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Quarter 2 > Phys Dx Exam 2 > Flashcards

Phys Dx Exam 2 Flashcards

1
Q

Sterna Angle/ Angle of Louis

A

between the Manubrium & Sternal Body

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2
Q

2nd Rib

A

lateral to Sternal Angle

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3
Q

Bottom tip of Scapula

A

Correlates with 7th rib/intercostal space

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4
Q

Lower lung borders

A

6th rib midclav line
8th rib midax line
T10 posteriorly

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5
Q

Major Fissures

A

Aka Oblique fissures

Each side

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6
Q

Minor Fissure

A

Only on R lung

Aka Horizontal fissure

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7
Q

Trachea bifurcates at:

A

Anteriorly: level of Sternal angle
Posteriorly: T4

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8
Q

Stridor

A

High pitched, usually inspiratory

  • Obstruction or airway disease
  • Croup in kids
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9
Q

Tracheal Deviation

A

*Large pleural effusion, Large PNX, mass/tumor

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10
Q

Accessory Muscle Usage

A

Sign of respiratory distress
Look for: SCM, Scalene, Supraclavicular muscles
*COPD, Asthma

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11
Q

Pectus Excavatum

“Funnel Chest”

A

Sternum depressed

cave in the chest

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12
Q

Barrel Chest

A

Increased A-P ratio (normal is 1:2)

*Aging, COPD

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13
Q

Pectus Carinatum

“Pigeon Chest”

A

Sticking out like a pigeon beak

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14
Q

Flail chest

A

rib fracture causing paradoxical movement of chest wall (EMERGENCY, secondary to trauma)

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15
Q

Bradypnea

A

<12 breaths/min

Diabetic coma, drug induced

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16
Q

Tachypnea

A

> 20 breaths/min

*Restrictive lung disease, elevated diaphragm, pain

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17
Q

Hyperventilation

A

deeper, faster
*Metabolic acidosis, Kussmaul breathing
Pt’s are trying to breathe off CO2

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18
Q

Sighing

A

Periodic deep breaths

Alveoli aren’t wanting to open and expand, involuntary reflex to help alveoli open back up

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19
Q

Obstructive Breathing

A

Prolonged expiration
2/2 increased airway resistance
*Asthma, Chronic bronchitis, COPD

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20
Q

Cheyne-Stokes Breathing

A

periods of gradually increasing and decreasing depths with periods of Apnea
Children: can be normal
Adults: *heart failure, uremia, brain damage, drug-induced

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21
Q

Kussmaul Breathing

A

Rapid and deep
Hyperventilation pattern
*Metabolic acidosis

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22
Q

Biot’s breathing

A

Irregular, unpredictable, shallow or deep with intermittent Apnea
*Respiratory depression, brain damage

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23
Q

Crepitus

A
  • Rib movement from fracture

* SubQ Emphysema (air under skin)

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24
Q

SubQ Emphysema

A

Air from lung/chest along tissue planes
Swelling of eyelids, cheeks, lips, nec, chest
*Lung injury (rib fx), postop thoracic surgery, etc

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25
Q

What causes Increased Fremitus? (vibration)

A

Consolidation/PNA

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26
Q

Resonant tone

A

Air (healthy lungs)

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27
Q

Dull tone

A

Solid (liver or other solid organs)

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28
Q

Flat tone

A

Muscle

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29
Q

Tympani tone

A

Hollow (GI bubble)

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30
Q

Hyper-resonant

A

not normal

Very loud, low pitch, long duration

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31
Q

Resonant

A

Loud, low pitch, long duration

*Healthy lungs

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32
Q

Tympanic

A

Loud, high pitch

*GI bubble

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33
Q

Dull

A

Medium, moderate, moderate

*Liver (or other solid organ)

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34
Q

Flat

A

Soft, high, short

*Muscle

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35
Q

Abnormal Hyper-resonance

A

COPD, PTX

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36
Q

Abnormal Resonance

A

Chronic bronchitis

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37
Q

Abnormal Tympanic

A

Large PTX

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38
Q

Abnormal Dull

A

PNA, Pleural Effusion

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39
Q

Abnormal Flat

A

Pleural Effusion

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40
Q

Hyper-resonance

A

very loud, low, long

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41
Q

Resonant

A

loud, low, long

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42
Q

Tympanic

A

loud, high

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43
Q

Flat

A

soft, high, short

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44
Q

Where is inspiration longer than expiration?

