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IPAP > PE: Block 2 > Flashcards

PE: Block 2 Flashcards

1
Q

Inferior border of the RV lies below the junction of ? and ?

A

Sternum

Xyphoid process

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2
Q

Where is the base of the heart in terms of the sternum?

A

R/L 2ICS

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3
Q

What part of the heart is being felt when feeling for the PMI?

Where is the PMI felt at?

A

Apex at the 5th ICS

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4
Q

What PMI measurement is concerning?

A

Diameter of PMI >2.5cm or lateral displacement indicates LV Hypertrophy or Aortic stenosis

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5
Q

In an acutely unwell PT, what 3 S/Sx can all be signs of impending danger?

What about in non-acute PTs?

A

Cyanosis, Pallor, Diaphoresis

Cachexia

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6
Q

Define Cachexia

A

Loss of body mass that can not be reversed nutritionally

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7
Q

What cardiac issues are associated with Malar Flush, Xanthomata and Corneal Arcus?

A

M: Mitral Stenosis
X: Hyperlipidemia
C: Hyperlipidemia

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8
Q

What part of VS is one of the most informative of all clinical tests?

A

Pulse

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9
Q

When/why is checking both radial pulses simultaneously important?

A

Chest pain as a gross screening tool for aortic dissections

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10
Q

What are checking peripheral pulses an important predictor of?

What other areas are checked?

A

CAD

Femoral, popliteal, Post. Tibial, Dorsalis Pedia

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11
Q

While checking a PTs pulse, what other cardiac issue can be assessed with visual examination?

A 
Infective Endocarditis: 
Clubbing
Splinter hemorrhages
Janeway Lesions
Osler's nodes
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12
Q

When should the BP be taken?

A

After PT rests for 5min in quiet room w/ correct cuff size and arm at heart level

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13
Q

How is a BP cuff measured to a PTs arm?

A

Measured around the middle of the upper arm and fallin the middle 75% of the cuff’s range other wise step UP to next size

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14
Q

What part of the stethoscope is used to take the manual BP?

A

Bell

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15
Q

When taking BPs, pump the cuff up how far and what do you listen for?

A

30mm above radial pulse then release at 2-3mm/sec

First 2 beats= SBP
Beats disappear= DBP

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16
Q

What are the BP levels for Pre/Stage 1/2 HTN for JCN7 and 2017 Criteria?

A

120-129/80 Pre/Elevated
130-139/80-89 Pre/Stage 1
140-159/90-99 Stage 1/Stage 2
+160/+100 Stage 2/Stage 2

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17
Q

Ranges for OHOTN?

A 
2-5min from supine to standing:
Dec SBP +20mm
Dec DBP +10mm
Pulse inc +20 bpm
Sx of cerebral HOTN
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18
Q

What are the 3 classifications of OHOTN?

A

Neurogenic- MS
Non-neurogenic
Iatrogenic- meds

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19
Q

Why is HR checked w/ OHOTN?

A

Lack of pulse response increase w/ BP drop= neurological cause

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20
Q

Visual and manual examination of the chest should look for what two things and where?

A

PMI

Ventricular movement of S3 and S4

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21
Q

What does the apical impulse represent?

A

LV pulsating and moving fwd to touch the anterior wall

Rolling PT on L side or lean fwd can assist with location

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22
Q

What are the reference points for locating the PMI?

A

Vertical: 4 or 5 ICS
Horizontal: distance from midsternal liine
Lateral displacement outside of MCL while supine= inc likelihood of heart enlargement

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23
Q

Heart diameter should be ? and occupy ? ICS

A

<2.5cm

Occupy less than one ICS

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24
Q

Define Amplitude

A

Small/brisk tapping
Hyperkinetic during excitement/after exercise

Hyperthyroid, severe anemia, aortic stenosis (inc press) or mitral regurgitation (vol inc)

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25
Q

Hand and finger pads are used to palpate over what areas to feel for deficits?

A

Valvular ares and sternum

Heaves, lifts or thrills

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26
Q

Define Thrills

A

Turbulence of underlying murmurs

Auscultate the area felt the palpate to appreciate

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27
Q

Define characteristics and cause of heaves and lifts?

