PE: Block 2 Flashcards
1
Q
Inferior border of the RV lies below the junction of ? and ?
A
Sternum
Xyphoid process
2
Q
Where is the base of the heart in terms of the sternum?
A
R/L 2ICS
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
4
Q
What PMI measurement is concerning?
A
Diameter of PMI >2.5cm or lateral displacement indicates LV Hypertrophy or Aortic stenosis
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
6
Q
Define Cachexia
A
Loss of body mass that can not be reversed nutritionally
7
Q
What cardiac issues are associated with Malar Flush, Xanthomata and Corneal Arcus?
A
M: Mitral Stenosis
X: Hyperlipidemia
C: Hyperlipidemia
8
Q
What part of VS is one of the most informative of all clinical tests?
A
Pulse
9
Q
When/why is checking both radial pulses simultaneously important?
A
Chest pain as a gross screening tool for aortic dissections
10
Q
What are checking peripheral pulses an important predictor of?
What other areas are checked?
A
CAD
Femoral, popliteal, Post. Tibial, Dorsalis Pedia
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
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
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
14
Q
What part of the stethoscope is used to take the manual BP?
A
Bell
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
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
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
18
Q
What are the 3 classifications of OHOTN?
A
Neurogenic- MS
Non-neurogenic
Iatrogenic- meds
19
Q
Why is HR checked w/ OHOTN?
A
Lack of pulse response increase w/ BP drop= neurological cause
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
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
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
23
Q
Heart diameter should be ? and occupy ? ICS
A
<2.5cm
Occupy less than one ICS
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)
25
Hand and finger pads are used to palpate over what areas to feel for deficits?
Valvular ares and sternum
| Heaves, lifts or thrills
26
Define Thrills
Turbulence of underlying murmurs
Auscultate the area felt the palpate to appreciate
27
Define characteristics and cause of heaves and lifts?
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
28
What is held as the key to physical exams?
Auscultation
29
Best uses for bell and diaphragm?
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
30
If an abnormality is heard over aortic/pulmonary area or the apex, what needs to be listened to next?
Aorta/Pulmonary: Carotid
Apex: Axilla
31
What is the sequence of auscultating the heart?
```
R 2ICS- aortic area
L 2ICS- pulmonic
3rd ICS- Erb's
LLSB- 4/5 ICS: tricuspid
Apex- mitral
```
32
What is the first part of auscultation?
Listen/distinguish normal S1 and S2
| Finger on carotid during auscultation will help ID S1/S2 and phase of the cardiac cycle
33
Define Physiologic Splitting
Splitting of S2 when aortic valve occurs earlier that that of pulmonary valve during inspiration
34
What are the physiologic events occurring during Physiological Splitting?
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
35
Define Reverse/Paradoxical Splitting of S2
AV closure is delayed, like w/ bundle branch block or
| PV closes early, like Woff-Parkinson-White Syndrome
36
When does a Widened Fixed Splitting of S2 occur?
When/how is it best heard?
Atrial Septal Defect
Erb's Point
37
When and where are Bruits listened for?
Middle aged/elder PT and suspected cerebrovascular dz
PT holds breath and listen w/ bell on carotids
38
What is the prevalence/inc risk of carotid brutis?
Inc w/ age
| 3x inc risk of ischemic heart dz and stroke at 75 y/o
39
Major peripheral pulses in arms and legs are palpated for ? and ?
An absent pulse may indicate ?
Symmetry and Intensity
Arterial disorder (atherosclerosis) or systemic embolism
40
What type of peripheral pulse defect may be felt in Thyrotoxicosis and Hypermetabolic PTs?
Rapid and Rebounding
41
What type of peripheral pulse defect may be felt in Myxedema PTs?
Slow and sluggish
42
What is the next step if peripheral pulses are asymmetric?
Auscultate over peripheral vessels may detect bruit from stenosis
43
At a minimum, what peripheral locations are checked for pulses?
```
Carotid
Radial
Dorsalis pedia
Posterior tibialis
Femoral
```
44
How are pulses graded?
```
+4: bounding
+3: increased, stronger than expected
+2: brisk, expected
+1: diminished, weaker than expected
0: absent, unable to palpate
```
45
What does clubbing on fingers suggest?
Chronic underlying issue
46
Inspect and palpate legs for what characteristics and what do irregularities suggest?
