Phys Dx Exam 2 Flashcards
1
Q
Sterna Angle/ Angle of Louis
A
between the Manubrium & Sternal Body
2
Q
2nd Rib
A
lateral to Sternal Angle
3
Q
Bottom tip of Scapula
A
Correlates with 7th rib/intercostal space
4
Q
Lower lung borders
A
6th rib midclav line
8th rib midax line
T10 posteriorly
5
Q
Major Fissures
A
Aka Oblique fissures
Each side
6
Q
Minor Fissure
A
Only on R lung
Aka Horizontal fissure
7
Q
Trachea bifurcates at:
A
Anteriorly: level of Sternal angle
Posteriorly: T4
8
Q
Stridor
A
High pitched, usually inspiratory
- Obstruction or airway disease
- Croup in kids
9
Q
Tracheal Deviation
A
*Large pleural effusion, Large PNX, mass/tumor
10
Q
Accessory Muscle Usage
A
Sign of respiratory distress
Look for: SCM, Scalene, Supraclavicular muscles
*COPD, Asthma
11
Q
Pectus Excavatum
“Funnel Chest”
A
Sternum depressed
cave in the chest
12
Q
Barrel Chest
A
Increased A-P ratio (normal is 1:2)
*Aging, COPD
13
Q
Pectus Carinatum
“Pigeon Chest”
A
Sticking out like a pigeon beak
14
Q
Flail chest
A
rib fracture causing paradoxical movement of chest wall (EMERGENCY, secondary to trauma)
15
Q
Bradypnea
A
<12 breaths/min
Diabetic coma, drug induced
16
Q
Tachypnea
A
> 20 breaths/min
*Restrictive lung disease, elevated diaphragm, pain
17
Q
Hyperventilation
A
deeper, faster
*Metabolic acidosis, Kussmaul breathing
Pt’s are trying to breathe off CO2
18
Q
Sighing
A
Periodic deep breaths
Alveoli aren’t wanting to open and expand, involuntary reflex to help alveoli open back up
19
Q
Obstructive Breathing
A
Prolonged expiration
2/2 increased airway resistance
*Asthma, Chronic bronchitis, COPD
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
21
Q
Kussmaul Breathing
A
Rapid and deep
Hyperventilation pattern
*Metabolic acidosis
22
Q
Biot’s breathing
A
Irregular, unpredictable, shallow or deep with intermittent Apnea
*Respiratory depression, brain damage
23
Q
Crepitus
A
- Rib movement from fracture
* SubQ Emphysema (air under skin)
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
25
What causes Increased Fremitus? (vibration)
Consolidation/PNA
26
Resonant tone
Air (healthy lungs)
27
Dull tone
Solid (liver or other solid organs)
28
Flat tone
Muscle
29
Tympani tone
Hollow (GI bubble)
30
Hyper-resonant
not normal
| Very loud, low pitch, long duration
31
Resonant
Loud, low pitch, long duration
| *Healthy lungs
32
Tympanic
Loud, high pitch
| *GI bubble
33
Dull
Medium, moderate, moderate
| *Liver (or other solid organ)
34
Flat
Soft, high, short
| *Muscle
35
Abnormal Hyper-resonance
COPD, PTX
36
Abnormal Resonance
Chronic bronchitis
37
Abnormal Tympanic
Large PTX
38
Abnormal Dull
PNA, Pleural Effusion
39
Abnormal Flat
Pleural Effusion
40
Hyper-resonance
very loud, low, long
41
Resonant
loud, low, long
42
Tympanic
loud, high
43
Flat
soft, high, short
44
Where is inspiration longer than expiration?
Vesicular
45
Where is expiration longer than inspiration?
Bronchial
46
Expiration is longer than Inspiration in ...
Bronchial
47
Inspiration is longer than Expiration in ...