A

How finger/hand moves by murmur

Central precordial heave- palpable lifting sensation under the sternum, epigastrum and/or anterior chest wall to left side of sternum suggesting severe RV hypertrophy

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28
Q

What is held as the key to physical exams?

A

Auscultation

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29
Q

Best uses for bell and diaphragm?

A

D: high pitch of S1 and S2, murmurs of aortic and mitral regurgitation and friction rubs

B: low pitch of S3 S4 and murmur of mitral stenosis

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30
Q

If an abnormality is heard over aortic/pulmonary area or the apex, what needs to be listened to next?

A

Aorta/Pulmonary: Carotid

Apex: Axilla

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31
Q

What is the sequence of auscultating the heart?

A 
R 2ICS- aortic area
L 2ICS- pulmonic
3rd ICS- Erb's
LLSB- 4/5 ICS: tricuspid
Apex- mitral
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32
Q

What is the first part of auscultation?

A

Listen/distinguish normal S1 and S2

Finger on carotid during auscultation will help ID S1/S2 and phase of the cardiac cycle

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33
Q

Define Physiologic Splitting

A

Splitting of S2 when aortic valve occurs earlier that that of pulmonary valve during inspiration

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34
Q

What are the physiologic events occurring during Physiological Splitting?

A

RV press tries to open PV
Press of PA tries to close PV
Higher press wins= PV closing is delayed from RV press inc from inspiration which keeps it open longer causing PV appearing after AV in inspiration

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35
Q

Define Reverse/Paradoxical Splitting of S2

A

AV closure is delayed, like w/ bundle branch block or

PV closes early, like Woff-Parkinson-White Syndrome

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36
Q

When does a Widened Fixed Splitting of S2 occur?

When/how is it best heard?

A

Atrial Septal Defect

Erb’s Point

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37
Q

When and where are Bruits listened for?

A

Middle aged/elder PT and suspected cerebrovascular dz

PT holds breath and listen w/ bell on carotids

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38
Q

What is the prevalence/inc risk of carotid brutis?

A

Inc w/ age

3x inc risk of ischemic heart dz and stroke at 75 y/o

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39
Q

Major peripheral pulses in arms and legs are palpated for ? and ?

An absent pulse may indicate ?

A

Symmetry and Intensity

Arterial disorder (atherosclerosis) or systemic embolism

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40
Q

What type of peripheral pulse defect may be felt in Thyrotoxicosis and Hypermetabolic PTs?

A

Rapid and Rebounding

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41
Q

What type of peripheral pulse defect may be felt in Myxedema PTs?

A

Slow and sluggish

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42
Q

What is the next step if peripheral pulses are asymmetric?

A

Auscultate over peripheral vessels may detect bruit from stenosis

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43
Q

At a minimum, what peripheral locations are checked for pulses?

A 
Carotid
Radial
Dorsalis pedia
Posterior tibialis
Femoral
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44
Q

How are pulses graded?

A 
\+4: bounding
\+3: increased, stronger than expected
\+2: brisk, expected
\+1: diminished, weaker than expected
0: absent, unable to palpate
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45
Q

What does clubbing on fingers suggest?

A

Chronic underlying issue

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46
Q

Inspect and palpate legs for what characteristics and what do irregularities suggest?

A 
Edema
Hair distribution
Temp
Varicosities
Hyperpigmentation
Sx of chronic circulation issues
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47
Q

Characteristics of S1

A

Lub

Starts systole- mitral/tricuspid valve closure best hear at apex

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48
Q

Characteristics of S2

A

Dub

Starts diastole- aortic/pulmonic valve closure best heard at 2ICS

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49
Q

Characteristics of S3

A

Lub du BUB
Heard soon after S2
From rapid/high volume filling of LV or passive atrial emptying

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50
Q

When/where is S3 heard best

A

Apex in left lateral decubitus position or along LLSB, below xiphoid w/ PT supine and louder on respiration

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51
Q

S3 sounds are found in pathologic and physiologic states such as ?

