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Physical exam > Test 2 Cardio, Pulm, ABD > Flashcards

Test 2 Cardio, Pulm, ABD Flashcards

1
Q

PMI is typically found at what ICS?

A

5th

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2
Q

PMI diameter of _____ or more or displacement _____ is evidence of pathology. What 2 conditions specifically?

A

> 2.5 cm
Laterally

Left Ventricular Hypertrophy or Aortic Stenosis

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3
Q

In a non acute patient, ________ is a feature that is an important prognostic sign in heart failure

A

Cachexia (Loss of body mass that can’t be reversed nutritionally)

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4
Q

Link the physical appearance/disorder with the corresponding cardiac abnormality

  1. Marfan’s
  2. Down’s
  3. Turner’s
  4. Spondyloarthritides
A
  1. Aortic regurgitation/dissection
  2. ASD, VSD
  3. Coarctation of the aorta
  4. Aortic regurgitation
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5
Q

Link the facial signs with their corresponding cardio disease

  1. Malar flush
  2. Xanthomata
  3. Corneal Arcus
A
  1. Mitral Stenosis
  2. Hyperlipidemia
  3. Age and hyperlipidemia
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6
Q

Peripheral pulse checks is especially important in predicting what?

A

CAD

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7
Q

A chest pain patient should have what pulses checked simultaneously as a gross screening test for Aortic Dissection?

A

Radial

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8
Q

List and describe 4 peripheral signs of infective endocarditis

A

Clubbing - broadened/thickedned tips of the fingers with increase legthwise curve of nail…

Splinter hemorrhages - streaks in nailbeds

Janeway lesions - nontender macules on hand and fingers

Osler’s nodes - TENDER nodules in fingers

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9
Q

An accurate BP should be taken after ______ minutes of rest with arm at ______ level

A

5, Heart

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10
Q

Patient arm size vs cuff range?

A

middle 75%

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11
Q

Describe JNC7 and 2017 ACC/AHA blood pressure guidelines

A

120-129/<80 Pre or Elevated
130-139/80-90 Pre or STAGE 1
140-159/90-99 STAGE 1 or STAGE II
Higher Stage 2 or Stage II

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12
Q

Describe orthostatic hypotension test and results

A

Pulse and BP measured supine and standing

Normal : Systolic drops slightly or doesnt change. Diastolic goes up slightly

Orthostatic - (w/in 2-5mins from sup to stand) Drop in systolic 20+, diastolic 10+, pulse rise 20+, symptoms of cerebral hypotension.

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13
Q

Lack of pulse increase when blood pressure drops during Tilt Test implies what?

A

Neurological cause

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14
Q

Describe a normal PMI size and location

A

4th or 5th ICS, MCL

Should be less than 2.5cm and occupy less than one ICS

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15
Q

What change in PMI position increases likelihood of cardiac enlargement?

A

Lateral displacement outside the MCL

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16
Q

Increased/Hyperkinetic amplitude of the PMI may reflect what 6 causes?

A 
Excitement
Exercise
Hyperthyroidism
Severe Anemia
Aortic Stenosis (Pressure overload)
Mitral Stenosis (Volume Overload)
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17
Q

A central precordial heave suggests what?

A

RV hypertrophy

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18
Q

Diaphragm picks up ______ sounds. Bell picks up _____ sounds

A

High pitched

Low pitched

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19
Q

Define physiologic splitting of S2

A

Sound of Aortic Valve A2 occurs earlier than that of the Pulmonary valve P2 during inspiration (aortic closes first due to high right ventricle pressure)

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20
Q

Wide OR fixed S2 split occurs with what condition? Where do you hear this?

A

ASD

LUSB

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21
Q

Reverse or PARADOXICAL splitting is most commonly associated with what?

A

Left Bundle Branch Block

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22
Q

List and describe pulse grades 0-4+

A 
0- Absent
1+ diminished (weaker than expected)
2+ Brisk (NORMAL)
3+ Increased
4+ Bounding
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23
Q

Clubbing (in general) represents a ______ issue

A

chronic

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24
Q

Cap refill over ____ seconds is abnormal

A

2

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25
Q

Describe S3 AKA Ventricular gallop

A

Early diastolic sound
APEX @ LLD

Due to RAPID, HIGH VOLUME filling of the Left Ventricle

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26
Q

An S3 in a person over ______ is almost certainly pathologic. What 3 potential causes?

