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PAM Semester 1 > Physical Diagnosis Exam 2 > Flashcards

Physical Diagnosis Exam 2 Flashcards

1
Q

Cough

A

response to irritant

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2
Q

Prostate gland location

A

Lies against the anterior rectal wall

Rounded, heart sharped

about 2.5cm long

lateral lobes nad median sulcus are palpable

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3
Q

5 tanner stage descriptions in boys

Stage 2

A
  • Public hair: Sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, chiefly at the base of the penis
  • Penis: Slight or no enlargement
  • Testes larger; scrotum larger, somewhat reddened, and altered in texture
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4
Q

Scalene muscle use

A

Used continuosly in COPD

Unable to see

Use fingers to palpate

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5
Q

Lower margin for et tube on x ray

A

T4, 2-3 cm above carina

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6
Q

Strawberry cervix

A

Vaginitis

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7
Q

Pneumothorax

A

acute onset of unilateral chest pain and dyspnea

unilateral expansion

decreased tactile fremitus

hyperresonance

diminshed breath sounds

mediastinal shift

cyanosis

hypotension in tension pneumothorax

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8
Q

Heavies or lifts

A

abnormal ventricular movements

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9
Q

Carotid pulse quality

A

Upstroke may be

Brisk = normal

delayed = aortic stenosis

bounding = suggests aortic insufficiency

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10
Q

5 tanner stage descriptions in boys

Stage 4

A
  • Pubic hair: Coarse and curly hair, as in the adult; area covered greater than in stage 3, but not as great as in the adult and not yet including the thighs
  • Penis: Further enlarged in length and breadth, with development of the glans
  • Testes and Scrotum: Further enlarged; scrotal skin darkened
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11
Q

5 tanner stage descriptions in girls

Stage 1

A

Stage 1: No hair. No glandular breast tissue palpable

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12
Q

Pediatric SVT

A

Most common rhythm disturbance in children

0.1 - 0.4% of population, 7% in patients with congenital defects

majority of patients are structurally normal

HR is age dependant, infants = 220-280, children/teens = 180-240

usually 10-15 minutes, can be hours

in early infancy often resolves by year 1

if presetn after 5 y/o, tends to persist

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13
Q

Grey turners sign

A

Necrotizing pancreatitis

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14
Q

Breathing Pattern Wave forms

A
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15
Q

cremasteric reflex

A

Testicular torsion

tickle thigh

watch for testicular retraction

no movement means a positive test

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16
Q

Rectum vs anus

A
  • A serrated line demarcates the anal canal from the rectum
  • The anorectal junction (often called the pectinate or dentate line) is the boundary between somatic and visceral nerve supplies
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17
Q

Site for decompression

A

2nd intercostal space, mid clavicular

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18
Q

ChronIc Bronchitis

A

Blue Bloater

Chronic bronchitis

Type of COPD

Obese, long expiration,

crackles, wheezes

edema, cyanosis

hemoptysis

productive cough

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19
Q

Membrane of scrotum

A

Tunica vaginalis

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20
Q

Vas deferens

A

Cordlike structure begins at tail of epididymis

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21
Q

What is the best anatomical place for a needle insertion with suspected tension pneumothorax?

A.1st ICS space

B.2nd ICS space

C.3rd ICS space

D.4th ICS Space

A

A.2nd ICS space

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22
Q

Irregular breathing patterns

A

Biots breathing (CNS injury)

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23
Q

Harsh, high-pitched sound during inspiration caused by laryngeal, tracheal or large upper obstruction airway disease/obstruction is this?

A.Stridor

B.Wheeze

C.Rale

D.Crackle

A

A.Stridor

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24
Q

Arrhythmias

in a symptomatic child

common symptoms

A
  • Weakness
  • Tiredness
  • Palpitations
  • Feeling lightheaded or dizzy
  • Fainting or near fainting
  • Paleness
  • Chest pain
  • A slow heartbeat
  • A fast heartbeat
  • Feeling pauses between heartbeats
  • Sweating
  • Shortness of breath
  • Irritability in infants
  • Difficulty feeding (infants)
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25
Q

Decreased bronchophony are related to all of the following conditions except for..

A.Asthma

B.COPD

C.Pleural effusion

D.Pneumonia

A

D.Pneumonia

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26
Q

Afterload

A

Factor in pressure overload

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27
Q

Breast exam techniques

A
  • Males - Palpate areola and breast tissue for nodules
  • Typically done without gloves to improve detection of abnormality•

Patient is supine with ipsilateral hand behind head or next to head

•Be sure to capture the tail of Spence in your exam

Axilla and chest wall

infraclavicular and supraclavicular nodes

3 method = vertical, radial (star), spiral

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28
Q

Normal S2 splitting

A

able to hear two distinct sounds

1st aortic, then pulmonic

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29
Q

Emphysema

A

Pink Puffer

Emphysema

Type of COPD

Dyspnea, minimal cough

increased minute ventilation

pink skin

pursed lips, accessory muscle use

hyperinflation, barrel chest

Tachypnea

decreased breath sounds

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30
Q

5 tanner stage descriptions in girls

Stage 2

A

Stage 2: Downy hair. Breast bud palpable under the areola (1st pubertal sign in females)