```
Edema
Hair distribution
Temp
Varicosities
Hyperpigmentation
Sx of chronic circulation issues
```
47
Characteristics of S1
Lub
| Starts systole- mitral/tricuspid valve closure best hear at apex
48
Characteristics of S2
Dub
| Starts diastole- aortic/pulmonic valve closure best heard at 2ICS
49
Characteristics of S3
Lub du BUB
Heard soon after S2
From rapid/high volume filling of LV or passive atrial emptying
50
When/where is S3 heard best
Apex in left lateral decubitus position or along LLSB, below xiphoid w/ PT supine and louder on respiration
51
S3 sounds are found in pathologic and physiologic states such as ?
```
Anything causing inc CO
Anemia
Thyrotoxicosis
LV failure
3rd trimester pregnancy
Athletic heart
```
S3 in PT >40y/o= almost certain pathologic
52
What causes S3 sounds?
What can it be AKA?
Inc resistance to ventricular filling during passive atrial emptying
Ventricular gallop: cadence of 3 sounds, esp in tachy, sounding like "be-lieve"
53
Characteristics of S4 BE-lub dup
Hear before S1
AKA Atrial gallop
Heard w/ bell at apex in LLDP sounding like "Believe" or "Teness-ee"
54
What can cause S4 to be audible?
```
Atrial contraction filling a stiff LV
HTN heart
CAD
Diastolic HF
Cardiomypoathy
```
55
Why is sitting a PT up and leaning forward used for auscultation?
Exhaling and holding breath-
| listen w/ diaphragm, brings out murmur of aortic regurgitation and pericardial friction rubs
56
How are murmurs described?
Timing
Location
Intensity
Other
57
Diastolic murmurs are indicative of ?
| Murmurs that coincide with carotid upstroke is ?
Indicate Dz
| Systolic
58
How are murmurs described for intensity?
```
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
```
59
Define Opening Snap
Very early diastolic sound of an opening stenotic mitral valve after S2
Represents a Dz'd mitral valve opening to stenotic position
60
Define Ejection Click
After S1 occurs in aortic stenosis and pulmonic stenosis
61
Define Mid-Systolic Click
Mitral valve prolapse, abnormal systolic ballooning of mitral valve into L atrium
62
Mid systolic clicks are often followed by ?
Late systolic murmur of mitral regurgitation
63
When/where are opening snaps best heard?
Best w/ diaphragm medial to apex along LLSB that can radiate to apex and pulmonic area
64
Define Pansystolic Murmurs
Holosystolic
Pathologic from blood flow leaving chamber with high pressure to one with low pressure through a valve or structure that should be closed
65
When do pan/holosystolic murmurs start?
Sq through S2 with no diastolic component
66
# Define Mitral Regurgitation and how is it listened for?
Define Tricuspid Regurgitation and how is it listened for?
Define Ventricular Septal Defect
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
67
What type of maneuver accentuates Tricuspid Regurgitation?
Inspiration (inc preload)
68
What are the most common kind of heart murmur?
Midsystolic ejection murmur that tend to peak near midsystole and stop before S2
69
What are the 3 types of midsystolic murmur
Innocent- no physiologic/structure abnormality
Physiologc- from changes in body metabolism
Pathologic- arising from structural abnormalities (aortic/pulmonic stenosis, HCM)
70
Characteristics of Innocent Midsystolic Murmur
2-4 ICS between LLSB and apex
Low intensity that dec/disappears w/ sitting
Common in kids/young adults w/ no underlying CVDz
71
Characteristics of Physiologic Midsystolic murmur
Similar to innocents
| Possibly caused by: anemia, pregnancy, fever, hyperthyroid
72
What are the 3 types of pathologic midsystolic murmurs?Ch
Aortic stenosis
Hypertrophic cardiomyopathy
Pulmonic stenosis
73
Characteristics of Aortic Stenosis
R2ICS that radiates to carotids or down to apex often w/ a loud thrill or medium de/cresendo pitch
74
Characteristics of Hypertrophic Cardiomyopathy
3 and 4 ICS that may radiate down L sternal border to apex
| LVH causes unusually rapid flow leaving the ventricle
75
What maneuvers accentuate HCM
Valsalva and standing (dec preload)- also inc MVP
76
Characteristics of Pulmonic Stenosis
2 and 3 LICS w/ loud thrill and/or de/crescendo pitch
77
Diastolic murmurs almost always indicate ?
