Physical Diagnosis 2 Flashcards
Tracheal deviation causes
- large pleural effusion,
- large PTX
- Mass
Cheyne Stokes Breathing
- Gradualing increasing and decreasing resps w/ periods of apnea
- HF, uremia, drugs, brain damage
- can be normal in sleeping children/elderly
Kussmaul Breathing
Hyperventlation
Metabolic acidosis
Biots breathing
irregular, unpredictable, intermittent apnea
Respiratory depression, brain damage
Causes of limited chest excursion
- pleural fibrosis
- pleural effusion
- lobar pneumonia
- pain/splinting
What increases tactile fremitus?
Pneumonia/consolidation.
Everything else decreases
Hyper resonance
Very loud, low pitch, long duration.
COPD, PTX
Resonant
loud, low pitch, long duration
Chronic bronchitis
Tympanic
Loud, high pitch, moderate duration.
Large PTX
Dull
medium, moderate pitch, moderate duration.
Pneumonia, pleural effusion
Flat
soft, high pitch, short duration
pleural effusion
Tracheal breath sounds
Insp = Exp, loud, high pitch
Bronchial breath sounds
insp < exp, loud, high pitch
Bronchovesicular breath sounds
insp = exp, moderately loud, moderate pitch
vesicular breath soulnds
insp > exp, soft, low pitch
Positive egophony or bronchophony indicates…
lung consolidation or collapse, pneumonia, atelectasis, tumors
Crackles indicate…
bronchitis, pulmonary fibrosis, CHF
rhonchi indicates…
secretions in large airways… chronic bronchitis
wheeze indicates
airflow through narrow bronchi… asthma, COPD, chronic bronchitis, bronchus obstruction
Pleural friction rub indicates…
recent URI, pneumonia
Mediastical crunch
Hamman’s sign. Crackles in sync w/ heartbeat seen w/ mediastinal emphysema
Percussion: dull
Breath Sounds: bronchial, crackles
+ bronchophony, egophony, whispered pectoriloquy
increased tactile fremitus
Pneumonia
Percussion: dull to flat
Breath sounds: decreased or absent
Decreased voice sounds
Decreased tactile fremitus
Pleural effusion
Percussion: hyperresonant or tympanic
Breath sounds: decreased, possible pleural rub
Voice sounds: decreased
Fremitus: decreased
Pneumo
percussion: diffusely hyperresonant
breath sounds: decreased
voice sounds: decreased
fremitus: decreased
increased AP diameter
COPD
percussion: resonant, diffusely hyperresonant
breath sounds: wheeze, crackles
voice sounds: decreased
fremitus: decreased
accessory muscle use:
asthma
percussion: resonant
breath sounds: vesicular, crackles, wheezes, rhonchi
voice sounds: normal
fremitus: normal
chronic bronchitis
Ejection click:
valve disease, dilated aorta/pulm a.
systolic click
mitral valve prolapse, mid-systolic
JVP measures….. and evaluates…
right atrium pressure, heart failure
Key areas of auscultation:
Aortic: 2ICS, RSB
Pulmonic: 2ICS, LSB
Tricuspid: 4, 5 ICS, LSB
Mitral: 5th ICS, MCL (apex)
Accentuated S1 indicates:
tachy, fever, HTN, anemia, mitral stenosis, hyperthyroidism
Soft S1 indicates:
weak contraction–thick chest wall, emphysematous lung
Physiologic splitting of S2 is caused by…
lower right sided pressure during inspiration
Wide pathologic splitting of S2…
during inspiration.
pulmonic stenosis, mitral regurg, r. bundle branch block
Fixed pathologic splitting of S2
no changes during respiration
ASD, r. vent. failure
Paradoxcal splitting of S2
left bundle branch block
S3…
ventricular gallop, early diastole, rapid distension of ventricular walls. heard w/ bell at apex
heart failure, anemia, volume overload of ventricle, decreased myocardial contractility
S4
atrial gallop, heard w/ bell at apex. resistance to ventricular filling
HTD, CAD, AS, cardiomyopathy.
Pan/holo murmurs:
systolic tricuspid and mitral valve regurgitation
Crescendo-decrescendo murmurs:
systolic aortic stenosis
Midsystolic murmur:
ASD
Early diastolic, decrescendo
Aortic regurgitation
Mddiastolic murmur, decrescendo
Mitral and tricuspid stenosis
opening snap and diastolic rumble…
mitral stenosis
machinery like murmur
patent ductus arteriosus
Effect of standing or valsalva strain:
- decreased volume in LV, decreased venous return to heart.
- decreased BP, pulmonary vascular resistance
- most murmurs decrease, HCM increases, prolapse of MV increases
Effect of squatting or valsalva release
- increased volume in LV, increased venous return.
- Increased BP, PVR
- decreased HCM, decreased prolapse of MV, increased intensity of other murmors
Increased JVP (> 8cm)
heart failure, pulmonary HTN, increased vasc. tone, pericardial tamponade
Decreased JVP
blood loss, decreased vasc. tone
Allen test
assess patency of ulnar artery
Homan sign
calf pain on passive dorsiflexion of foot.
can indcate DT
soft papules and plaques in anogenital region…
condyloma acuminata
painful vesicles and ulcers on erythematous base…
genital herpes
painless papule that erodes into a painless ulcer.
syphilitic chancre
dysuria and urethral discharge, inclammed meatus
urethritis due to gonoccocal, or trachomatis
fibrosis in tunica albuginea. painful penile curvature, ED
peyronie’s disease
firm nodule or ulcer that doesn’t heal. nontender. +/- inguinal adeonopathy
carcinoma of penis
soft bag of worms, developed slowly, collapse if elevated scrotum while supine
varicocele. infertility association
swelling that transilluminates
Hydrocele
painless mass above testis, smaller than hydrocele
spermatocele
+Prehn’s sign (elevation provides releif
Fever/chills
hemi scrotal swelling
acute epididymitis
testicular tenderness and swelling
complication of mumps and epididymitis
acute orchitis
acute onset of scrotal pain
after trauma, vigorous activity
pain on palpation
absent cremasteric reflex
testicular torsion
Bright red bleading w/ defecation
internal hemorrhoid
tender, swollen, bluish mass at anal margin
external hemorrhoid
perianal erythema, palpable mass
can lead to anorectal fistula
anorectal abscess
firm, nodular mass
blood per rectum
rectal carcinoma
uti sxs, fever, chills
tender prostate
perineal or abdominal pain
acute prostatitis
recurrent UTI, normal prostate exam
chronic prostatitis
enlarged, firm nodule
irrecular contour
obstructive voiding sxs
carcinoma of prostate