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31
Q

Sexual history 5 P’s

A

Partners

Practices

Protection (STD’s)

Past history

Prevention of pregnancy

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32
Q

Tieze syndrome

A

Slipping rib syndrome

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33
Q

A sign which confirms the presence of peritonitis is:

a. Borborygmus
b. Friction rub
c. Voluntary guarding
d. Rebound tenderness

A

d.Rebound tenderness

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34
Q

Whisper pectorilquy

A

Whisper 99

should only hear faint sounds or no sounds

if you hear sounds well, consolidation

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35
Q

S1 heart sound

A

Caused by closure of AV valves

best heard at apex

slightly longer than S2

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36
Q

Preload

A

factor in volume overload

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37
Q

Splenic Percussion

A
  • To detect an enlarged spleen, percuss the lowest interspace in the left anterior axillary line.
  • Shifting from tympany to dullness with inspiration suggests an enlarged spleen. This is a positive splenic percussion sign.
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38
Q

Central cyanosis Peds

A

Congenital heart disease

Cyanotic cardiac lesions account for approximately 15 % of all congenital heart disease (CHD) cases and 1/3 of potentially fatal forms of CHD

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39
Q

Bowel Sounds

A

borborygmi

•The normal frequency of sound is 5-34 sounds per minute.

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40
Q

PMI indications

A

Tapping = normal

Sustained = suggests LVH due to hypertension, or aortic stenosis

Diffuse = dilated ventricle due to congenital heart failure and cardiomyopathy

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41
Q

Translumination

A

Scrotal assessment

masses

hernias

enlargment

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42
Q

Ill vs well breath sounds

A
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43
Q

Kehrs sign

A

Pain in left shoulder

Splenic rupture

Ectopic prenancy

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44
Q

Diastolic BP

A

Pressure generated by blood remaining in the arterial tree during diastole when ventricles are relaxed

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45
Q

Increased AP diameter

A

COPD

Barrel CHest

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46
Q

When examining a patient for the apical impulse (PMI), which of the following is LEAST important to assess?

a. Location
b. Amplitude
c. Rhythm
d. Diameter

A

c.Rhythm

•Assess location, amplitude, duration, and diameter

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47
Q

Dysmenorrhea

A

Pain with menstuation

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48
Q

inguinal hernia types

A

indirect (most common)

all ages, children as well

direct

men over 40

femoral hernias (least common)

more in women

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49
Q

Listening for S3 in LL deQ position, what part of the stethoscope should be used?

A.Bell

B.Diaphragm

A

A.Bell

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50
Q

Broncophony

A

99

Increased =

Consolidation, segmental atelectasis

Decreased =

Hyperinflation, pneumothorax, COPD, asthma, pleural effusion

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51
Q

Testicular torsion

A

Sudden severe pain

surgical emergency

swelling

spermatic cord is wrapped around

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52
Q

Which Tanner Stage of Male correlates with darker, coarser, curlier hair spreading sparsely over the pubic symphysis?

A.Stage 1

B.Stage 2

C.Stage 3

D.Stage 4

E.Stage 5

A

A.Stage 3

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53
Q

Percussion sounds

A

Flatness

dullness

resonance

hyperresonance

tympany

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54
Q

Wheeze description

A

Musical respiratory sounds

Whistling sound

louder on expiration

caused by small airway obstruction

Distal airway obstruction

  • TB
  • Bronchitits, bronchiolitis
  • ASthma, COPD, Emphysema
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55
Q

Stridor

A
  • Harsh high pitched sound during inspiration caused by laryngeal, tracheal or large upper obstruction airway disease / obstruction
  • Etiologies: Epiglotitis, Laryngitis, Retropharyngeal abscess
  • Inspiratory and expiratory
  • Barking cough
  • Retractions involve subcostal and intercostal spaces
  • Cyanosis even with O2
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56
Q

5 tanner stage descriptions in boys

Stage 3

A
  • Pubic hair: Darker, coarser, curlier hair spreading sparsely over the pubic symphysis
  • Penis: Larger, especially in length
  • Testes and scrotum: Further enlarged
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57
Q

Ventricular Septal Defect (VSD)

A

most common cardiac abnormality

Often not heard at birth, but as the ductus arteriosus closes and the pressure gradient between the two ventricles becomes greater the murmur intensifies

Best heard at the left lower sternal border as a harsh murmur often on day 2 or 3.

Holo- or pansystolic murmur

Many VSDs will close spontaneously over the course of several weeks to months.

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58
Q

How many lobes of the lungs are there?