Vesicular
48
Where do you listen for Bronchial sounds
Manubrium
49
Where do you listen for Broncho-vesicular sounds
Anteriorly: 1&2 intercostal spaces
Posteriorly: Interscapular
50
Bronchophony
99, sound is louder
* Consolidation/collapse
* PNA, Atelectasis, Tumors
51
Egophany
Ask to say "E"
sounds like "Aaaye"
*Consolidation/collapse
*PNA, Atelectasis, Tumors
52
Adventitious lung sounds
Sounds are superimposed on usual breath sounds
| i.e. Crackles, Rhonchi, Wheezes
53
Crackles, Rhonchi, & Wheezes are examples of
Adventitious lung sounds
54
Crackles
Velco-like, discontinuous
Intermittent, not musical
Heard when small airways pop open during inspiration or when air bubbles flow through secretions or closed airways
55
Crackles
Bronchitis, Pulm Fibrosis, CHF
56
Rhonchi
Continuous, low pitched
Suggest secretions in larger airways, often cleared with cough
*Chronic Bronchitis
57
Wheeze
Continuous, high pitched
Rapid airflow through narrowed (almost closed) bronchi
High pitched, whistling
*Asthma, COPD, Chronic bronchitis, bronchus obstruction
*Stridor, inspiratory wheeze
58
Stridor
an Inspiratory wheeze
narrowed space
whistling
59
Pleural Friction Rub
Crackle like creaking sound
Inflamed pleural surface rubbing together
*Recent URI, PNA
60
Mediastinal Crunch
| "Hamman's Sign"
Precordial crackles in sync w/heartbeat
Not respiration
*Mediastinul emphysema
Best heard in left lateral position
61
Normal length for Diaphragmatic Excursion
3-5.5 cm
62
Bronchophony
Collapse/Consolidation
63
Pleural Effusion
Fluid collection within the chest but outside the lung, causing lung compression
64
Pneumothorax
air collection within the chest but outside the lung, causing lung compression
65
COPD
Overdistention of distal airspaces-->
| Limited expiratory flow and Lung hyperinflation
66
Consolidation/Infiltration
Alveoli filled w/fluid/blood/pus increasing the density and opacity of lungs
67
Pneumothorax exam signs:
Percussion: Hyperresonant or tympanic
Decreased or absent everything else
68
COPD
Percussion: Diffusely hyperresonant
Decreased or absent everything else
69
PNA (Consolidation)
Percussion: Dull
Tactile Fremitus and Breath Sounds: INCREASED
70
Pleural Effusion
Percussion: Dull
Decreased everything else
71
Precordium
anterior chest wall overlying the heart
72
PMI
Apical impulse: Point of maximal impulse
73
Diaphragm
high pitched sounds
| firm pressure
74
Bell
low pitched sounds
| light pressure
75
Four Key Areas to listen
Aortic- 2nd, Right sternal border
Pulmonic- 2nd, Left sternal border
Tricuspid- 4-5th, Left sternal border
Mitral- 5th, Midclavicular line
76
S1
"Lub"
closing of AV valves
best heard at apex (near triscuspid and mitral area)
77
Abnormal S1; Accentuated
Louder: diseased AV valve or more forceful closure
| i.e. Tachy, fever, HTN, exercise, anemia, hyperthyroid, mitral stenosis
78
Abnormal S1; Diminished
Softer: weak contraction of heart or reduced sound transmission
ie. Thick chest wall, emphysema lungs
79
S2
"Dub"
Closing of SL valves (aortic or pulmonic)
Best heard at the base (top of heart)
80
Physiologic Splitting of S2
Pulmonic valve (on right side of heart) closing occurs after the Aortic
1st: Aortic
2nd: Pulmonic
81
Pathologic Splitting of S2
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
Paradoxical Splitting
when A2 follows P2, UNUSUAL
Aortic is usually first
When L ventricle delays to contract i.e. LBBB
83
S3
Rapid ventricular filling
heard best with Bell at Apex
Could be normal in: children, young healthy adults, and pregnant women
84
Pathologic S3
over age 40
| Heart failure, anemia, volume overload, decreased contractility
85
S4
Low pitched sound
"Atrial kick" when atria contract to do the last part of the atrial contraction
Heart best with Bell at Apex
86
S3 and S4 best heard:
with Bell at Apex
87
S4
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
Pathologic S4
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
Characteristics of Murmurs
Intensity, pitch, quality, shape, timing, radiation
90
Murmur
prolonged heart sound made by blood rushing through:
- narrowed valve
- leaking valve
- wall b/w chambers of heart (abnormal!)