A 
Anything causing inc CO
Anemia
Thyrotoxicosis
LV failure
3rd trimester pregnancy
Athletic heart

S3 in PT >40y/o= almost certain pathologic

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52
Q

What causes S3 sounds?

What can it be AKA?

A

Inc resistance to ventricular filling during passive atrial emptying

Ventricular gallop: cadence of 3 sounds, esp in tachy, sounding like “be-lieve”

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53
Q

Characteristics of S4 BE-lub dup

A

Hear before S1
AKA Atrial gallop
Heard w/ bell at apex in LLDP sounding like “Believe” or “Teness-ee”

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54
Q

What can cause S4 to be audible?

A 
Atrial contraction filling a stiff LV
HTN heart
CAD
Diastolic HF
Cardiomypoathy
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55
Q

Why is sitting a PT up and leaning forward used for auscultation?

A

Exhaling and holding breath-

listen w/ diaphragm, brings out murmur of aortic regurgitation and pericardial friction rubs

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56
Q

How are murmurs described?

A

Timing
Location
Intensity
Other

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57
Q

Diastolic murmurs are indicative of ?

Murmurs that coincide with carotid upstroke is ?

A

Indicate Dz

Systolic

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58
Q

How are murmurs described for intensity?

A 
1- barely
2- faint, hear upon listening
3- moderate loud w/out thrill
4- lout w/ thrill
5- hear w/ stethoscope on edge
6- hear w/out stethoscope
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59
Q

Define Opening Snap

A

Very early diastolic sound of an opening stenotic mitral valve after S2
Represents a Dz’d mitral valve opening to stenotic position

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60
Q

Define Ejection Click

A

After S1 occurs in aortic stenosis and pulmonic stenosis

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61
Q

Define Mid-Systolic Click

A

Mitral valve prolapse, abnormal systolic ballooning of mitral valve into L atrium

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62
Q

Mid systolic clicks are often followed by ?

A

Late systolic murmur of mitral regurgitation

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63
Q

When/where are opening snaps best heard?

A

Best w/ diaphragm medial to apex along LLSB that can radiate to apex and pulmonic area

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64
Q

Define Pansystolic Murmurs

A

Holosystolic
Pathologic from blood flow leaving chamber with high pressure to one with low pressure through a valve or structure that should be closed

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65
Q

When do pan/holosystolic murmurs start?

A

Sq through S2 with no diastolic component

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66
Q

Define Mitral Regurgitation and how is it listened for?

Define Tricuspid Regurgitation and how is it listened for?

Define Ventricular Septal Defect

A

Mitral valve fails to close; w/ diaphragm at apex, harsh radiation to L axilla

Tricuspid valve fails to close; diaphragm LLSB, blowing that radiates to right sternum/xiphoid

3-5 L ICS; very loud w/ thrill

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67
Q

What type of maneuver accentuates Tricuspid Regurgitation?

A

Inspiration (inc preload)

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68
Q

What are the most common kind of heart murmur?

A

Midsystolic ejection murmur that tend to peak near midsystole and stop before S2

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69
Q

What are the 3 types of midsystolic murmur

A

Innocent- no physiologic/structure abnormality
Physiologc- from changes in body metabolism
Pathologic- arising from structural abnormalities (aortic/pulmonic stenosis, HCM)

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70
Q

Characteristics of Innocent Midsystolic Murmur

A

2-4 ICS between LLSB and apex
Low intensity that dec/disappears w/ sitting
Common in kids/young adults w/ no underlying CVDz

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71
Q

Characteristics of Physiologic Midsystolic murmur

A

Similar to innocents

Possibly caused by: anemia, pregnancy, fever, hyperthyroid

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72
Q

What are the 3 types of pathologic midsystolic murmurs?Ch

A

Aortic stenosis
Hypertrophic cardiomyopathy
Pulmonic stenosis

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73
Q

Characteristics of Aortic Stenosis

A

R2ICS that radiates to carotids or down to apex often w/ a loud thrill or medium de/cresendo pitch

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74
Q

Characteristics of Hypertrophic Cardiomyopathy

A

3 and 4 ICS that may radiate down L sternal border to apex

LVH causes unusually rapid flow leaving the ventricle

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75
Q

What maneuvers accentuate HCM

A

Valsalva and standing (dec preload)- also inc MVP

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76
Q

Characteristics of Pulmonic Stenosis

A

2 and 3 LICS w/ loud thrill and/or de/crescendo pitch

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77
Q

Diastolic murmurs almost always indicate ?