A.3

B.4

C.5

D.6

A

C.5

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59
Q

Colorectal cancer

A

older than 50, median age is 68

family history is very important

3 - 10% have first degree relative

Male, black, highest incidence

45 years and older to get screening

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60
Q

A patient you are seeing complains of a sore on his lower leg that does not seem to get better. Based on examination findings, you suspect venous insufficiency. Which of the clinical findings below would suggest venous insufficiency as the cause of his problem?

a. Leg discomfort is exacerbated by dependency
b. Hyperpigmentation is present around the lower calf area
c. Ulceration is present on the medial side of the ankle
d. Affected leg feels warm to the touch
e. All the above

A

e.All the above

  • Leg discomfort is exacerbated by dependency
  • Hyperpigmentation is present around the lower calf area
  • Ulceration is present on the medial side of the ankle
  • Affected leg feels warm to the touch
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61
Q

Grade of edema

A

1+ slight pitting no visible distortion, disappears rapidly

2+ somewhat deeper pit, still no readily detectable distortion and disappears in 10-15 seconds

3+Pit is noticeably deep and may last more than a minute

4+ Pit is very deep, lasts as long as 2-5 minutes

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62
Q

What is that practitioner checking for?

A.Regurgitant murmurs

B.PMI

C.S3

A

C.S3

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63
Q

parietal pain

A

Parietal pain is more severe and is usually easily localized (appendicitis)

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64
Q

S 2 splitting occurs more with

A.Inspiration

B.Expiration

A

A.Inspiration

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65
Q

What do jugular veins represent in the heart

A

Right atrial pressure

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66
Q

Causes of snoring / gurgling

A

Disorders in nasopharnyx

Hypertrophied tonsils (palatine)

Hypertrophied adenoids (pharyngeal tonsils)

nasla polyps

Foreign body

rhinitis

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67
Q

Diastasis recti

A

Abdominal muscles seperate

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68
Q

Hypospadias

A

displacement of the urethra

(underneath/back/ventral)

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69
Q

What to listen fo with Bell of Stethoscope

A

•Accentuates lower frequency sounds & murmurs

–Diastolic “gallops”

  • S3
  • S4

–Diastolic rumbles

  • Mitral
  • Tricuspid

–Don’t press the bell into the skin thus creating another diaphragm, just rest the bell on the skin

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70
Q

Cardiac output

A

Stroke volume x heart rate

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71
Q

Where does the trachea bifurcate

A

at the carina into mainstem bronchi at sternal angle anteriorly T4 spinous process posteriorly

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72
Q

Right lung demarcation lines

A

horizontal fissure (top) oblique fissure

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73
Q

Menopause

A

absence of menses for 12 consecutive months

typically around 55 years of age

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74
Q

Best evaluation of a murmur

A.EKG

B.Echocardiogram

C.CPR

D.Cardiac cath

A

B.Echocardiogram

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75
Q

Blood pressure formula

A

Cardiac output

x

systemic vascular resistance

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76
Q

Visceral pain

A

Visceral pain is usually gnawing, cramping, or aching and is often difficult to localize

Hollow or solid organs

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77
Q

Depth of deep abdmoinal palpation

A

2-3 inches

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78
Q

Breast exam guidlines

U.S. Preventative Services Task Force

A

U.S. Preventative Services Task Force—average risk women

Mammogram = 50–74 years—biennially

Clincial breast exam = over 40

Breast self exam = recommend against BSE

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79
Q

High risk breast cancer screening

A

MRI at 25 for BRCA1 and BRCA2

MRI at 30 if famiy member

high risk women should have clinical exam every 6-12 months

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80
Q

Thrills

A

turbulence

damaged heart valve

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81
Q

Tanner stages Males

What are 3 charecterisitics

A

Pubic hair

penis size

testes/scrotum

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82
Q

Pediatric SVT symptoms in infants

A

Pallor, fussiness, poor feeding, cyanosis

sweating while eating

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83
Q

S3 Heart sound

A

Caused by rapid ventricular filling in early diastole

low pitched

best heard with bell at apex

occurs just after S2

resembles galloping horse

normal in children

pathological in 30-35 (LV failure, anemis, thyotoxicosis)

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84
Q

menarche

A

Age of onset of menstuation

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85
Q

HPV test women

A

tested with PAP

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86
Q

Cough durations

A

Acute less than 3 weeks

sub acute 3-8 weeks

chronic 8 weeks or longer

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87
Q

Tachypnea

A

20-25 Breaths per minute

Metabolic acidosis

DKA

Hypoxemia

stimulants

anxiety

Pain

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88
Q

Epididymis

A

On the posterolateral surfcae of each teste

soft, comma shape

is a reservoir for storage, maturation and transport of sperm

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89
Q

Which of the following statements about hernias is true?

a. Indirect inguinal hernias are the most common form of hernia
b. Femoral hernias are the least common form and are more common in women
c. Direct inguinal hernias are more common in men over age 40
d. Indirect inguinal hernias originate above the inguinal ligament near its midpoint
e. All of the above