Heart Dz
78
What are the types of diastolic murmurs?
Aortic regurgitation
| Mitral stenosis
79
Characteristics of Aortic Regurgitation
2-4LICS radiation to apex/Rsternal border w/ blowing crescendo and high pitch heard w/ diaphragm
80
How are aortic regurgitation heard best?
PT sitting, leaning fwd and holding breath after exhalation
81
What causes aortic regurgitation to be audible?
Leaflets of aortic valve fail to completely close during diastole and blood regurgitates into aorta
82
What sign on the hands can signal the presence of an aortic regurgitation?
Quincke's Sign- alternate reddening and blanching of nail bed w/ each HB
83
Characteristics of Mitral Stenosis
Rumbling murmur in mid/late diastole, decresendo, low pitched sound heard w/ Bell
Opening snap heard w/ diaphragm following S2 and initiates the murmur
84
Define Austin Flint Murmur and the characteristics
Result of mitral valve leaflet displacement and turbulent mixing of antegrade mitral flow and retrograde aortic flow
85
What does an Austin Flint Murmur sound like and where is it heard?
What is it associated with?
Described as mid-diastolic low pitched rumble murmur best heard at apex
Severe aortic regurgitation
86
Define Systolic Click
Mitral valve prolapse usually mid/late systolic and followed by systolic murmur of mitral regurgitation
87
Where are Systolic Clicks heard
Common in 5% of population
| Apex and LLSB as high pitched noise heard w/ diaphragm
88
What are the high frequency murmurs heard with the diaphragm?
What are the low frequency murmurs heard with the bell?
MR TR AR
MS TS Gallops
89
Define a Venous Hum
Benign sound from turbulence of blood in jugular veins common in kids
90
What does a Venous Hum sound like and where is it heard?
Continuous murmur w/out silent interval (loudest at diastole) above the medial 3rd of clavivle (esp R) humming quality heard with bell
91
Define Pericardial Friction Rub
From inflammation of pericardial sac best heard in L3ICS and increases w/ PT leaning forward
92
What does a Pericardial Friction Rub sound like and where is it heard?
Scratchy/Scraping sound heard w/ diaphragm
93
Characteristics of PDA
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
Why is HCM famous?
Leading cause of cardiac death in young adults
95
How is HCM listened for and accentuated?
Lay supine and valsalva
| Diaphragm on L3ICS and sound inc w/ valsalva
96
How to distinguish between HCM and Aortic stenosis murmurs?
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
FamHx of HCM murmur need what tests of a work up?
Hx/PE
ECG
Echocardiography annually between 12-18y/o
98
Slides 86
and 87, compare
99
Systolic murmur by position
```
RUSB- AS
LUSB- PS, PDA
Erb's- HCM
LLSB- TR, VSD
Apex- MR, MVP
PS MR ASTER is HoME
```
100
Diastolic murmurs by position
LUSB- PI, Split S2
Erb's- AI
LLSB- TS
Apex- MS
101
What are the continuous murmurs?
PAD- LUSB
Arteriovenous malformations
Venous hum
102
JVP provides info on what two things?
Volume status
| Cardiac function
103
JVP reflects pressures where?
R atrium
| Central venous pressure
104
If PT is hypovolemic, what change can be done to increase the visual identification of the jugular?
What if they're hypervolemic?
Lower HOB to 0*
Inc HOB to 60-90*
105
With HOB at 30*, JVP > ? is considered abnormally high
3-4cm
106
Elevated JVP is 98% specific for ? issue
Elevated R atrial pressure from inc LV end diastolic pressure and low LV ejection fraction
Inc risk of death from HF
107
What is the clinical pearl to do after listening to the heart?
Listen to base of lungs for fine inspiratory crackles of pulmonary edema from LV failure to remove blood from pulmonary circulation
108
What follow up test can be done if a right sided cardiac pathology is suspected?
Palpate liver for enlargement, congested or pulsatile in cases of RV failure or TRICUSPID valve dz
109
What are the 4 components of the lung exam?
What is the exam also used for?
Inspection
Palpation
Percussion
Auscultation
Examine heart and abdomen
110
How many palpable interspaces do we have?
7 palpable
111
What are the needle decompression and chest tube land marks?
ND- 2IS MCL
| CT- 4IS MAL
112
When numbering ribs where do you start?
