PE: Block 2 Flashcards
Inferior border of the RV lies below the junction of ? and ?
Sternum
Xyphoid process
Where is the base of the heart in terms of the sternum?
R/L 2ICS
What part of the heart is being felt when feeling for the PMI?
Where is the PMI felt at?
Apex at the 5th ICS
What PMI measurement is concerning?
Diameter of PMI >2.5cm or lateral displacement indicates LV Hypertrophy or Aortic stenosis
In an acutely unwell PT, what 3 S/Sx can all be signs of impending danger?
What about in non-acute PTs?
Cyanosis, Pallor, Diaphoresis
Cachexia
Define Cachexia
Loss of body mass that can not be reversed nutritionally
What cardiac issues are associated with Malar Flush, Xanthomata and Corneal Arcus?
M: Mitral Stenosis
X: Hyperlipidemia
C: Hyperlipidemia
What part of VS is one of the most informative of all clinical tests?
Pulse
When/why is checking both radial pulses simultaneously important?
Chest pain as a gross screening tool for aortic dissections
What are checking peripheral pulses an important predictor of?
What other areas are checked?
CAD
Femoral, popliteal, Post. Tibial, Dorsalis Pedia
While checking a PTs pulse, what other cardiac issue can be assessed with visual examination?
Infective Endocarditis: Clubbing Splinter hemorrhages Janeway Lesions Osler's nodes
When should the BP be taken?
After PT rests for 5min in quiet room w/ correct cuff size and arm at heart level
How is a BP cuff measured to a PTs arm?
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
What part of the stethoscope is used to take the manual BP?
Bell
When taking BPs, pump the cuff up how far and what do you listen for?
30mm above radial pulse then release at 2-3mm/sec
First 2 beats= SBP
Beats disappear= DBP
What are the BP levels for Pre/Stage 1/2 HTN for JCN7 and 2017 Criteria?
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
Ranges for OHOTN?
2-5min from supine to standing: Dec SBP +20mm Dec DBP +10mm Pulse inc +20 bpm Sx of cerebral HOTN
What are the 3 classifications of OHOTN?
Neurogenic- MS
Non-neurogenic
Iatrogenic- meds
Why is HR checked w/ OHOTN?
Lack of pulse response increase w/ BP drop= neurological cause
Visual and manual examination of the chest should look for what two things and where?
PMI
Ventricular movement of S3 and S4
What does the apical impulse represent?
LV pulsating and moving fwd to touch the anterior wall
Rolling PT on L side or lean fwd can assist with location
What are the reference points for locating the PMI?
Vertical: 4 or 5 ICS
Horizontal: distance from midsternal liine
Lateral displacement outside of MCL while supine= inc likelihood of heart enlargement
Heart diameter should be ? and occupy ? ICS
<2.5cm
Occupy less than one ICS
Define Amplitude
Small/brisk tapping
Hyperkinetic during excitement/after exercise
Hyperthyroid, severe anemia, aortic stenosis (inc press) or mitral regurgitation (vol inc)
Hand and finger pads are used to palpate over what areas to feel for deficits?
Valvular ares and sternum
Heaves, lifts or thrills
Define Thrills
Turbulence of underlying murmurs
Auscultate the area felt the palpate to appreciate
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
What is held as the key to physical exams?
Auscultation
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
If an abnormality is heard over aortic/pulmonary area or the apex, what needs to be listened to next?
Aorta/Pulmonary: Carotid
Apex: Axilla
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
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
Define Physiologic Splitting
Splitting of S2 when aortic valve occurs earlier that that of pulmonary valve during inspiration
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
Define Reverse/Paradoxical Splitting of S2
AV closure is delayed, like w/ bundle branch block or
PV closes early, like Woff-Parkinson-White Syndrome
When does a Widened Fixed Splitting of S2 occur?
When/how is it best heard?
Atrial Septal Defect
Erb’s Point
When and where are Bruits listened for?