A

e.All of the above

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90
Q

Crackles

(Rales)

A

Discontinuous (more obvious on inspiration)

Does not clear with cough

Etiology

Fibrosis

atelectasis

pneumonia

fluid (CHF)

91
Q

STD Rates and number in florida

A
  • Two out of every three reported STD cases in Florida were under the age of 25.
  • One out of every 33 persons with a reportable STD in Florida is co-infected with HIV.
  • Floridians between the ages of 15 and 24 represented only 13 percent of Florida’s population in 2011, but accounted for 70 percent of reported cases of Chlamydia infections.
  • Gonorrhea rates for 15 to 24 year olds are at least twice as high as any groups over age 25 in Florida.
  • 40 percent of older adolescents surveyed incorrectly believe that the contraceptive “pill” and “shot” protect against STDs and HIV.
92
Q

Foramen ovale

A

An opening in the septum between the two atria of the heart that is normally present only in the fetus

After birth, the pressure in the pulmonary circulation drops, and the foramen ovale closes.

93
Q

Breathing that involves changing rates and depths with apneic periods is.

A.Cheyne-Stokes

B.Kussmaul’s

C.Obstructive

D.Biot’s/ataxic

A

A.Cheyne-Stokes

94
Q

Peripheral Cyanosis- Acrocyanosis

A

Painless condition where the small blood vessels in your skin constrict, turning the color of your hands and feet bluish

The blue color comes from the decrease in blood flow and oxygen moving through the narrowed vessels to your extremities

95
Q

Conditions which limit diaphragmatic excursion

A

Pulmonary (COPD)

Abdominal (massive ascites, tumor)

Superficial (fractured rib)

diaphragm paralysis

96
Q

Smoking risk reduction due to quitting

A

Quitting reduces CV risk of MI and death from CAD by one half after year 1

Stroke risk is reduced within 2-5 years to the same level

Lung cancer risk is cut in half after 10 years

97
Q

Systole

A

Contraction of ventricles

Semilunar valves open

98
Q

Syncope

A

caused by decreased perfusion to brain

also can be associated neurological symptoms

99
Q

What does vocal resonance test for

Egophony, bronchophony, whispered pectoriloquy

A

Checks for pneumonia

Consolidation

Egophony EEE (A means pneumonia)

Bronchophony 99

Whispered pectoriloquy Whisper 99

100
Q

Normal breath sounds

A

Bronchial region:

Louder, higher pitch

Bronchovesicular

intermediate intesity and pitch

Vesicular

Soft and low pitched

101
Q

Pectus carinatum

A

Outward protruding chest

can occur secondary to childhood asthma

however, predominatley congenital

102
Q

With the five A’s involved with tobacco cessation, which “A” don’t belong?

A.Advise patient to stop smoking

B.Assess patient readiness to quit

C.Assess patient mental status

D.Assist patient to set stop dates

A

C.Assess patient mental status

103
Q

Sleep apnea

A

Defined as breathing cessation for greater than 10 seconds

104
Q

Periodic breathing patterns

A

Cyclical / repetitive pattern increase / decrease in depth of respiration with periods of apnea Cheyne-stokes breathing (CHF)

105
Q

Perscussion sound : Tympany

A

Tympanic

Air : Loud, high pitch

106
Q

name lung membranes

A

Serous membranes

parietal pleura (outer)

Visceral pleura (inner)

107
Q

Levines sign

A

a clenched fist over chest Angina

108
Q

Murmur workup

A

Echo checks the valves

Only thing better is cath but its invasive

109
Q

Murmurs in children

A

•Heart murmurs are common in infants and children, but only a minority of patients with murmurs have heart disease

Children > 1 year

  • Innocent Still murmur
  • Cervical venous hum
  • Atrial septal defect
  • Mitral regurgitation
  • Bicuspid aortic valve
  • Pericarditis
110
Q

POst menopausal bleeding

A

occurs at least 6 months after menopause

111
Q

Perscussion sound : resonance

A

Loud low pitch aound

Striking a surface which covers an air filled structure

112
Q

Rhonchi

A

Low pitch

Continuos, more on expiration

Loud, snorting

Causes

thicker secretions in larger airways

(cough may clear sound)

113
Q

peyronies disease

A

Bent or crooked penis

due to fibrous black on corpus

114
Q

Testicular cancer cure rate

A

90% of new cases can be cured

115
Q

A patient you are seeing complains of severe pain in her right foot. Based on examination findings, you suspect arterial insufficiency. Which of the clinical findings below would suggest arterial insufficiency as the cause of her problem?

a. Brisk posterior tibial and dorsalis pedis pulses
b. Pallor of the foot upon elevation
c. Pitting edema of the lower leg
d. Warmth of the right foot

A

b. Pallor of the foot upon elevation

  • Decreased posterior tribal and dorsalis pedis pulses
  • No edema of the lower leg
  • Cool right foot
116
Q

Tripod position

A

Emphysema

Pursed lips

leaning forward to breath easier

117
Q

Which of the following tests is not used for appendicitis?