A

Heart Dz

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78
Q

What are the types of diastolic murmurs?

A

Aortic regurgitation

Mitral stenosis

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79
Q

Characteristics of Aortic Regurgitation

A

2-4LICS radiation to apex/Rsternal border w/ blowing crescendo and high pitch heard w/ diaphragm

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80
Q

How are aortic regurgitation heard best?

A

PT sitting, leaning fwd and holding breath after exhalation

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81
Q

What causes aortic regurgitation to be audible?

A

Leaflets of aortic valve fail to completely close during diastole and blood regurgitates into aorta

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82
Q

What sign on the hands can signal the presence of an aortic regurgitation?

A

Quincke’s Sign- alternate reddening and blanching of nail bed w/ each HB

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83
Q

Characteristics of Mitral Stenosis

A

Rumbling murmur in mid/late diastole, decresendo, low pitched sound heard w/ Bell
Opening snap heard w/ diaphragm following S2 and initiates the murmur

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84
Q

Define Austin Flint Murmur and the characteristics

A

Result of mitral valve leaflet displacement and turbulent mixing of antegrade mitral flow and retrograde aortic flow

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85
Q

What does an Austin Flint Murmur sound like and where is it heard?

What is it associated with?

A

Described as mid-diastolic low pitched rumble murmur best heard at apex

Severe aortic regurgitation

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86
Q

Define Systolic Click

A

Mitral valve prolapse usually mid/late systolic and followed by systolic murmur of mitral regurgitation

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87
Q

Where are Systolic Clicks heard

A

Common in 5% of population

Apex and LLSB as high pitched noise heard w/ diaphragm

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88
Q

What are the high frequency murmurs heard with the diaphragm?

What are the low frequency murmurs heard with the bell?

A

MR TR AR

MS TS Gallops

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89
Q

Define a Venous Hum

A

Benign sound from turbulence of blood in jugular veins common in kids

90
Q

What does a Venous Hum sound like and where is it heard?

A

Continuous murmur w/out silent interval (loudest at diastole) above the medial 3rd of clavivle (esp R) humming quality heard with bell

91
Q

Define Pericardial Friction Rub

A

From inflammation of pericardial sac best heard in L3ICS and increases w/ PT leaning forward

92
Q

What does a Pericardial Friction Rub sound like and where is it heard?

A

Scratchy/Scraping sound heard w/ diaphragm

93
Q

Characteristics of PDA

A

Channel stays open between aorta and pulmonary artery
Continuous murmur w/ silent interval in late diastole
Heard in L2ICS as machinery like w/ thrill

94
Q

Why is HCM famous?

A

Leading cause of cardiac death in young adults

95
Q

How is HCM listened for and accentuated?

A

Lay supine and valsalva

Diaphragm on L3ICS and sound inc w/ valsalva

96
Q

How to distinguish between HCM and Aortic stenosis murmurs?

A

HCM murmur increases in intensity w/ maneuver that dec vol of blood in LV (standing or valsalva)
Loudest at L sternal angle 3-4ICS

97
Q

FamHx of HCM murmur need what tests of a work up?

A

Hx/PE
ECG
Echocardiography annually between 12-18y/o

98
Q

Slides 86

A

and 87, compare

99
Q

Systolic murmur by position

A 
RUSB- AS
LUSB- PS, PDA
Erb's- HCM
LLSB- TR, VSD
Apex- MR, MVP
PS MR ASTER is HoME
100
Q

Diastolic murmurs by position

A

LUSB- PI, Split S2
Erb’s- AI
LLSB- TS
Apex- MS

101
Q

What are the continuous murmurs?

A

PAD- LUSB
Arteriovenous malformations
Venous hum

102
Q

JVP provides info on what two things?

A

Volume status

Cardiac function

103
Q

JVP reflects pressures where?

