium due to increased intensity of systolic contraction of one or more cardiac chambers
Heave: a more pronounced lift
Lift: RV hypertrophy
situs inversus/dextrocardia
the inversion or transposition of the body viscera so that the heart is on the right and the liver is on the left; the chest and abdominal contents become mirror images of the usual.
gallop heart sounds
S3, S4
Rub heart sound
audible through stethoscope - resulting from rubbing of opposed, inflamed, serous surfaces(ex: pericarditis)
Click
classic finding in mitral valve prolapse. Usually heard during mid or late systole. usually accompanied w a late systolic murmur indicative of mitral regurgitation.
Snap
associated w aortic stenosis. if thickening or deformities of the leaflets occur, a sound is generated in early diastole that corresponds to the opening of the valves.
ejection sounds
abnormal dilation or calcification of the aortic and pulmonic valves can cause an abnormal early systolic ejection sound as they open during systole.
claudication
Pain, burning, fatigue in legs/ buttocks, occurs w/ walking, better with rest, symptom of narrowing of artery or blockage, may be able to hear bruit (atherosclerosis is the most common cause of arterial blockage which can cause claudication)
paroxysmal nocturnal dyspnea
sudden onset of SOB after sleeping
xanthelasma
irregular shaped yellow lesions on periorbital tissues representing deposition of lipids indicating pt has abnormality of lipid metabolism
pulsus alternans
pulse has constant rate & rhythm but amplitude alternates between small/large - indicative of vent. dysfunction/failure.
pulsus bigeminus
normal pulse beat followed by a premature beat (due to premature vent. cont.) and a pause. Premature beat’s amp is less than the amp of the normal beat. indicative of heart disease
pulsus bisferiens
pulse has 2 peaks during systole - first is normal pulse during vent. cont., 2nd is an early diastole due to back flow of blood. best noted on carotid palpation.
pulsus paradoxus
atypical decrease in systolic BP and amp. during inspiration. Usually there is a slight decrease here, but should be <10mmHg. Can be indicative of emphysema, asthma, premature heart cont., tracheobronchoral obstruction, or effusion.
pulse deficit
difference between rates in pulse when auscultating heart’s apex vs palpating peripheral artery. Occurs when vent. contraction doesn’t eject a sufficient amount of blood to produce a pulse wave in arteries.
tracheal lung sounds
high pitched, harsh, heard over trachea/neck
bronchovesicular lung sounds
med pitched, heard mostly at 1st &2nd interspaces anteriorly and between scapulae
Bronchial lung sounds
relatively high pitched, heard over manubrium
vesicular lung sounds
soft, relatively low pitched sound heard over most of lungs
fine crackles lung sounds
heard during end of inspiration, high-pitched, discrete, crackling sound not cleared by cough
medium crackles - lung sounds
heard during mid-step of inspiration. lower, more moist, not cleared by cough
course crackles - lung sound
heard during inspiration, loud, bubbly, not cleared by cough
wheezes
expiration>inspiration, musical, high-pitched, hissing, squeak, continuous
In lower airways is suggestive of narrowing of airways
stridor
a wheeze that is predominately inspiratory, indicating partial obstruction of trachea
rhoncus
continuous through inspiration&expiration, loud, low, course sound similar to snore or honk
vocal fremitus/resonance
auscultate apices/anterior/lateral/posterior lung fields w stetho. as the pt says “99”. muffled, indistinct words= normal. clarity and increased loudness= bronchophony (possible consolidation of lungs)
egophony
auscultate apices/anterior/lateral/posterior lung fileds w stetho. as pt says “E”. “E” becomes “A” = abnormal
whispered pectoriloquy
auscultate apices/anterior/lateral/posterior lung fields w stetho as pt whispers “1, 2, 3”. increased intensity and pitch= abnormal (possible pneumonia or fibrosis)
tactile fremitus
palpable vibrations on chest. gives insight to density of lungs
barrel chest
increased AP diameter of chest, abnormally large ribcage - seen w COPD
flail chest
flapping, unfixed chest wall caused by loss of stability of thoracic cage after fracture of sternum or ribs
scoliosis
lateral curvature of spine
kyphosis
increased convex curvature of thoracic spine
gibbus
anterior angular deformity of lower back due to hypoplasia or wedging of one or more lower thoracic or upper portions of vertebral bodies – humpback
lordosis
accentuation of lumbar curvature
pectus carinatum
forward protrusion of sternum (pigeon chest
pectus excavatum
depression of sternum (funnel chest)
hemoptysis
coughing up blood
pleural rub
palpable, course, grating vibration
cyanosis
blue color of skin due to oxygen deprivation
stridor
harsh, high pitched sound during respiration caused by laryngeal or tracheal obstruction
cullen sign
bluish color of/around umbilicus indicated intraperitoneal hemorrhage, pancreatitis, or ectopic pregnancy
ballottement
to assess for presence or size of a mass: pressing down on suspected are at 90 degree angle to abdomen. push in toward organ/mass w fingertips. if mass is freely moveable, it will float up and touch fingertips.