A.Obturator sign

B.Psoas sign

C.Murphy’s sign

D.Rovsing’s sign

A

C.Murphy’s sign

118
Q

Prostate cancer screening

A

DRE

or

PSA

119
Q

Sternocleidomastoid muscle use

A

SCM Retractions

last to be recruited and patients tire very quickly

sign that patient will soon need to be intubated

120
Q

5 T’s of Cyanosis

A

Transposition of great arteries

Tetralogy of Fallot

Truncus arteriosus

Total anomalous pulmonsry venous return

Tricuspid valv abnormalities

121
Q

Prostate cancer info

A

3rd leading cause of death in men in US

Risk factors are age, ethnicity, family history

  • one of the most common types of cancer that affects men.
  • In the United States, the lifetime risk of being diagnosed with prostate cancer is approximately 11%, and the lifetime risk of dying of prostate cancer is 2.5%.

The median age of death from prostate cancer is 80 years

African americans have highest risk

122
Q

All of the following breath sounds are considered normal breath sounds except for..

A.Rubs

B.Vesicular

C.Bronchial

D.Bronchovesicular

A

A.Rubs

123
Q

Diastole

A

Ventricles relax

AV valves open

124
Q

STD’s

A
  • The US has the highest rate of STI in the industrialized world
  • Chlamydia is the most commonly reported and most common in women
  • HPV is the most common STI among both male and female.
  • Sixth consecutive year for increased cases of gonorrhea, chlamydia and syphilis
  • A total of 2.4 million infections that were diagnosed and reported in last year. Undiagnosed cases are estimated significantly higher.
125
Q

Pleural Rub

A

Low or medium pitch

Raspy, dry, scratchy

inspiration or expiration (sound disappears with breath holding)

Loudest at end of inspiration or begginning of expiration

Caused by pleural irritation and inflammation

126
Q

Dextrocardia

A

an abnormal condition in which the heart is situated on the right side and the great blood vesselsof the right and left sides are reserved

Similar to situs inversus

127
Q

Tissue in shaft of penis

A

3 columns of vascular erectile tissue

Corpus spongiosum (containing urethra)

Forms bulb of penis, ending in the cone shaped glans

2 columns of Corpora cavernosa

128
Q

Patent Foramen Ovale (PFO)

A

Flap fusion is complete by age two in 70 - 75 % of children,

the remaining 25% have a PFO which persists into adulthood.

Most patients with a PFO remain asymptomatic

129
Q

Systolic BP

A

Pressure generated by Left ventircle during systole (contraction)

Pressure waves in the arteries create pulses

130
Q

Pursed lip breathing

A

Obstructive lung disease

This allows for controlled expiration

131
Q

Ankle brachial index

A

ABI normal = 0.90 - 1.30

ABI mild = 0.41 - 0.90

ABI Severe = 0.00 - 0.40

132
Q

Testes size

A

about 4.5cm

Left is lower than right

sperm and tesosterone

133
Q

A 21-year-old male presents complaining of a “nodule” on the back of his left testicle found during testicular self-examination.

  • On examination, you find both testicles to be of normal size, shape, and consistency.
  • On the back of the left testicle in the area of the “nodule,” you find a soft, nodular, tube-like structure with no areas of abnormal tenderness.

a. Acute epididymitis
b. Cyst of the epididymis
c. Normal epididymis
d. Carcinoma of the epididymis

A

c.Normal epididymis

134
Q

Epispadias

A

displacement of urethral opening

(Top/front/dorsal)

135
Q

All of the following are considered conditions that present with increased fremitus except..

A.Atelectasis

B.Emphysema

C.Lung Cancer

D.Pneumonia

A

B.Emphysema

136
Q

Inncent heart murmur is peds

A

1/3 - 3/4 have an innocent murmur noted between ages 1-14 y/o

137
Q

WHat are adventitious sounds

A

Added sounds

Snore, crackles / rales (fine medium, coarse), wheezes, stridor, rub or rhonchi

138
Q

Dark, tarry stools is best described by this term?

A.Hematochezia

B.Melena

C.Hematemesis

D.Hemoptysis

A

A.Melena

139
Q

What is the preferred order for examination of the abdomen?

a. Inspection, auscultation, percussion, palpation
b. Percussion, auscultation, palpation, inspection
c. Auscultation, inspection, palpation, percussion
d. Inspection, palpation, auscultation, percussion

A

a.Inspection, auscultation, percussion, palpation

140
Q

Caput medusae

A

Dilated veins seen on the badomen of a patient with cirrhosis of the liver

portal hypertension

141
Q

A patient with dyspnea, pinkish skin, pursed-lip breathing, barrel chest most likely has this condition..