A

Vesicular

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45
Q

Where is expiration longer than inspiration?

A

Bronchial

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46
Q

Expiration is longer than Inspiration in …

A

Bronchial

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47
Q

Inspiration is longer than Expiration in …

A

Vesicular

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48
Q

Where do you listen for Bronchial sounds

A

Manubrium

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49
Q

Where do you listen for Broncho-vesicular sounds

A

Anteriorly: 1&2 intercostal spaces
Posteriorly: Interscapular

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50
Q

Bronchophony

A

99, sound is louder

  • Consolidation/collapse
  • PNA, Atelectasis, Tumors
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51
Q

Egophany

A

Ask to say “E”
sounds like “Aaaye”
*Consolidation/collapse
*PNA, Atelectasis, Tumors

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52
Q

Adventitious lung sounds

A

Sounds are superimposed on usual breath sounds

i.e. Crackles, Rhonchi, Wheezes

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53
Q

Crackles, Rhonchi, & Wheezes are examples of

A

Adventitious lung sounds

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54
Q

Crackles

A

Velco-like, discontinuous
Intermittent, not musical
Heard when small airways pop open during inspiration or when air bubbles flow through secretions or closed airways

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55
Q

Crackles

A

Bronchitis, Pulm Fibrosis, CHF

56
Q

Rhonchi

A

Continuous, low pitched
Suggest secretions in larger airways, often cleared with cough
*Chronic Bronchitis

57
Q

Wheeze

A

Continuous, high pitched
Rapid airflow through narrowed (almost closed) bronchi
High pitched, whistling
*Asthma, COPD, Chronic bronchitis, bronchus obstruction
*Stridor, inspiratory wheeze

58
Q

Stridor

A

an Inspiratory wheeze
narrowed space
whistling

59
Q

Pleural Friction Rub

A

Crackle like creaking sound
Inflamed pleural surface rubbing together
*Recent URI, PNA

60
Q

Mediastinal Crunch

“Hamman’s Sign”

A

Precordial crackles in sync w/heartbeat
Not respiration
*Mediastinul emphysema
Best heard in left lateral position

61
Q

Normal length for Diaphragmatic Excursion

A

3-5.5 cm

62
Q

Bronchophony

A

Collapse/Consolidation

63
Q

Pleural Effusion

A

Fluid collection within the chest but outside the lung, causing lung compression

64
Q

Pneumothorax

A

air collection within the chest but outside the lung, causing lung compression

65
Q

COPD

A

Overdistention of distal airspaces–>

Limited expiratory flow and Lung hyperinflation

66
Q

Consolidation/Infiltration

A

Alveoli filled w/fluid/blood/pus increasing the density and opacity of lungs

67
Q

Pneumothorax exam signs:

A

Percussion: Hyperresonant or tympanic

Decreased or absent everything else

68
Q

COPD

A

Percussion: Diffusely hyperresonant

Decreased or absent everything else

69
Q

PNA (Consolidation)

A

Percussion: Dull

Tactile Fremitus and Breath Sounds: INCREASED

70
Q

Pleural Effusion

A

Percussion: Dull

Decreased everything else

71
Q

Precordium

A

anterior chest wall overlying the heart

72
Q

PMI

A

Apical impulse: Point of maximal impulse

73
Q

Diaphragm

A

high pitched sounds

firm pressure

74
Q

Bell

A

low pitched sounds

light pressure

75
Q

Four Key Areas to listen

A

Aortic- 2nd, Right sternal border
Pulmonic- 2nd, Left sternal border
Tricuspid- 4-5th, Left sternal border
Mitral- 5th, Midclavicular line