A

40

LV failure
Preg in 3RD TRIMESTER
Athletic heart

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27
Q

Describe an S4 AKA Atrial Gallop

A

Late Diastolic sound
BELL @ Apex in LLD
Atrial contraction fills a STIFF left ventricle

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28
Q

What conditions could give an S4 sound?

A

Hypertensive heart, CAD

Diastolic heart failure, Cardiomyopathy

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29
Q

Sitting up, leaning forward, exhaling and holding breath will help to hear what?

A

Aortic Regurg w/ Diaphragm @ apex

Also friction rub

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30
Q

Describe the grades of murmurs from 1 - 6

A
  1. Barely audible
  2. Faint but heard immed
  3. Moderately loud w/ a thrill
  4. Loud with a thrill
  5. Loud enough to be heard w/ stethescope on edge
  6. Head with stethescope off chest
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31
Q

What are associated with an opening snap

A

**Mitral valve stenosis

Tricuspid valve

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32
Q

What are associated with an ejection click

A

Aortic stenosis

Pulmonic Stenosis

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33
Q

What is associated with a mid systolic click or late systolic murmur?

A

Mitral prolapse (+ late murmur or regurge)

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34
Q

What are our 3 pansystolic/Holosystolic murmurs?

A 
Mitral regurg (radiate to left axilla)
Tricuspid Regurg (INCREASE w/ INSPIRATION)
VSD (Same spot as TR, no increase w/ insp)
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35
Q

_______ Murmurs are the most common kind of heart murmur. They can be one of what 3 types?

A

Midsystolic

  1. innocent
  2. physiologic - change in metabolism
  3. pathologic - structural abnormalities
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36
Q

Aortic stenosis murmur radiates where? What maneuver decreases it by increasing afterload?

A

Carotids

Handgrip

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37
Q

HCM is a ______ murmur that is accentuated by _____ and ______

A

midsystolic

valsalva and standing

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38
Q

What is the name for alternate reddening and blanching of the nailbed with each heartbeat?

A

Quincke’s sign

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39
Q

Mitral stenosis is best heard with the ______

A

Bell

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40
Q

What is an Austin Flint murmur?

A

Severe aortic regurg causes turbulent mixing of antegrade mitral flow and retrograde aortic flow

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41
Q

Regurg is generally best heard with the ______.

Stenosis and gallops are best heard with the _______/

A

Diaphragm

Bell

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42
Q

A PDA causes what murmur?

A

Constant, harsh, machinery like w/ a thrill @ L2ICS

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43
Q

Aortic area and pulmonic areas will have what murmurs?

A

Stenosis, regurg, and PDA @ pulmonic

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44
Q

Erbs point will have what type of murmurs?

A

Aortic and Pulmonic regurg

45
Q

JVP bed w/ hypovolemia = ____ degrees. Hypervolemia _____ degrees

46
Q

Failure of left ventricle may present with what lung findings? Right sided cardiac pathology buys palpation of what organ?

A

Fine inspiratory crackles of pulmonary edema

Liver

47
Q

Sternal angle is next to what rib?

48
Q

Inferior tip of the scapula is next to what rib?

49
Q

Lower border of the lung crosses what ribs?

A

6th @ MCL and 8th @ MAL anterior

post = Around T10

50
Q

At what thoracic vert. level and angle level does the trachea bifurcate?

A

Sternal angle and T4

51
Q

Parietal pleura is innervated by the what?

A

Costal and phrenic nerves

52
Q

Describe the division of the main bronchi

A

Lobar –> segmental –> Bronchioles –> Alveoli

53
Q

What are the accessory muscles of inspiration?