A.Asthma

B.Chronic bronchitis

C.Pleural effusion

D.Emphysema

A

D.Emphysema

142
Q

Causes arrhythmias

A

Infections

chemical imbalances

fever

medications

heart defect

cardiomyopathy

143
Q

Listening for regurgitant murmurs in upright leaning forward position, what part of the stethoscope should be used?

A.Bell

B.Diaphragm

A

B.Diaphragm

144
Q

Rapid breathing patterns

A

Kussmaul (DKA)

145
Q

5 tanner stage descriptions in boys

Stage 1

A
  • Pubic hair-none except for the fine body hair (vellus hair) similar to that on the abdomen
  • Penis is same size and proportions as in childhood.
  • Testes and Scrotum—same size and proportions as in childhood
146
Q

S4 heart sound

A

caused by atrial contraction against a stiff ventricle

low pitched best heard with bell

heard before S1

always abnormal

147
Q

COPD 2 types

A

Chronic bronchitis = long term cough with mucous

Emphysema = destruction of lung over time

148
Q

What are the stages of change (tobacco)

A

Precontemplation

Contemplation

Preperation

Action

Maintenance

149
Q

5 A’s of tobacco cessation

A

Ask about smoking each visit

Advise patient to regularly stop smoking

Assess patient readiness to quit

Assist patient to set stop dates

Arrange for followup visits

150
Q

5 tanner stage descriptions in girls

Stage 3

A

Stage 3: Scant terminal hair. Breast tissue palpable outside areola; no areolar development.

151
Q

Abdominal Percussion

A
  • Tympany is normally present over most of the abdomen in the supine position.
  • Unusual dullness may be a clue to an underlying abdominal mass
152
Q

Arrhythmias in an asymptomatic child

A

Sinus arrhythmia

PVC’s

PAC’s

153
Q

Pediatric SVT Symptoms in children / adolescents

A

palpitations, chst discomfort, fatigue, lightheadedness

syncope is less common but is a sign risk of sudden death

abrupt onset and termination

can occur at rest

154
Q

How to evaluate competency of venous valves

A

Trendelenberg test

155
Q

Perscussion sound : dullness

A

replacment air filled lung tissue with fluid

mass or consolidation (diminished air exchange)

solid organ

Muted tone, medium pitch

156
Q

What is emphysema

A

One type of COPD destruction of lungs over time

157
Q

Tactile fremitus

A

Think pneumonia

vibrations of spoken sounds palpated through chest wall

best felt in intrascapular spaces

less felt in lower lung fields

cant feel below diaphragm

Occurs when sound vibrations travel through medium of abnormal density

158
Q

Aortic width

A

AAA = greater than 4 cm with pulsations

159
Q

Which of the following breath sounds are most often auscultated over the majority of both lungs?

a. Vesicular
b. Bronchial
c. Bronchovesicular
d. None of the above

A

a.Vesicular

  • Bronchial - usually heard over the manubrium
  • Bronchovesicular - usually heard over the 1st and 2nd interspaces
160
Q

PAP cytology results

A
  • Normal
  • ASCUS: Atypical squamous cells of undertermned significance
  • AGUS: Atypical glandular cells of undertermned significance
  • LSIL: Low-grade squamous intraepithelial lesion encompassing: HPV/mild dysplasia/CIN1
  • HSIL: High-grade squamous intraepithelial lesion encompassing: moderate and severe dysplasia, CIN2, CIN3, and carcinoma in situ
161
Q

What is bronchiectasis

A

destruction and widening of the large airways

162
Q

Pectus excavatum

A

Sunken chest

poor posture

pot belly

funnel chest

usually benign, no treatment

163
Q

Causes of Bounding Pulse

A

•Hyperkinetic circulation states

–Hyperthyroidism

–Fever

–Anxiety

–Exercise

–Anemia

  • Patent ductus arteriosis
  • Aortic rigidity
  • Atherosclerosis
  • Marked vasodilatation
164
Q

Factors that increase breast cancer risk

A

BRCA1, BRCA2

1st degree relatives with mutation as well

History of cancer or hyperplasia

family history

other gene mutations

165
Q

Perscussion sound : hyper-resonance

A

Processes that lead to

chronic (emphysema) or

acute (pneumothorax)

air trapping in lung or pleural space, respectively, will produce hyper-resonant (more drum like) notes on percussion.

166
Q

Recto-vaginal Exam- Three primary purposes

A

To palpate a retroverted uterus, the uterosacral ligaments, cul-de-sac, and adnexa

To screen for colorectal cancer in women ages 50 years or older

To assess pelvic pathology

167
Q

3 different signs of chest pain

A

clenched fist = angina

finger point = muscoskeletal

hand moving from neck down = GERD

168
Q

5 tanner stage descriptions in boys

Stage 5

A
  • Pubic hair: Hair adult in quantity and quality, spreads to the medial surfaces of the thighs but not up over the abdomen
  • Penis: Adult in size and shape
  • Testes and Scrotum: Adult in size and shape
169
Q

5 tanner stage descriptions in girls

Stage 4

A

Stage 4: Terminal hair that fills the entire triangle overlying the pubic region. Areola elevated above contour of the breast, forming “double scoop” appearance.