76
Q

S1

A

“Lub”
closing of AV valves
best heard at apex (near triscuspid and mitral area)

77
Q

Abnormal S1; Accentuated

A

Louder: diseased AV valve or more forceful closure

i.e. Tachy, fever, HTN, exercise, anemia, hyperthyroid, mitral stenosis

78
Q

Abnormal S1; Diminished

A

Softer: weak contraction of heart or reduced sound transmission
ie. Thick chest wall, emphysema lungs

79
Q

S2

A

“Dub”
Closing of SL valves (aortic or pulmonic)
Best heard at the base (top of heart)

80
Q

Physiologic Splitting of S2

A

Pulmonic valve (on right side of heart) closing occurs after the Aortic

1st: Aortic
2nd: Pulmonic

81
Q

Pathologic Splitting of S2

A

Delayed closure of pulmonic
Wide: increase during respiration
i.e.: pulmonic stenosis, mitral regurgitation (regurg on the L), RBBB
Fixed: no varying with inspiration
i.e. atrial septal defect, R. ventricle failure

82
Q

Paradoxical Splitting

A

when A2 follows P2, UNUSUAL
Aortic is usually first
When L ventricle delays to contract i.e. LBBB

83
Q

S3

A

Rapid ventricular filling
heard best with Bell at Apex
Could be normal in: children, young healthy adults, and pregnant women

84
Q

Pathologic S3

A

over age 40

Heart failure, anemia, volume overload, decreased contractility

85
Q

S4

A

Low pitched sound
“Atrial kick” when atria contract to do the last part of the atrial contraction
Heart best with Bell at Apex

86
Q

S3 and S4 best heard:

A

with Bell at Apex

87
Q

S4

A

may be normal in trained athletes or some older individuals (without heart disease!)

think, these people have well trained Atria that can contract better to help blood into the ventricles

88
Q

Pathologic S4

A

Atrial gallop
over age 40
Resistance to ventricular filling, stiffness of heart, HTN, CAD, AS, Cardiomyaophty
Right sided S4 from Lung stuff: Pulmonary HTN, Pulmonary stenosis

89
Q

Characteristics of Murmurs

A

Intensity, pitch, quality, shape, timing, radiation

90
Q

Murmur

A

prolonged heart sound made by blood rushing through:

  • narrowed valve
  • leaking valve
  • wall b/w chambers of heart (abnormal!)

TURBULENT FLOW

91
Q

grade 4 murmur

A

Loud, with palpable thrill

92
Q

grade 5 murmur

A

Very loud, with palpable thrill heard with stethoscope partially off chest

93
Q

grade 6 murmur

A

Very loud, with palpable thrill heard with stethoscope ENTIRELY off chest

94
Q

grade 1 murmur

A

barely audible in quiet room

95
Q

grade 2 murmur

A

quiet but clearly audible

96
Q

grade 3 murmur

A

moderately loud

97
Q

All systolic murmurs are what pitch?

A

Medium

98
Q

Mitral and Tricuspid stenosis are what pitch?

A

Low

99
Q

Innocent Systolic Murmur

A

common in children and young adults

PATHOLOGIC: pregnant, anemia, fever, hyperthyroidism (increased flow across valve)

100
Q

Characteristics of an Innocent Systolic Murmur

A 
Grade 2 or less
Softer when sitting
Short systolic
Minimal radiation
MUSICAL
101
Q

Atrial Septal Defect

A

shunting of blood from LA-> RA

102
Q

Mitral Stenosis

A

LA–> LV
“Opening snap and diastolic rumble”
Narrowed valve

103
Q

Continuous Murmur

A

Patent Ductus Arteriosus
When the channel b/w Pulmonary and Aortic artery fail to close after birth
“Machinery like”