Middle aged/elder PT and suspected cerebrovascular dz
PT holds breath and listen w/ bell on carotids
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
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
What type of peripheral pulse defect may be felt in Thyrotoxicosis and Hypermetabolic PTs?
Rapid and Rebounding
What type of peripheral pulse defect may be felt in Myxedema PTs?
Slow and sluggish
What is the next step if peripheral pulses are asymmetric?
Auscultate over peripheral vessels may detect bruit from stenosis
At a minimum, what peripheral locations are checked for pulses?
Carotid Radial Dorsalis pedia Posterior tibialis Femoral
How are pulses graded?
\+4: bounding \+3: increased, stronger than expected \+2: brisk, expected \+1: diminished, weaker than expected 0: absent, unable to palpate
What does clubbing on fingers suggest?
Chronic underlying issue
Inspect and palpate legs for what characteristics and what do irregularities suggest?
Edema Hair distribution Temp Varicosities Hyperpigmentation Sx of chronic circulation issues
Characteristics of S1
Lub
Starts systole- mitral/tricuspid valve closure best hear at apex
Characteristics of S2
Dub
Starts diastole- aortic/pulmonic valve closure best heard at 2ICS
Characteristics of S3
Lub du BUB
Heard soon after S2
From rapid/high volume filling of LV or passive atrial emptying
When/where is S3 heard best
Apex in left lateral decubitus position or along LLSB, below xiphoid w/ PT supine and louder on respiration
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
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”
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”
What can cause S4 to be audible?
Atrial contraction filling a stiff LV HTN heart CAD Diastolic HF Cardiomypoathy
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
How are murmurs described?
Timing
Location
Intensity
Other
Diastolic murmurs are indicative of ?
Murmurs that coincide with carotid upstroke is ?
Indicate Dz
Systolic
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
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
Define Ejection Click
After S1 occurs in aortic stenosis and pulmonic stenosis
Define Mid-Systolic Click
Mitral valve prolapse, abnormal systolic ballooning of mitral valve into L atrium
Mid systolic clicks are often followed by ?
Late systolic murmur of mitral regurgitation
When/where are opening snaps best heard?
Best w/ diaphragm medial to apex along LLSB that can radiate to apex and pulmonic area
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
When do pan/holosystolic murmurs start?
Sq through S2 with no diastolic component
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
What type of maneuver accentuates Tricuspid Regurgitation?
Inspiration (inc preload)
What are the most common kind of heart murmur?
Midsystolic ejection murmur that tend to peak near midsystole and stop before S2
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)
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
Characteristics of Physiologic Midsystolic murmur
Similar to innocents
Possibly caused by: anemia, pregnancy, fever, hyperthyroid
What are the 3 types of pathologic midsystolic murmurs?Ch
Aortic stenosis
Hypertrophic cardiomyopathy
Pulmonic stenosis
Characteristics of Aortic Stenosis
R2ICS that radiates to carotids or down to apex often w/ a loud thrill or medium de/cresendo pitch
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
What maneuvers accentuate HCM
Valsalva and standing (dec preload)- also inc MVP
Characteristics of Pulmonic Stenosis
2 and 3 LICS w/ loud thrill and/or de/crescendo pitch
Diastolic murmurs almost always indicate ?
Heart Dz
What are the types of diastolic murmurs?
Aortic regurgitation
Mitral stenosis
Characteristics of Aortic Regurgitation
2-4LICS radiation to apex/Rsternal border w/ blowing crescendo and high pitch heard w/ diaphragm
How are aortic regurgitation heard best?
PT sitting, leaning fwd and holding breath after exhalation
What causes aortic regurgitation to be audible?
Leaflets of aortic valve fail to completely close during diastole and blood regurgitates into aorta
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
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
Define Austin Flint Murmur and the characteristics
Result of mitral valve leaflet displacement and turbulent mixing of antegrade mitral flow and retrograde aortic flow
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
Define Systolic Click
Mitral valve prolapse usually mid/late systolic and followed by systolic murmur of mitral regurgitation
Where are Systolic Clicks heard
Common in 5% of population
Apex and LLSB as high pitched noise heard w/ diaphragm
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
Define a Venous Hum
Benign sound from turbulence of blood in jugular veins common in kids
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
Define Pericardial Friction Rub
From inflammation of pericardial sac best heard in L3ICS and increases w/ PT leaning forward
What does a Pericardial Friction Rub sound like and where is it heard?