170
Q

Smoking statistics

A

19% of adults smoke

23% of high schoolers smoke

7% of middle schoolers

50% of long term smokers lose an average of 10 years

171
Q

Paraphimosis

A

inability to reduce foreskin back to anatomical position

Urological emergencey

Surgical emergency

“para”-phimosis = “para”-medics

172
Q

PAP test recommendations

A

screening with cytology every 3 years for women age 21 – 65

women 30-65 who want to lengthen the screening interval – screen with combo of cytology and HPV testing every 5 years.

•Not to screen women under age 21 unless there is immune compromise, in utero exposure to diethylstilbestrol.

173
Q

S2 heart sounds

A

Second heart sound

Closure of semilunar valves

indicates end of systole

higher pitched and shorter than S1

174
Q

Smegma

A

Secretions of the glans

175
Q

Normal heart rates in Peds

A

Newborn = 100-205

Infant = 100-180

Toddler = 98-140

Preschool = 80-120

Schol-age = 75-118

Adolescent = 60-100

176
Q

Gnawing, cramping, or aching and is often difficult to localize describes this type of pain?

A.Parietal pain

B.Visceral pain

C.Somatic pain

D.Referred pain

A

B.Visceral pain

177
Q

4 positions of breast exam

A
  • Sitting with arms at side
  • Sitting with arms over head
  • Sitting with hands on hips
  • Leaning forward.
178
Q

Dyspnea of heart disease vs lung disease

A

Heart disease is not usually exertional, may occur at rest

Orthopnea helps

occurs when sleeping

179
Q

Increasd tactile fremitus

A

Coarser rougher feel

Consolidation: lobar pneumonia

tumor

heavy bronchial secretions

segmental atelectasis

180
Q

Bradypnea

A

less than 12 Breaths per minute

Metabolic alkalosis

volume depletion,

vomiting

Narcotics

elevated ICP

Extreme obesity

181
Q

Murmur causes

A

Thyrotoxicosis

anemia

pregnancy

VSD or ASD

PDA

182
Q

Pleural effusion

A

can be asymptomatic

chest pain

dullness to percussion, decreased breath sounds

pleural friction rub heard

183
Q

Tanner Scale Female

A

Breasts, genitals, pubic hair

Stage 1: No hair. No glandular breast tissue palpable

Stage 2: Downy hair. Breast bud palpable under the areola (1st pubertal sign in females)

Stage 3: Scant terminal hair. Breast tissue palpable outside areola; no areolar development.

Stage 4: Terminal hair that fills the entire triangle overlying the pubic region. Areola elevated above contour of the breast, forming “double scoop” appearance.

Stage 5: Terminal hair that extends beyond the inguinal crease onto the thigh. Areolar mound recedes back into single breast count with areolar hyperpigmentation, papillae development and nipple protrusion

184
Q

Splinter hemorrhage

A

Bacterial endocarditis

185
Q

Perscussion sound : Flatness

A

Muscle

soft tone

high pitch

186
Q

The bell of the stethoscope is most useful for auscultating:

a. Diastolic murmurs
b. High-pitched heart sounds
c. Low-pitched heart sounds
d. Systolic clicks
e. Systolic murmurs

A

c.Low-pitched heart sounds

•The bell is best for detecting low-pitched sounds like S3 and the rumble of mitral stenosis

187
Q

Inguinal canal

A

forms a canal for the vas deferens

lies above and parallel to inguinal ligament

exterior opening of tunel is external inguinal ring

internal opening is internal inguinal ring

188
Q

Intercostal muscle use

A

COPD patients

Deeper breathin and retractions

189
Q

Phimosis

A

inability to retract foreskin

can be normal up to 3 y/o

clinically significant after 4

190
Q

Leading cause of preventable death in the US

A

Smoking

191
Q

Liver percussion

A

•Percuss over the liver in both the midclavicular line
and at the midsternal line

•Begin in an area of tympany both above and below the liver, percussing to an area of dullness

–Midclavicular percussion should be 6–12 cm; longer than this indicates an enlarged liver

–Midsternal line percussion should be 4–8 cm; shorter than this can indicate a small, hard cirrhotic liver

192
Q

Central venous pressure estimation

A

Inspect and measure JVP

193
Q

Mammogram guidelines

A

•Typically should start screening mammography at age 40-44

194
Q

Nail clubbing

A

Associated with pulmonary and CVD

Colitis

cirrhosis

neoplastic and thyroid disease

195
Q

Murmur intesity scale

A

1 - 6

4 - 6 must have accompanied thrill

196
Q

What to listen fo with Diaphragm of stethscope

A

•Accentuates higher-pitched sounds & murmurs

–S1 and S2

–Systolic ejection murmurs (SEM)