Bottom of the scapula is at what rib level?
Sternal angle of Louis
7th rib IS
113
How far up and down do lungs exist?
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
Define Respiratory Excursion
Lower lung border at level of T10 descends to T12 w/ inspiration
115
What spinous level does the trachea bifurcate?
Sternal angle and T4
116
What kind of breath sounds are heard over the trachea and bronchi?
Harsher quality than over parenchyma
117
What is the descending sequence of structures from the main bronchi?
```
Main
Lobar
Segmental
Bronchioles
Terminate
Alveoli
```
118
How does the actual lung tissue receive oxygenated blood?
Bronchial arteries from aorta, also perfuse the muscular wall of bronchi and bronchioles
119
Accessory muscles of inspiration?
Parasternals
Scalenes
Sternomastoids
Abd muscles
120
What is the best PT positions for examining the thorax?
Posterior- seated
| Anterior- supine
121
What is the sequence of steps for examining a thorax?
Inspection
Palpation
Percussion
Auscultation
122
What are the normal respiratory rates?
What can influence these?
Adult: 12-20
Child: 20-30
Infant: 30-60
Metabolism, Emotions, Neurologic, Obstructive
123
Define Kussmaul Breathing
Deep labored sighing respirations that are compensatory to metabolic acidosis
124
Define Cheyne-Stokes Breathing
Cyclic hyperventilating followed by compensatory apnea
125
Define Hyperpnea/ventilation
Any breathing pattern that reduces CO2 in blood due to inc rate and depth of respiration
126
Bradypnea is not a concern as long as ? test proves it's sufficient for life?
ABG
127
Define Obstructive, Painful and Restrictive abnormal breathing patterns?
Obstructive: expiration is prolonged from narrow airway
Restrictive: reduced lung capacity
Painful: pain from thoracic movement
128
If chest pain is said to be pleuritic means that it is caused by ?
Movement of breathing
129
Define Platypena and it's cause
Dyspnea worse w/ upright posture
| Pericarditis
130
When is an AP diameter > than lateral diameter seen?
Age
COPD
"Barrel Chest"
131
Bulging of interspaces during expiration indicates ?
Outflow obstruction (aneurysm) tumor or CHF
132
What are some S/Sx of respiratory compromise?
Retractions
Use of accessories: SCM and scalene
Pursing/cyanosis
Nasal flaring
133
Define Pectus Excavatum
Funnel Chest
Depression of lower sternum
Compresses the heart and great vessels, possible cause of murmurs
134
Define Pectus Carinatum
Pigeon Chest
| Sternum is displaced anteriorly, inc AP diameter while adjacent costal cartilage is depressed
135
Define Thoracic Kyphoscoiosis
Abnormal spinal curvature and vertebral rotation that deforms the chest
136
Flailed chest movement correlation to breathing
Inspiration- in
| Expiration- out
137
Define Lung Excursion
Placing hands on T10 and watching for equal rise and fall of chest expansion
138
What can cause Retraction of Interspace?
During inspiration due to obstruction- stridor, caved in
139
Define Fremitus
AKA Vocal Fremitus
| Palpable vibration transmitted through bronchopulmonary tree to chest wall during low frequency speech
140
Why is the words "99" repeated for tactile fremitus?
What are some preferred terms?
German word Neun-und-Neunzig
Boy oh Boy and Toy Boat- Diphthong Phrases
141
Tactile Fremitus is pathologically increased areas of ? like during ?
Can be decreased during ?
Consolidation, Pneumonia
Pleural effusion/pneumothorax (when liquid or air instead of lung)
142
Why is increased fremitus increased?
Sound waves transmitted w/ less decay in solid or fluid medium (consolidation) than in gas (aerated)
Pneumonia
143
Why is decreased fremitus decreased?
Pleural effusion, pneumothorax, COPD, thickened chest wall
| Pathology that separates the lung tissue from body wall and prevent sound transmission
144
What finger is used to percussive exam the thorax?
Pleximeter- middle
| Strike on distal interphalangeal joint
145
What are the meanings of flat, dull, resonating, hyperresonant and tympanic sounds during perussion?
Flat: thick effusion
Dull: pneumonia, small effusion, hemothorax, tumor
Resonance: normal, bronchitis
Hyper: air trapped (asthma, emphysema, small pneumothorax)
Tympanic: large pneumothorax
146
What does a positive CVA sign indicate?