104
Q

To and Fro Murmur

A

systolic-diastolic murmur

Aortic stenosis/severe regurgitation

105
Q

Ask pt to lean forward and exhale, listening at the base (top ) of heart

A

Best for hearing soft murmurs @ base:
Aortic Regurg
Pulmonic Regurg

106
Q

Squatting and Release phase of Vasalva

A

Increase Aortic stenosis murmur sound

Hypertrophic Cardiomyopathy is opposite

107
Q

Aortic or Pulmonic Ejection Click

A

High pitched

Valve disease or dilated artery or pulmonary artery

108
Q

Systolic Click

A

Mitral valve prolapse
Ballooning of mitral leaflet into left atrium

during systole

common: over 5% of general population has benign case

109
Q

Venous hum

A

turbulent flow through jugular veins

both sys and diast

common in children

110
Q

Pericardial friction rub

A

inflammation of pericardial sac

triphasic-3 components

Scratchy/squeaky,intermittent

111
Q

Jugular Venous Pressure

A

indication of pressure in R. Atrium

112
Q

Jugular venous pressure

A

best evaluated from Pulsations in the Right Internal Jugular Vein

113
Q

Dominant movement of Right Jugular

A

inward

114
Q

Characteristics of Right Jugular

A

Rarely palpable, soft biphasic (inward deflection), pulses eliminated with light pressure, height of pulsations can be changed w body position and inspiration

115
Q

Sternal angle is how far above the Right midatrium?

A

5 cm

116
Q

What is abnormal Jugular Venous Pressure?

A

Elevated >8cm above the Right Atrium

-heart failure, pulmonary HTN, increased venous vascular tone, pericardial tamponade

117
Q

Hepatojugular reflex (abdominojugular)

A

Firm pressure on RUQ for 10 seconds
observe neck, should increase and then go away when you release pressure

ABNORMAL: >3 cm increase or remains elevated after you take your hand off

118
Q

Thrill

A

buzzing or vibratory sensation

119
Q

Use ball of hand to palpate for

A

Lift/Heave: vigorous cardiac impulse that can be seen/felt thru chest

120
Q

Location of PMI

point of maximal impulse

A

5th Intercostal space in Mid Clavicular Line

5th ICS in MCL

121
Q

Lateral placement of PMI/Cardiac impulse

A

Left ventricular enlargement

122
Q

PMI in epigastric region or xiphoid (more medial than normal)

A

Right Ventricular Hypertrophy

123
Q

Cardiac percussion

A

listen for onset of dullness

124
Q

Left lateral decubitis

A

have pt lie on side, brings apex closer to chest
Best for hearing low pitched sounds
Gallops, murmurs-mitral stenosis

125
Q

MRG

A

Murmurs, rubs, gallops

126
Q

SEM

A

Systolic ejection murmur

127
Q

2+ brisk peripheral pulse

A

normal

128
Q

Palpate Carotid Arteries

A

just inside medial border of relaxed Sternocleidomastoid Muscle

129
Q

Carotid Upstroke palpation abnormalities

A

Small, thready, or weak: Cardiogenic shock

Bounding: Aortic regurgitation

Delayed: Aortic stenosis

130
Q

Bruit

A

turbulent flow

131
Q

High grade stenosis sound like what?

A

Low pitch

132
Q

Allen test

A

testing the Ulnar artery to make sure it’s okay to puncture the radial artery for blood gas evaluation

The cool test, make a first, block arteries, watch hand be white, release and blood flushes back

133
Q

Abnormal abdominal artery findings

A

Adults >50 yo

abnormal: >3cm

134
Q

Auscultate for Abdominal bruits

A

Aorta, Renal, Iliac, Femoral

135
Q

Check for pitting edema

A

Dorsum of each foot
Behind medial malleolus
Over shins

136
Q

Homan Sign

A

Calf pain with passive dorsiflexion

unreliable or presence of DVT

Quarter 2 (16 decks)

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