grey turner sign
eccymosis of flanks indicates hemoperitoneum or pancreatitis
shifting dullness
determine border of tympany and dullness by percussion while supine, mark this border. have pt shift to side and reassess. if ascites present, the dullness will shift to the lowered side. 3 cm or more difference in those borders indicates fluid presence.
murphys sign
abrupt cessation of inspiration while palpating gallbladder indicates cholecystitis
fluid wave
pt uses own hand as barrier in mid-abdomen. tap one side of abdomen while palpating the other. wave transmitted accross= + ascites
rovsing sign
RLQ pain intensified by LLQ abdominal palpation
iliopsoas test
painful RLQ suggests irritation of peritoneal by flexion of psoas muscle
mcburney sign
pain w palpation at mcburney point (RLQ midway between umbilicus and R anterior superior iliac spine) - indicative of appendicitis or other peritoneal inflamm
obturator sign
testing for irritation from obturator muscle
rebound tenderness (Blumberg sign)
pressing gently and deeply into abdomen in region remote to pain, when pressure released, underlying structures rebounding back to original position causes pain - indicates peritoneal inflamm/irritation
borborygmi
rumbling, gurgling, tinkling noises heard on auscultation due to hyperactive intestinal peristalsis
heel jar test
pt stands on tip toes then drops to heels. if this causes pain, indicates peritoneal inflamm
hematochezia
passage of bright red blood through stool
hematemesis
vomitting of blood
dysphagia
difficulty or painful swallowing
melena
passage of dark, tarry stool
globus
persistant or intermittent nonpainful sensation of a lump or foreign body in throat. occurring between meals.
singultus
hiccup (having reflex spasm of diaphragm accompanied by a rapid closure of the glottis producing an audible sound)
reflux
backwards flow of contents of stomach into esophagus that causes heartburn
gastroparesis
delayed gastric emptying: condition consisting of a partial paralysis of the stomach, resulting in food remaining in stomach for an abnormally long time
eructation
belch
lymphadenopathy
swollen or enlarged nodes due to infectious, autoimmune, or malignant disease
lymphedema
edematous swelling due to excess lymph fluid in tissues caused by inadequate lymph drainage
lymphadenitis
infection and inflamm of nodes
lymphangitis - acute
inflamm of one or more lymph vessels. red streaks following ducts, indurated, and palpable
paraphimosis
foreskin becomes trapped behind the glans penis
hypospadias
urethral opening is on underside of penis
chancre
painless ulceration formed during primary stage of syphilis
condyloma
presence of warts caused by HPV
peyronie disease
connective tissue disorder, chronic infammation and scar tissue formation in the tunica albuginea
hydrocele
collection of fluid in scrotum
spermatocele
benign, sperm-filled cyst at head of epididymis
varicocele
enlargement of veins within the scrotum
epididymitis
inflammation or infection of epididymis; generally caused by chlamydia, gonorrhea, or E coli
testicular tumor
cancer that develops in the testicles
epispadias
urethral deformity. can open on top, side, or be open along length of penis
indirect inguinal hernia
most common abd hernia - internal opening of inguinal canal remains open and a portion of the intestines slip through the canal, generally congenital, often diagnosed early in life.
direct inguinal hernia
portion of intestine bulges through and wall along inguinal canal
femoral hernia
bulging of intestines into femoral canal
cryptochidism
undescended testicles