Scratchy/Scraping sound heard w/ diaphragm
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
Why is HCM famous?
Leading cause of cardiac death in young adults
How is HCM listened for and accentuated?
Lay supine and valsalva
Diaphragm on L3ICS and sound inc w/ valsalva
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
FamHx of HCM murmur need what tests of a work up?
Hx/PE
ECG
Echocardiography annually between 12-18y/o
Slides 86
and 87, compare
Systolic murmur by position
RUSB- AS LUSB- PS, PDA Erb's- HCM LLSB- TR, VSD Apex- MR, MVP PS MR ASTER is HoME
Diastolic murmurs by position
LUSB- PI, Split S2
Erb’s- AI
LLSB- TS
Apex- MS
What are the continuous murmurs?
PAD- LUSB
Arteriovenous malformations
Venous hum
JVP provides info on what two things?
Volume status
Cardiac function
JVP reflects pressures where?
R atrium
Central venous pressure
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*
With HOB at 30*, JVP > ? is considered abnormally high
3-4cm
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
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
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
What are the 4 components of the lung exam?
What is the exam also used for?
Inspection
Palpation
Percussion
Auscultation
Examine heart and abdomen
How many palpable interspaces do we have?
7 palpable
What are the needle decompression and chest tube land marks?
ND- 2IS MCL
CT- 4IS MAL
When numbering ribs where do you start?
Bottom of the scapula is at what rib level?
Sternal angle of Louis
7th rib IS
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
Define Respiratory Excursion
Lower lung border at level of T10 descends to T12 w/ inspiration
What spinous level does the trachea bifurcate?
Sternal angle and T4
What kind of breath sounds are heard over the trachea and bronchi?
Harsher quality than over parenchyma
What is the descending sequence of structures from the main bronchi?
Main Lobar Segmental Bronchioles Terminate Alveoli
How does the actual lung tissue receive oxygenated blood?
Bronchial arteries from aorta, also perfuse the muscular wall of bronchi and bronchioles
Accessory muscles of inspiration?
Parasternals
Scalenes
Sternomastoids
Abd muscles
What is the best PT positions for examining the thorax?
Posterior- seated
Anterior- supine
What is the sequence of steps for examining a thorax?
Inspection
Palpation
Percussion
Auscultation
What are the normal respiratory rates?
What can influence these?
Adult: 12-20
Child: 20-30
Infant: 30-60
Metabolism, Emotions, Neurologic, Obstructive
Define Kussmaul Breathing
Deep labored sighing respirations that are compensatory to metabolic acidosis
Define Cheyne-Stokes Breathing
Cyclic hyperventilating followed by compensatory apnea
Define Hyperpnea/ventilation
Any breathing pattern that reduces CO2 in blood due to inc rate and depth of respiration
Bradypnea is not a concern as long as ? test proves it’s sufficient for life?
ABG
Define Obstructive, Painful and Restrictive abnormal breathing patterns?
Obstructive: expiration is prolonged from narrow airway
Restrictive: reduced lung capacity
Painful: pain from thoracic movement
If chest pain is said to be pleuritic means that it is caused by ?
Movement of breathing
Define Platypena and it’s cause
Dyspnea worse w/ upright posture
Pericarditis
When is an AP diameter > than lateral diameter seen?
Age
COPD
“Barrel Chest”
Bulging of interspaces during expiration indicates ?
Outflow obstruction (aneurysm) tumor or CHF
What are some S/Sx of respiratory compromise?