A

Scalenes
Parasternal intercostal muscles
Sternocleidomastoids

54
Q

Chronic cough is measured as ____ weeks or greater

55
Q

What are the normal respiratory rates for:
Adults
Children
Newborn

A

Adults: 12-20 (F>M)

Child : 20-30

Newborn : 30-60

56
Q

Describe the characteristics of normal breathing

A

Nasal, diaphragmatic, slow, and imperceptible

Insp: 1.5-2s
pause: 2s
Exp: 1.5-2s

57
Q

Describe Kussmaul breathing

A

Deep, labored sighing respirations. Compensatory to metabolic acidosis (DKA)

58
Q

Describe Cheyne-Stokes breathing

A

Cyclic hyperventilation followed by compensatory apnea

59
Q

Describe hyperpnea or hyperventilation

A

Any breathing pattern that reduces CO2 due to increased rate and depth of respiration

60
Q

Define platypnea

A

Dyspnea worse with upright posture (Pericarditis)

61
Q

Pectus excavatum results in what?

A

Compression of the heart and great vessles. May cause murmurs

62
Q

Describe the ABCDEEFG of melanoma

A 
Asymmetry
Border irregularity
Color variations
Diameter >6mm
Evolving or changing
Elevated
Firm
Growing progressivley
63
Q

List reasons for increased fremitus

64
Q

List reasons for decreased fremitus

A

Anything that causes sepration of lung tissue from body wall or prevents transmision

Effusion
Pneumothorax
COPD
Thickened chest wall

65
Q

Percussion only penetrates ______ cm into the chest

66
Q

Percussion sounds

  1. Flatness
  2. Dullness
  3. Resonance
  4. Hyperresonance
  5. Tympanic
A
  1. Soft/high pitched - thick effusion
  2. thud like - pneumonia, fluid, tumor
  3. Hollow- normal lung, bronchitis
  4. Booming - air trapping
  5. Tympanic - large pneumothorax
67
Q

Vesicular lung sounds are heard over most of the lungs. Inspiratory is _____ than expiratory

68
Q

Bronchial breath sounds are heard over the _____ (if at all) and inspiratory is _____ than expiratory

A

Manubrium

Shorter

69
Q

Tracheal breath sounds are loud and high pitch darth vader noises. Inspiratory is _____ to expiratory

70
Q

Bronchophony is when a patient repeats words while being auscultated. What findings can we have with pneumonia or lung cancer?

A

Voice remains loud at the periphery of the lungs (not normal) or sounds louder than usual over a distinct area of consolidation.

71
Q

Whispered pectoriloquy is valuable in detecting early _____, _____, and ________

A

Pneumonia, infarction, atelectasis

72
Q

Egophony is a form of broncophony where what happens? What does this indicate?

A

E–>A transition. “Bleating” quality. Pneumonia

73
Q 
Ronchi = snore
crackles = crackles
wheeze = wheeze
A

Ronchi - bronchitis/secretion
Wheezing - narrowing COPD, Bronch, Asthma
Crackles - Heart, Fibrosis, pneumonia, (FIne or coarse)

74
Q

Lungs extend 2-3cm over what

A

Each clavicle

75
Q

______ nodes are the most palpable

76
Q

Who should be vaccinated

A

Everyone, especially:

Adults with medical conditions
Immunosuppressed
Residents of nursing homes or health care persons
Caregivers of children under 5 or people over 50

77
Q 
What is the
Percussion note
Trachea position
Breath sounds
Adventitious sounds

OF

Lobar pneumonia

A

Percussion - Dull (airless area)

Trachea - midline

Breathsounds - bronchial over area

Adventitious - late inspiratory crackles

78
Q 
What is the
Percussion note
Trachea position
Breath sounds
Adventitious sounds

OF

Left sided heart failure

A

Percuss - Resonant

Trachea - midline

Breath - vesicular

Adventitious - late inspiratory crackles in dependant lungs, maybe wheeze

79
Q 
What is the
Percussion note
Trachea position
Breath sounds
Adventitious sounds

OF

Pleural effusion

A

Percuss - Dull to flat over fluid

Trachea - shifted away

Breath sounds - decreased to absent. Possible bronchial at top

Adventitious - none, possible pleural rub

80
Q 
What is the
Percussion note
Trachea position
Breath sounds
Adventitious sounds

OF

Pneumothorax

A

Percussion - Hyperresonant or tympanic

Trachea - shifted away

Breath sound- none/decreased

Adventitious- none, possible pleural rub

81
Q 
What is the
Percussion note
Trachea position
Breath sounds
Adventitious sounds

OF

Asthma

A

Percussion - Resonant to diffusely hyperresonant

Trachea position - midline

Breath sounds - Obscured by wheezes

Adventitious - wheezes, crackles

82
Q

What are the main organs of the RUQ?