TURBULENT FLOW
91
grade 4 murmur
Loud, with palpable thrill
92
grade 5 murmur
Very loud, with palpable thrill heard with stethoscope partially off chest
93
grade 6 murmur
Very loud, with palpable thrill heard with stethoscope ENTIRELY off chest
94
grade 1 murmur
barely audible in quiet room
95
grade 2 murmur
quiet but clearly audible
96
grade 3 murmur
moderately loud
97
All systolic murmurs are what pitch?
Medium
98
Mitral and Tricuspid stenosis are what pitch?
Low
99
Innocent Systolic Murmur
common in children and young adults
| PATHOLOGIC: pregnant, anemia, fever, hyperthyroidism (increased flow across valve)
100
Characteristics of an Innocent Systolic Murmur
```
Grade 2 or less
Softer when sitting
Short systolic
Minimal radiation
MUSICAL
```
101
Atrial Septal Defect
shunting of blood from LA-> RA
102
Mitral Stenosis
LA--> LV
"Opening snap and diastolic rumble"
Narrowed valve
103
Continuous Murmur
Patent Ductus Arteriosus
When the channel b/w Pulmonary and Aortic artery fail to close after birth
"Machinery like"
104
To and Fro Murmur
systolic-diastolic murmur
Aortic stenosis/severe regurgitation
105
Ask pt to lean forward and exhale, listening at the base (top ) of heart
Best for hearing soft murmurs @ base:
Aortic Regurg
Pulmonic Regurg
106
Squatting and Release phase of Vasalva
Increase Aortic stenosis murmur sound
Hypertrophic Cardiomyopathy is opposite
107
Aortic or Pulmonic Ejection Click
High pitched
| Valve disease or dilated artery or pulmonary artery
108
Systolic Click
Mitral valve prolapse
Ballooning of mitral leaflet into left atrium
during systole
common: over 5% of general population has benign case
109
Venous hum
turbulent flow through jugular veins
both sys and diast
common in children
110
Pericardial friction rub
inflammation of pericardial sac
triphasic-3 components
Scratchy/squeaky,intermittent
111
Jugular Venous Pressure
indication of pressure in R. Atrium
112
Jugular venous pressure
best evaluated from Pulsations in the Right Internal Jugular Vein
113
Dominant movement of Right Jugular
inward
114
Characteristics of Right Jugular
Rarely palpable, soft biphasic (inward deflection), pulses eliminated with light pressure, height of pulsations can be changed w body position and inspiration
115
Sternal angle is how far above the Right midatrium?
5 cm
116
What is abnormal Jugular Venous Pressure?
Elevated >8cm above the Right Atrium
| -heart failure, pulmonary HTN, increased venous vascular tone, pericardial tamponade
117
Hepatojugular reflex (abdominojugular)
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
Thrill
buzzing or vibratory sensation
119
Use ball of hand to palpate for
Lift/Heave: vigorous cardiac impulse that can be seen/felt thru chest
120
Location of PMI
| point of maximal impulse
5th Intercostal space in Mid Clavicular Line
5th ICS in MCL
121
Lateral placement of PMI/Cardiac impulse
Left ventricular enlargement
122
PMI in epigastric region or xiphoid (more medial than normal)
Right Ventricular Hypertrophy
123
Cardiac percussion
listen for onset of dullness
124
Left lateral decubitis
have pt lie on side, brings apex closer to chest
Best for hearing low pitched sounds
Gallops, murmurs-mitral stenosis
125
MRG
Murmurs, rubs, gallops
126
SEM
Systolic ejection murmur
127
2+ brisk peripheral pulse
normal
128
Palpate Carotid Arteries
just inside medial border of relaxed Sternocleidomastoid Muscle
129
Carotid Upstroke palpation abnormalities
Small, thready, or weak: Cardiogenic shock
Bounding: Aortic regurgitation
Delayed: Aortic stenosis
130
Bruit
turbulent flow
131
High grade stenosis sound like what?
Low pitch
132
Allen test
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
Abnormal abdominal artery findings
Adults >50 yo
| abnormal: >3cm
134
Auscultate for Abdominal bruits
Aorta, Renal, Iliac, Femoral
135
Check for pitting edema
Dorsum of each foot
Behind medial malleolus
Over shins
136
Homan Sign
Calf pain with passive dorsiflexion
unreliable or presence of DVT