A

R atrium

Central venous pressure

104
Q

If PT is hypovolemic, what change can be done to increase the visual identification of the jugular?

What if they’re hypervolemic?

A

Lower HOB to 0*

Inc HOB to 60-90*

105
Q

With HOB at 30*, JVP > ? is considered abnormally high

A

3-4cm

106
Q

Elevated JVP is 98% specific for ? issue

A

Elevated R atrial pressure from inc LV end diastolic pressure and low LV ejection fraction
Inc risk of death from HF

107
Q

What is the clinical pearl to do after listening to the heart?

A

Listen to base of lungs for fine inspiratory crackles of pulmonary edema from LV failure to remove blood from pulmonary circulation

108
Q

What follow up test can be done if a right sided cardiac pathology is suspected?

A

Palpate liver for enlargement, congested or pulsatile in cases of RV failure or TRICUSPID valve dz

109
Q

What are the 4 components of the lung exam?

What is the exam also used for?

A

Inspection
Palpation
Percussion
Auscultation

Examine heart and abdomen

110
Q

How many palpable interspaces do we have?

A

7 palpable

111
Q

What are the needle decompression and chest tube land marks?

A

ND- 2IS MCL

CT- 4IS MAL

112
Q

When numbering ribs where do you start?

Bottom of the scapula is at what rib level?

A

Sternal angle of Louis

7th rib IS

113
Q

How far up and down do lungs exist?

A

Apex- 2-4cm above clavicle
Lower- crosses 6th rib MCL and 8th rib MAL
Posterior- lower lung border at T10, descends to 12 w/ inspiration
Horizontal fissure at level of #4

114
Q

Define Respiratory Excursion

A

Lower lung border at level of T10 descends to T12 w/ inspiration

115
Q

What spinous level does the trachea bifurcate?

A

Sternal angle and T4

116
Q

What kind of breath sounds are heard over the trachea and bronchi?

A

Harsher quality than over parenchyma

117
Q

What is the descending sequence of structures from the main bronchi?

A 
Main
Lobar
Segmental
Bronchioles
Terminate
Alveoli
118
Q

How does the actual lung tissue receive oxygenated blood?

A

Bronchial arteries from aorta, also perfuse the muscular wall of bronchi and bronchioles

119
Q

Accessory muscles of inspiration?

A

Parasternals
Scalenes
Sternomastoids
Abd muscles

120
Q

What is the best PT positions for examining the thorax?

A

Posterior- seated

Anterior- supine

121
Q

What is the sequence of steps for examining a thorax?

A

Inspection
Palpation
Percussion
Auscultation

122
Q

What are the normal respiratory rates?

What can influence these?

A

Adult: 12-20
Child: 20-30
Infant: 30-60

Metabolism, Emotions, Neurologic, Obstructive

123
Q

Define Kussmaul Breathing

A

Deep labored sighing respirations that are compensatory to metabolic acidosis

124
Q

Define Cheyne-Stokes Breathing

A

Cyclic hyperventilating followed by compensatory apnea

125
Q

Define Hyperpnea/ventilation

A

Any breathing pattern that reduces CO2 in blood due to inc rate and depth of respiration

126
Q

Bradypnea is not a concern as long as ? test proves it’s sufficient for life?

A

ABG

127
Q

Define Obstructive, Painful and Restrictive abnormal breathing patterns?

A

Obstructive: expiration is prolonged from narrow airway

Restrictive: reduced lung capacity

Painful: pain from thoracic movement

128
Q

If chest pain is said to be pleuritic means that it is caused by ?

A

Movement of breathing

129
Q

Define Platypena and it’s cause

A

Dyspnea worse w/ upright posture

Pericarditis

130
Q

When is an AP diameter > than lateral diameter seen?

A

Age
COPD
“Barrel Chest”

131
Q

Bulging of interspaces during expiration indicates ?

A

Outflow obstruction (aneurysm) tumor or CHF

132
Q

What are some S/Sx of respiratory compromise?