A 
Liver and gallbladder
Pylorus and Duodenum
Head of pancreas
Superior right kidney
Hepatic flexure
83
Q

What are some important LUQ organs?

A 
Left lobe of liver
Spleen
Stomach
Pancreas body
Left adrenal gland/sup left kidney
Splenic flexure
84
Q

List the LLQ organs

A

Lower L kidney
Sigmoid colon
Left ureter
Left ovary and tube

85
Q

List the RLQ organs

A

Lower R kidney
Cecum and Appendix
Ascending colon
R ovary/R ureter

86
Q

Smooth muscle of the bladder holds around ______ml before being stimulated to contract

87
Q

With peritonitis, patients tend to lie ____. With obstruction, patients tend to ________

A

Still

Constantly move

88
Q

Flanks of the abdomen bulge with ________

89
Q

Describe umbilical hernia.

A

Protrusion through defective umbilical ring.

Most common in infants.

Dont close on own.

Protrude more with raise head or shoulders

90
Q

An incisional hernia is a protrusion of what through what? WHat can cause size increase?

A

Fat, bowel, omentum through operative scar.

Rase head or shoulders

91
Q

Fascial dehiscence can cause 2 things.

  1. After hernia repair
  2. After abd surgery
A
  1. Recurrent hernia

2. future incisional hernia

92
Q

Describe diastasis recti

A

Sep. of two rectus abdominis muscles. ABD contents form ridge w/ head and shoulder raise.

Preg, obesity, chronic lung disease

No signifigance

93
Q

Normal bowel sounds are present at what rate? How long should you listen before declaring absent?

A

5-34

2 minutes

94
Q

Bowel sounds

  1. tinkling
  2. rushes of high pitched w/ cramp
  3. decreased
A
  1. dilated bowel
  2. intestinal obstruction
  3. Ileus and Peritonitis
95
Q

If a bruit has systolic and diastolic components (Renal) think what?

A

Renal Artery Stenosis

96
Q

If a bruit over iliac or femoral arteries has systolic and diastolic component, what should you think

A

Partial arterial occlusion

Arterial insufficiency

97
Q

Loss of liver dullness could be what?

A

Pneumoperitoneum

98
Q

List liver sizes @ MCL and MSL

A

MCL - 6-12 cm

MSL - 4-8

99
Q

Involuntary rigidity of abd may indicate what?

A

Peritoneal inflammation

100
Q

Normal aorta for people over 50 is how wide?

A

less than 3 cm

101
Q

What are the risk factors for AAA?

A

Over 65
Smoker
Male
1st degree relative

102
Q

Rupture of AAA is more likely for who?

A

> 5cm size

103
Q

How should aorta be examined?

A

Palpation followed by ultrasound

104
Q

Describe the normal liver edge

A

Soft, sharp and regular w/ smooth surface

105
Q

Tenderness @ Mcburney’s point will be present if appendix is where?

A

In the iliac fossa

106
Q

Retrocecal appendicitis might present with what instead of RLQ pain

A

Flank pain

107
Q

If you think a patient may have appendicitis, what should you do?

A 
Locate pain (cough/point)
Palpate lightly
Feel for gaurding (invol)
Perform DRE (R sided rectal tender - pelvic appendix or uterine adnexa)
Check for rebound tender
Rovsing's sign
108
Q

Psoas sign is indicative of what?

A

Abnormality in retroperitoneum

** Such as retrocecal appendicitis

109
Q

Obturator sign is indicative of what?

A

Pelvic appendicitis

Or other pelvic issue

Physical exam (1 decks)

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