Retractions
Use of accessories: SCM and scalene
Pursing/cyanosis
Nasal flaring
Define Pectus Excavatum
Funnel Chest
Depression of lower sternum
Compresses the heart and great vessels, possible cause of murmurs
Define Pectus Carinatum
Pigeon Chest
Sternum is displaced anteriorly, inc AP diameter while adjacent costal cartilage is depressed
Define Thoracic Kyphoscoiosis
Abnormal spinal curvature and vertebral rotation that deforms the chest
Flailed chest movement correlation to breathing
Inspiration- in
Expiration- out
Define Lung Excursion
Placing hands on T10 and watching for equal rise and fall of chest expansion
What can cause Retraction of Interspace?
During inspiration due to obstruction- stridor, caved in
Define Fremitus
AKA Vocal Fremitus
Palpable vibration transmitted through bronchopulmonary tree to chest wall during low frequency speech
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
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)
Why is increased fremitus increased?
Sound waves transmitted w/ less decay in solid or fluid medium (consolidation) than in gas (aerated)
Pneumonia
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
What finger is used to percussive exam the thorax?
Pleximeter- middle
Strike on distal interphalangeal joint
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
What does a positive CVA sign indicate?
Renal malady- pyelonephritis
What is the most important technique for assessing air flow through bronchial trees?
Auscultation
What is heard with the bell and diaphragm?
Bell: low frequency
Diaphragm: high
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)
Define Bronchial Breath sounds
Louder and higher pitch with short silence between inspiration/expiration
Heard over manubrium
(Expiratory longer than inspiratory)
Define Tracheal breath sounds
Very loud high pitched heard over trachea (Darth Vader)
Inspiratory=expiratory
Adventitous Sounds indicate what issues?
Cardiac or Pulmonary condition
Define Crackles
Intermittent non musical and brief from lung abnormality like pneumonia, fibrosis or early CF or or airways
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
If crackles/wheezes and rhonchi are cleared after coughing, what does it suggest?
Inspissated secretions like bronchitis
Lymph nodes border what structures in the armpit?
C: axilla
L: humerus
A: pec major
P: scapula
What are the pharmacotherapy options for tobacco cessation?
Buproprion
Varenicline
What are the two forms of the Step Pneumo vaccine?
Polysaccharide
Conjugated
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
Define Sacral Promontory
Bony anterior edge of S1 and uterus and ovaries
What is the sequence of events for an abdominal exam
Inspection Auscultation Percussion Palpation (Pulm: IPPA)
How will PT present with peritonitis or with small bowel obstruction?
Still
Moving
What color striae are normal and what color are pathologic?
Silver
Pink-purple= Cushing’s
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
Bulging flanks = ?
Visible intestinal peristalsis = ?
Ascites
Intestinal obstruction
Characteristics of localized bulges
Protrusion of fat, bowel and/or omentum through operative scar
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
Define Epigastric Hernia
Midline protrusion through linea alba between xiphoid and umbilicus
Protrudes w/ head raise or shoulders
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
Define Lipoma
Benign fatty tumor usually in subcutaneous tissue that are soft, lobulated and mobile
Auscultating bowels provides what info?
Where are sounds listened at?
Motility
RLQ due to sound transmission
What are “normal” bowel sounds?
Clicks/gurgles at 5-34/min
Listen for 2min to declare sounds are absent
Define Borborygmi
Prolonged gurgles of hyperperistalsis
What does “high-pitched tinkling” abdominal sounds mean?
Intestinal fluid and air under tension in dilated bowel
Rushes of high-pitched sounds coinciding with an abdominal cramp indicates ?
Intestinal obstruction
Decreased or absent bowel sounds indicate ?
Ileus
Peritonitis
Bruits w/ S/Diastolic components over renal arteries = ?
Over iliac or femoral arteries = ?
Renal artery stenosis
Partial arterial occlusion or arterial insufficiency
Where is the stethoscope placed to listen for the renal arteries?
1” lateral to midline in upper quadrants or at CVA
Purpose of abdominal percussion
Assess amount and distribution of gas and fluid in abdomen and ID any masses that are solid or fluid filled
Why does tympany predominate in abdominal exams?
When is it concerning?