A

Retractions
Use of accessories: SCM and scalene
Pursing/cyanosis
Nasal flaring

133
Q

Define Pectus Excavatum

A

Funnel Chest
Depression of lower sternum
Compresses the heart and great vessels, possible cause of murmurs

134
Q

Define Pectus Carinatum

A

Pigeon Chest

Sternum is displaced anteriorly, inc AP diameter while adjacent costal cartilage is depressed

135
Q

Define Thoracic Kyphoscoiosis

A

Abnormal spinal curvature and vertebral rotation that deforms the chest

136
Q

Flailed chest movement correlation to breathing

A

Inspiration- in

Expiration- out

137
Q

Define Lung Excursion

A

Placing hands on T10 and watching for equal rise and fall of chest expansion

138
Q

What can cause Retraction of Interspace?

A

During inspiration due to obstruction- stridor, caved in

139
Q

Define Fremitus

A

AKA Vocal Fremitus

Palpable vibration transmitted through bronchopulmonary tree to chest wall during low frequency speech

140
Q

Why is the words “99” repeated for tactile fremitus?

What are some preferred terms?

A

German word Neun-und-Neunzig

Boy oh Boy and Toy Boat- Diphthong Phrases

141
Q

Tactile Fremitus is pathologically increased areas of ? like during ?
Can be decreased during ?

A

Consolidation, Pneumonia

Pleural effusion/pneumothorax (when liquid or air instead of lung)

142
Q

Why is increased fremitus increased?

A

Sound waves transmitted w/ less decay in solid or fluid medium (consolidation) than in gas (aerated)
Pneumonia

143
Q

Why is decreased fremitus decreased?

A

Pleural effusion, pneumothorax, COPD, thickened chest wall

Pathology that separates the lung tissue from body wall and prevent sound transmission

144
Q

What finger is used to percussive exam the thorax?

A

Pleximeter- middle

Strike on distal interphalangeal joint

145
Q

What are the meanings of flat, dull, resonating, hyperresonant and tympanic sounds during perussion?

A

Flat: thick effusion
Dull: pneumonia, small effusion, hemothorax, tumor
Resonance: normal, bronchitis
Hyper: air trapped (asthma, emphysema, small pneumothorax)
Tympanic: large pneumothorax

146
Q

What does a positive CVA sign indicate?

A

Renal malady- pyelonephritis

147
Q

What is the most important technique for assessing air flow through bronchial trees?

A

Auscultation

148
Q

What is heard with the bell and diaphragm?

A

Bell: low frequency
Diaphragm: high

149
Q

Define Vesicular Breath sounds

A

Soft and low pitched sounds heard through inspiration, fade about 1/3 during expiration and heard over most of both lungs
(inspiration longer than expiratory)

150
Q

Define Bronchial Breath sounds

A

Louder and higher pitch with short silence between inspiration/expiration
Heard over manubrium
(Expiratory longer than inspiratory)

151
Q

Define Tracheal breath sounds

A

Very loud high pitched heard over trachea (Darth Vader)

Inspiratory=expiratory

152
Q

Adventitous Sounds indicate what issues?

A

Cardiac or Pulmonary condition

153
Q

Define Crackles

A

Intermittent non musical and brief from lung abnormality like pneumonia, fibrosis or early CF or or airways

154
Q

Define Wheeze and Rhonchi

A

Continuous, musical and prolonged
High pitched with shrill suggesting narrowed airway from asthma, COPD or bronchitis

Rhonchi- lower pitched w/ snoring quality meaning secretions in larger airway

155
Q

If crackles/wheezes and rhonchi are cleared after coughing, what does it suggest?

A

Inspissated secretions like bronchitis

156
Q

Lymph nodes border what structures in the armpit?

A

C: axilla
L: humerus
A: pec major
P: scapula

157
Q

What are the pharmacotherapy options for tobacco cessation?

A

Buproprion

Varenicline

158
Q

What are the two forms of the Step Pneumo vaccine?

A

Polysaccharide

Conjugated

159
Q

Gallbladder is generally not palpable except if ?

When is the lower pole of the R kidney possibly palpable?