Renal malady- pyelonephritis
147
What is the most important technique for assessing air flow through bronchial trees?
Auscultation
148
What is heard with the bell and diaphragm?
Bell: low frequency
Diaphragm: high
149
Define Vesicular Breath sounds
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
Define Bronchial Breath sounds
Louder and higher pitch with short silence between inspiration/expiration
Heard over manubrium
(Expiratory longer than inspiratory)
151
Define Tracheal breath sounds
Very loud high pitched heard over trachea (Darth Vader)
| Inspiratory=expiratory
152
Adventitous Sounds indicate what issues?
Cardiac or Pulmonary condition
153
Define Crackles
Intermittent non musical and brief from lung abnormality like pneumonia, fibrosis or early CF or or airways
154
Define Wheeze and Rhonchi
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
If crackles/wheezes and rhonchi are cleared after coughing, what does it suggest?
Inspissated secretions like bronchitis
156
Lymph nodes border what structures in the armpit?
C: axilla
L: humerus
A: pec major
P: scapula
157
What are the pharmacotherapy options for tobacco cessation?
Buproprion
| Varenicline
158
What are the two forms of the Step Pneumo vaccine?
Polysaccharide
| Conjugated
159
Gallbladder is generally not palpable except if ?
When is the lower pole of the R kidney possibly palpable?
Acute cholecystitis or CBD obstruction
Thin person with abd muscles relaxed
160
Define Sacral Promontory
Bony anterior edge of S1 and uterus and ovaries
161
What is the sequence of events for an abdominal exam
```
Inspection
Auscultation
Percussion
Palpation
(Pulm: IPPA)
```
162
How will PT present with peritonitis or with small bowel obstruction?
Still
| Moving
163
What color striae are normal and what color are pathologic?
Silver
| Pink-purple= Cushing's
164
What are the 4 contours of the abdomen
Flat- in shape
Round- obese
Protuberant- fat, poor muscles, inc abd contents/pregnancy/ascites/splenomegaly
Scaphoid- hollowed
165
Bulging flanks = ?
Visible intestinal peristalsis = ?
Ascites
Intestinal obstruction
166
Characteristics of localized bulges
Protrusion of fat, bowel and/or omentum through operative scar
167
Define Dehiscence
```
Spontaneous wound opening w/ inc incidence w/ infections
Skin- not bad
Fascial- bad.
After hernia repair- recurrent hernia
After abd surgyer- incision hernia
```
168
Define Epigastric Hernia
Midline protrusion through linea alba between xiphoid and umbilicus
Protrudes w/ head raise or shoulders
169
Define Diastasis Recti
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
Define Lipoma
Benign fatty tumor usually in subcutaneous tissue that are soft, lobulated and mobile
171
Auscultating bowels provides what info?
Where are sounds listened at?
Motility
RLQ due to sound transmission
172
What are "normal" bowel sounds?
Clicks/gurgles at 5-34/min
| Listen for 2min to declare sounds are absent
173
Define Borborygmi
Prolonged gurgles of hyperperistalsis
174
What does "high-pitched tinkling" abdominal sounds mean?
Intestinal fluid and air under tension in dilated bowel
175
Rushes of high-pitched sounds coinciding with an abdominal cramp indicates ?
Intestinal obstruction
176
Decreased or absent bowel sounds indicate ?
Ileus
| Peritonitis
177
Bruits w/ S/Diastolic components over renal arteries = ?
| Over iliac or femoral arteries = ?
Renal artery stenosis
Partial arterial occlusion or arterial insufficiency
178
Where is the stethoscope placed to listen for the renal arteries?
1" lateral to midline in upper quadrants or at CVA
179
Purpose of abdominal percussion
Assess amount and distribution of gas and fluid in abdomen and ID any masses that are solid or fluid filled
180
Why does tympany predominate in abdominal exams?
| When is it concerning?
Gas in GI tract
| Protuberant abdomen that is tympanic throughout= obstruction or ileus
181
What would a pneumoperitoneum sound like on abdomen percussion?
Loss of liver dullness, possible tympanic sound
182
If using both hands to palpate the abdomen, what is each hand doing?
Top= pressure
| Bottom- passive
183
Involuntary rigidity that persists despite relaxation techniques indicates ?