Gas in GI tract
Protuberant abdomen that is tympanic throughout= obstruction or ileus
What would a pneumoperitoneum sound like on abdomen percussion?
Loss of liver dullness, possible tympanic sound
If using both hands to palpate the abdomen, what is each hand doing?
Top= pressure
Bottom- passive
Involuntary rigidity that persists despite relaxation techniques indicates ?
Peritoneal inflammation
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
When is the hook method preferred for palpating the liver?
PT is obese
When the spleen enlarges, which way does it move?
Anterior
Down
Medially
Replaces tympany of stomach and colon w/ dullness
Landmark for McBurney’s
1/3 distance from ASIS
Pos McBurneys point is only applicable if the appendix is located where?
In Iliac fossa
Retrocecal appendicitis= flank pain presentation
If performing DRE on suspected appendix PT, what else can cause right sided rectal tenderness?
Inflammed pelvic appendix
Uterine adnexa
What special test is good for identifying a retrocecal appendicitis or retroperitoneum abnormality?
Psoas sign
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
Define Cutaneous Hyperesthesia
Fold skin along abdominal wall
Ascites can be caused by ?
Inc hydrostatic pressure from cirrhosis, CHF, pericarditis, dec osmotic pressure from nephrotic syndrome or malnutrition
Testing for CVA tenderness can indicate the presence of what three issues?
Retrocecal appendicitis
Hepatic abscess
Acute cholecystitis
Whom are umbilical hernias most commonly seen in?
Infants, usually close on own in 1-2yrs
What are the four criteria for describing bowel sounds?
Active
Increased/hyper
Dec/hypo
Absent
Percussion of the liver helps evaluate what three things?
Surface
Consistency
Tenderness
What are the normal liver span measurements?
6-12cm in R MCL
4-8 cm in MSL
Most abdominal aneurysms are located where?
Below renal arteries
What is a normal size of AA in PTs +50y/o?
<3.0cm
What can PT do to help locate/pin point pain if suspected appendicitis?
Cough
What Dzs have physical findings commonly seen in the LUQ?
Mono PUD Renal colic Constipation Cardiac Dz
What Dzs have physical findings commonly seen in the LLQ?
Constipation Diverticulitis Colon cancer Ulcerative colitis Ovarian cysts
What Dzs have physical findings commonly seen in the RLQ?
Renal colic Appendicitis Crohn's Dz Ectopic pregnancy Ovarian cysts
What questions are asked for pain?
OPQRST
What are the time frames for acute, subacute and chronic for this class?
Acute: < 3wks
Subacute: < 3-8wks
Chronic: > 8wks
Chronic Diarrhea: >30 days
Define Palliates
(asked during P for OPQRST)
Makes Dz/Sx less sever w/out removing cause
What is the cause of Voluminous Diarrhea?
What are three causes of Osmotic Diarrhea?
Malabsorption
Lactose intolerance, Abuse/Osmotic purgatives, secretory diarrhea
Acute causes of upper abdominal discomfort/pain
GERD Pancreatitis Perforated ulcers Cholecystitis Cholangitis
Chronic causes of upper abdominal/pain
Dyspepsia
Discomfort
Acute causes of lower abdominal pain?
Appendicitis
Bowel obstruction
Nephrolithiasis
Ovarian torsion
Chronic causes of lower abdominal pain?
IBDz
IBS
Endometriosis
Incisional hernia is a protrusion of what contents?
Fat
Bowel
Omentum
Renal bruit is most predictive when heard ? and ?
Systolic and Diastolic
Liver tenderness = ?
Hepatitis of any kind can cause ?
Hepatitis
Ascites, venous congestion, spider angiomas, jaundice
Criteria for acute cough?
How long for chronic?
3wks or less
+8 wks
Define Pulsus Alternans
Varying strength of pulse indicative of severe left ventricular dysfunction
Snaps
And Clicks
Which lymph nodes are most palpable?
Central
Pg 381 Table
Table pg 402
Characteristics of Pulsus Alternans
Strong then weak pulses from severe L ventricle dysfunction
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