A

Acute cholecystitis or CBD obstruction

Thin person with abd muscles relaxed

160
Q

Define Sacral Promontory

A

Bony anterior edge of S1 and uterus and ovaries

161
Q

What is the sequence of events for an abdominal exam

A 
Inspection
Auscultation
Percussion
Palpation
(Pulm: IPPA)
162
Q

How will PT present with peritonitis or with small bowel obstruction?

A

Still

Moving

163
Q

What color striae are normal and what color are pathologic?

A

Silver

Pink-purple= Cushing’s

164
Q

What are the 4 contours of the abdomen

A

Flat- in shape
Round- obese
Protuberant- fat, poor muscles, inc abd contents/pregnancy/ascites/splenomegaly
Scaphoid- hollowed

165
Q

Bulging flanks = ?

Visible intestinal peristalsis = ?

A

Ascites

Intestinal obstruction

166
Q

Characteristics of localized bulges

A

Protrusion of fat, bowel and/or omentum through operative scar

167
Q

Define Dehiscence

A 
Spontaneous wound opening w/ inc incidence w/ infections
Skin- not bad
Fascial- bad. 
After hernia repair- recurrent hernia
After abd surgyer- incision hernia
168
Q

Define Epigastric Hernia

A

Midline protrusion through linea alba between xiphoid and umbilicus
Protrudes w/ head raise or shoulders

169
Q

Define Diastasis Recti

A

Separation of rectus abdominis muscles through contents form midline ridge during head raises or shoulders
Often seen repeat pregnancy, obesity and chronic lung dz
NO CLINICAL SIGNIFICANCE

170
Q

Define Lipoma

A

Benign fatty tumor usually in subcutaneous tissue that are soft, lobulated and mobile

171
Q

Auscultating bowels provides what info?

Where are sounds listened at?

A

Motility

RLQ due to sound transmission

172
Q

What are “normal” bowel sounds?

A

Clicks/gurgles at 5-34/min

Listen for 2min to declare sounds are absent

173
Q

Define Borborygmi

A

Prolonged gurgles of hyperperistalsis

174
Q

What does “high-pitched tinkling” abdominal sounds mean?

A

Intestinal fluid and air under tension in dilated bowel

175
Q

Rushes of high-pitched sounds coinciding with an abdominal cramp indicates ?

A

Intestinal obstruction

176
Q

Decreased or absent bowel sounds indicate ?

A

Ileus

Peritonitis

177
Q

Bruits w/ S/Diastolic components over renal arteries = ?

Over iliac or femoral arteries = ?

A

Renal artery stenosis

Partial arterial occlusion or arterial insufficiency

178
Q

Where is the stethoscope placed to listen for the renal arteries?

A

1” lateral to midline in upper quadrants or at CVA

179
Q

Purpose of abdominal percussion

A

Assess amount and distribution of gas and fluid in abdomen and ID any masses that are solid or fluid filled

180
Q

Why does tympany predominate in abdominal exams?

When is it concerning?

A

Gas in GI tract

Protuberant abdomen that is tympanic throughout= obstruction or ileus

181
Q

What would a pneumoperitoneum sound like on abdomen percussion?

A

Loss of liver dullness, possible tympanic sound

182
Q

If using both hands to palpate the abdomen, what is each hand doing?

A

Top= pressure

Bottom- passive

183
Q

Involuntary rigidity that persists despite relaxation techniques indicates ?

A

Peritoneal inflammation

184
Q

Pulsing masses in the abdomen bigger than ? suggest AAA

What are the risk factors

A 
>3cm, rupture likely +5cm
\+65
Hx of smoking
Male
1* relative w/ AAA repair Hx
185
Q

When is the hook method preferred for palpating the liver?

A

PT is obese

186
Q

When the spleen enlarges, which way does it move?

A

Anterior
Down
Medially
Replaces tympany of stomach and colon w/ dullness

187
Q

Landmark for McBurney’s

A

1/3 distance from ASIS

188
Q

Pos McBurneys point is only applicable if the appendix is located where?

A

In Iliac fossa

Retrocecal appendicitis= flank pain presentation

189
Q

If performing DRE on suspected appendix PT, what else can cause right sided rectal tenderness?

A

Inflammed pelvic appendix

Uterine adnexa

190
Q

What special test is good for identifying a retrocecal appendicitis or retroperitoneum abnormality?