Peritoneal inflammation
184
Pulsing masses in the abdomen bigger than ? suggest AAA
| What are the risk factors
```
>3cm, rupture likely +5cm
+65
Hx of smoking
Male
1* relative w/ AAA repair Hx
```
185
When is the hook method preferred for palpating the liver?
PT is obese
186
When the spleen enlarges, which way does it move?
Anterior
Down
Medially
Replaces tympany of stomach and colon w/ dullness
187
Landmark for McBurney's
1/3 distance from ASIS
188
Pos McBurneys point is only applicable if the appendix is located where?
In Iliac fossa
Retrocecal appendicitis= flank pain presentation
189
If performing DRE on suspected appendix PT, what else can cause right sided rectal tenderness?
Inflammed pelvic appendix
| Uterine adnexa
190
What special test is good for identifying a retrocecal appendicitis or retroperitoneum abnormality?
Psoas sign
191
Function of the obturator muscle
What does a pos test mean
Lateral rotation and abduction of the hip and opposite movement stretches it
Inflamed pelvis appendix
192
Define Cutaneous Hyperesthesia
Fold skin along abdominal wall
193
Ascites can be caused by ?
Inc hydrostatic pressure from cirrhosis, CHF, pericarditis, dec osmotic pressure from nephrotic syndrome or malnutrition
194
Testing for CVA tenderness can indicate the presence of what three issues?
Retrocecal appendicitis
Hepatic abscess
Acute cholecystitis
195
Whom are umbilical hernias most commonly seen in?
Infants, usually close on own in 1-2yrs
196
What are the four criteria for describing bowel sounds?
Active
Increased/hyper
Dec/hypo
Absent
197
Percussion of the liver helps evaluate what three things?
Surface
Consistency
Tenderness
198
What are the normal liver span measurements?
6-12cm in R MCL
| 4-8 cm in MSL
199
Most abdominal aneurysms are located where?
Below renal arteries
200
What is a normal size of AA in PTs +50y/o?
<3.0cm
201
What can PT do to help locate/pin point pain if suspected appendicitis?
Cough
202
What Dzs have physical findings commonly seen in the LUQ?
```
Mono
PUD
Renal colic
Constipation
Cardiac Dz
```
203
What Dzs have physical findings commonly seen in the LLQ?
```
Constipation
Diverticulitis
Colon cancer
Ulcerative colitis
Ovarian cysts
```
204
What Dzs have physical findings commonly seen in the RLQ?
```
Renal colic
Appendicitis
Crohn's Dz
Ectopic pregnancy
Ovarian cysts
```
205
What questions are asked for pain?
OPQRST
206
What are the time frames for acute, subacute and chronic for this class?
Acute: < 3wks
Subacute: < 3-8wks
Chronic: > 8wks
Chronic Diarrhea: >30 days
207
Define Palliates
(asked during P for OPQRST)
| Makes Dz/Sx less sever w/out removing cause
208
What is the cause of Voluminous Diarrhea?
What are three causes of Osmotic Diarrhea?
Malabsorption
Lactose intolerance, Abuse/Osmotic purgatives, secretory diarrhea
209
Acute causes of upper abdominal discomfort/pain
```
GERD
Pancreatitis
Perforated ulcers
Cholecystitis
Cholangitis
```
210
Chronic causes of upper abdominal/pain
Dyspepsia
| Discomfort
211
Acute causes of lower abdominal pain?
Appendicitis
Bowel obstruction
Nephrolithiasis
Ovarian torsion
212
Chronic causes of lower abdominal pain?
IBDz
IBS
Endometriosis
213
Incisional hernia is a protrusion of what contents?
Fat
Bowel
Omentum
214
Renal bruit is most predictive when heard ? and ?
Systolic and Diastolic
215
Liver tenderness = ?
Hepatitis of any kind can cause ?
Hepatitis
Ascites, venous congestion, spider angiomas, jaundice
216
Criteria for acute cough?
| How long for chronic?
3wks or less
| +8 wks
217
Define Pulsus Alternans
Varying strength of pulse indicative of severe left ventricular dysfunction
218
Snaps
And Clicks
219
Which lymph nodes are most palpable?
Central
220
Pg 381 Table
Table pg 402
221
Characteristics of Pulsus Alternans
Strong then weak pulses from severe L ventricle dysfunction
222
Characteristics of Paradoxical PUlse
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