–Systolic clicks

–Diastolic regurgitant mumurs

–Pericardial friction rubs

–Opening snaps

197
Q

Asthma

A

airway obstruction

airway hyper responsiveness

airway inflammation

can be episodic or chronic

Wheezing, dyspnea or cough

Worse at night or in early morning

198
Q

GP FPAL

A

Gravida = total number of pregnancies

Para = outcomes after 24 weeks

F = Full term

P = Premature

A = Abortion

L = Living Children

199
Q

lower genitourinary tract

A

the vas deferns, a cordlike structure, begins at the tail of the epididymis

it ascends within the scrotal sac (as the spermatic cord) and passes through the external inguinal ring on its way to the abdomen and pelvis

Behind bladder, iti is joined by the duct from the seminal vesicle and enters the urethra within the prostate gland

200
Q

diaphragmatic excursion

A

distance is 3 - 6 cm

201
Q

Arrhythmia definition

A

Definition: a condition in which the heart beats with an irregular or abnormal rhythm

an alteration in rhythm of the heartbeat either in time or force

202
Q

Acites

A

Free fluid in pertoneal cavity

203
Q

Age related changes

A
  • Pre-menstrual syndrome – mood changes, cramping – typically emerges in teen years
  • Menopause, vaginal wall thinning, decrease in vaginal secretions – typically in late ‘40’s – early 50’s
  • Breast pain – expected with menses prior to menopause
  • Loss of tone, pendulous breasts – typical as age progresses
204
Q

Cullens sign

A

Necrotizing pancreatitis

205
Q

Which of the following statements about percussion is true?

a. Use the lightest percussion that produces a clear note
b. Percussion should be done up and down each side of the chest rather than side to side (one side of the chest to the other)
c. Strike using the pad of your tapping finger
d. The heart normally produces an area of tympany to the left of the sternum from the 3rd to 5th rib interspaces

A

a. Use the lightest percussion that produces a clear note

•The heart normally produces an area of dullness to the left of the sternum from the 3rd to 5th rib interspaces

206
Q

pneumonia

A

Infection of lung parenchyma

usually acute

exertion and smoking can make worse

reast can improve

207
Q

Sources of chest pain

A

MI

Angina

Pericarditis

Aoritc dissection

Bronchitis

Pneumonia

PE

Pneumothorax

Costochondritis

Zoster

Gerd,spasm, tear ETC

208
Q

Contractility

A

Ventricles contract during sytole

209
Q

Amplitude of arterial pulses

A

3+ Bounding

2+ Brisk, expected (normal)

1+ Diminished, weaker than expected

0 Absent, unable to palpate

210
Q

Decreased tactile fremitus

A

feels muffled or diminshed sound

Emphysema

Pleural effusion, fibrosis or thickening

Massive pulmonary edema

hemothorax

211
Q

Chronic disorder of the airways characterized by variable airway obstruction, airway hyperresponsiveness, and airway inflammation best describes this..

A.COPD

B.Asthma

C.Pleural effusion

D.Pneumothorax

A

B.Asthma

212
Q

Pulmonary embolism

A

Dyspnea

chest pain

hempotysis

syncope

tachypnea

widened alveolar arterila PO2 difference

213
Q
A
214
Q

Arrhythmias in a symptomatic child

A

● Atrial arrhythmias

● Supraventricular tachycardia

● Ventricular tachycardia

● Sinus node dysfunction

● Second degree heart block

215
Q

Chest tube insertion site

A

4th or 5th intercoastal space Anterior axillary line

216
Q

Percussion sound : hyperinflation

A

Very loud,

very low pitch

217
Q

Markle test

A

Heel jar test

standing or lying flat

218
Q

Patent Ductus arteriosus (PDA)

A

Washing machine like sound

Best heard at the left upper sternal border

present just after birth, as part of a normal transition, it usually occurs as a soft systolic murmur which disappears in a few hours or a few days

Closes in approximately 90% of full-term neonates by 48 hours

219
Q

Anal Canal sphincters

A

External (voluntary

Internal (involuntary)

Lots of somatic nerves

220
Q

5 tanner stage descriptions in girls

Stage 5

A

Stage 5: Terminal hair that extends beyond the inguinal crease onto the thigh. Areolar mound recedes back into single breast count with areolar hyperpigmentation, papillae development and nipple protrusion

221
Q

What is chronic bronchitis

A

One type of COPD long term cough with mucous

222
Q

Normal respiration rate

A

12-20 with no discomfort periodic deep breaths (less than 5 per minute)

223
Q

Order of exam techniques

A

Inspect Palpate Percuss Auscultate

224
Q

Lobes of the lung

A

3 on right 2 on left

PAM Semester 1 (16 decks)

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