Random PCM I Exam 2 Flashcards
Landmark for needle decompression?
- 2nd intercostal space just superior to the 3rd rib margin at the midclavicular line
- Emergent decompression of tension pneumothorax
Landmark for thoracentesis?
7th ICS
Landmark for Chest Tube insertion?
4th ICS at mid or anterior axillary line in the 4th ICS just superior to the margin of the 5th rib
Decreased or absent tactile fremitus in what diseases?
COPD, pleural effusions, fibrosis, pneumothorax, thick chest wall, or an infiltrating tumor
Increased tactile fremitus in what condition?
Pneumonia
Generalized hyperresonance may be heard over lungs in what conditions?
COPD/emphysema
Asthma
Unilateral hyperresonance of lungs suggest?
Large pneumothorax
Large air-filled bulla in lung
Which breath sound is heard best in 1st and 2nd interspaces anteriorly and between the scapulae?
Bronchovesicular
Which breath sounds are loud, high pitched and heard over the manubrium?
Bronchial
Rhonchi are associated with what in the airways?
Secretions in large airways
In patients with fever and cough, the presence of bronchial breath sounds and egophany more than triple the likelihood of?
Pneumonia
4 steps in order for CV exam?
1) Inspection
2) Palpation
3) Percussion
4) Auscultation
Point of maximal impulse (PMI) is usually palpated where?
4th-5th ICS in the mid-clavicular line
Where are the listening posts for the aortic valve, pulmonic valve, tricuspid valve, and mitral valve ?
Aortic - R 2nd ICS at SB
Pulmonic - L 2nd ICS at SB
Tricuspid - L 4th ICS at SB
Mitral - L 5th ICS at Mid-Clavicular line
What is Erb’s point and where is it heard?
- L 3rd ICS at SB
- Point at which S1 and S2 heard equally
S1 heart sound is closure of and indicates?
S2?
Which valves close first?
S1 = closure of mitral (1st) and tricuspid (2nd) valves (beginning of systole)
S2 = closure of aortic and pulmonic valves (end of systole, beginning of diastolic)
What is the S3 sound due to?
Due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase
Sound of a grade 3 heart murmur?
Grade 4?
- Moderately loud, no thrill
- Loud with palpable thrill
Dullness replacing resonance in the lungs during percussion can be due to?
Pneumonia, pleural effusions, pus, or blood
The “A wave” coincides with what events in the heart?
- Right atrial contraction
- Tricuspid valve open
- Coincides with S1
The C wave coincides with what events in heart?
Backward push by closure of tricuspid valve during isovolumetric systole
The V wave coincides with what events in the heart?
- Atrial filling
- Increasing volume and pressure in RA when TV closed
The “Y slope or descent” coincides with what event in the heart?
- Open TV and rapid RV filling in RV diastole
S1 is heard loudest where?
S2 heard loudest?
S1 at the apex
S2 at the base
What is Kussmauls sign?
Seen in what diseases?
- Venous column (JVP) rises during inspiration, rather than falls
- Seen in right heart failure, constrictive pericarditis or RV infarction
Clubbing nails seen in?
- CHD
- Cystic fibrosis
- Interstitial Lung Disease
Presentation with pink tinge to urine is associated with?
Genetically associated with?
- Renal Cell Carcinoma
- VHL (Von Hippel Lindau) association