A

Psoas sign

191
Q

Function of the obturator muscle

What does a pos test mean

A

Lateral rotation and abduction of the hip and opposite movement stretches it

Inflamed pelvis appendix

192
Q

Define Cutaneous Hyperesthesia

A

Fold skin along abdominal wall

193
Q

Ascites can be caused by ?

A

Inc hydrostatic pressure from cirrhosis, CHF, pericarditis, dec osmotic pressure from nephrotic syndrome or malnutrition

194
Q

Testing for CVA tenderness can indicate the presence of what three issues?

A

Retrocecal appendicitis
Hepatic abscess
Acute cholecystitis

195
Q

Whom are umbilical hernias most commonly seen in?

A

Infants, usually close on own in 1-2yrs

196
Q

What are the four criteria for describing bowel sounds?

A

Active
Increased/hyper
Dec/hypo
Absent

197
Q

Percussion of the liver helps evaluate what three things?

A

Surface
Consistency
Tenderness

198
Q

What are the normal liver span measurements?

A

6-12cm in R MCL

4-8 cm in MSL

199
Q

Most abdominal aneurysms are located where?

A

Below renal arteries

200
Q

What is a normal size of AA in PTs +50y/o?

A

<3.0cm

201
Q

What can PT do to help locate/pin point pain if suspected appendicitis?

A

Cough

202
Q

What Dzs have physical findings commonly seen in the LUQ?

A 
Mono
PUD
Renal colic
Constipation
Cardiac Dz
203
Q

What Dzs have physical findings commonly seen in the LLQ?

A 
Constipation
Diverticulitis
Colon cancer
Ulcerative colitis
Ovarian cysts
204
Q

What Dzs have physical findings commonly seen in the RLQ?

A 
Renal colic
Appendicitis
Crohn's Dz
Ectopic pregnancy
Ovarian cysts
205
Q

What questions are asked for pain?

A

OPQRST

206
Q

What are the time frames for acute, subacute and chronic for this class?

A

Acute: < 3wks
Subacute: < 3-8wks
Chronic: > 8wks
Chronic Diarrhea: >30 days

207
Q

Define Palliates

A

(asked during P for OPQRST)

Makes Dz/Sx less sever w/out removing cause

208
Q

What is the cause of Voluminous Diarrhea?

What are three causes of Osmotic Diarrhea?

A

Malabsorption

Lactose intolerance, Abuse/Osmotic purgatives, secretory diarrhea

209
Q

Acute causes of upper abdominal discomfort/pain

A 
GERD
Pancreatitis
Perforated ulcers
Cholecystitis
Cholangitis
210
Q

Chronic causes of upper abdominal/pain

A

Dyspepsia

Discomfort

211
Q

Acute causes of lower abdominal pain?

A

Appendicitis
Bowel obstruction
Nephrolithiasis
Ovarian torsion

212
Q

Chronic causes of lower abdominal pain?

A

IBDz
IBS
Endometriosis

213
Q

Incisional hernia is a protrusion of what contents?

A

Fat
Bowel
Omentum

214
Q

Renal bruit is most predictive when heard ? and ?

A

Systolic and Diastolic

215
Q

Liver tenderness = ?

Hepatitis of any kind can cause ?

A

Hepatitis

Ascites, venous congestion, spider angiomas, jaundice

216
Q

Criteria for acute cough?

How long for chronic?

A

3wks or less

+8 wks

217
Q

Define Pulsus Alternans

A

Varying strength of pulse indicative of severe left ventricular dysfunction

218
Q

Snaps

A

And Clicks

219
Q

Which lymph nodes are most palpable?

A

Central

220
Q

Pg 381 Table

A

Table pg 402

221
Q

Characteristics of Pulsus Alternans

A

Strong then weak pulses from severe L ventricle dysfunction

222
Q

Characteristics of Paradoxical PUlse

A

Detected by palpable decrease in pulse amplitude on quiet inspiration
BP dec by >10-12mm during inspiration from pericardial tamponade, asthma exacerbation and COPD or constrictive pericarditis

IPAP (212 decks)

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