Test 2 Cardio, Pulm, ABD Flashcards
1
Q
PMI is typically found at what ICS?
A
5th
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
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)
4
Q
Link the physical appearance/disorder with the corresponding cardiac abnormality
- Marfan’s
- Down’s
- Turner’s
- Spondyloarthritides
A
- Aortic regurgitation/dissection
- ASD, VSD
- Coarctation of the aorta
- Aortic regurgitation
5
Q
Link the facial signs with their corresponding cardio disease
- Malar flush
- Xanthomata
- Corneal Arcus
A
- Mitral Stenosis
- Hyperlipidemia
- Age and hyperlipidemia
6
Q
Peripheral pulse checks is especially important in predicting what?
A
CAD
7
Q
A chest pain patient should have what pulses checked simultaneously as a gross screening test for Aortic Dissection?
A
Radial
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
9
Q
An accurate BP should be taken after ______ minutes of rest with arm at ______ level
A
5, Heart
10
Q
Patient arm size vs cuff range?
A
middle 75%
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
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.
13
Q
Lack of pulse increase when blood pressure drops during Tilt Test implies what?
A
Neurological cause
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
15
Q
What change in PMI position increases likelihood of cardiac enlargement?
A
Lateral displacement outside the MCL
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)
17
Q
A central precordial heave suggests what?
A
RV hypertrophy
18
Q
Diaphragm picks up ______ sounds. Bell picks up _____ sounds
A
High pitched
Low pitched
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)
20
Q
Wide OR fixed S2 split occurs with what condition? Where do you hear this?
A
ASD
LUSB
21
Q
Reverse or PARADOXICAL splitting is most commonly associated with what?
A
Left Bundle Branch Block
22
Q
List and describe pulse grades 0-4+
A
0- Absent 1+ diminished (weaker than expected) 2+ Brisk (NORMAL) 3+ Increased 4+ Bounding
23
Q
Clubbing (in general) represents a ______ issue
A
chronic
24
Q
Cap refill over ____ seconds is abnormal
A
2
25
Describe S3 AKA Ventricular gallop
Early diastolic sound
APEX @ LLD
Due to RAPID, HIGH VOLUME filling of the Left Ventricle
26
An S3 in a person over ______ is almost certainly pathologic. What 3 potential causes?
40
LV failure
Preg in 3RD TRIMESTER
Athletic heart
27
Describe an S4 AKA Atrial Gallop
Late Diastolic sound
BELL @ Apex in LLD
Atrial contraction fills a STIFF left ventricle
28
What conditions could give an S4 sound?
Hypertensive heart, CAD
| Diastolic heart failure, Cardiomyopathy
29
Sitting up, leaning forward, exhaling and holding breath will help to hear what?
Aortic Regurg w/ Diaphragm @ apex
| Also friction rub
30
Describe the grades of murmurs from 1 - 6
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
31
What are associated with an opening snap
**Mitral valve stenosis
| Tricuspid valve
32
What are associated with an ejection click
Aortic stenosis
| Pulmonic Stenosis
33
What is associated with a mid systolic click or late systolic murmur?
Mitral prolapse (+ late murmur or regurge)
34
What are our 3 pansystolic/Holosystolic murmurs?
```
Mitral regurg (radiate to left axilla)
Tricuspid Regurg (INCREASE w/ INSPIRATION)
VSD (Same spot as TR, no increase w/ insp)
```
35
_______ Murmurs are the most common kind of heart murmur. They can be one of what 3 types?
Midsystolic
1. innocent
2. physiologic - change in metabolism
3. pathologic - structural abnormalities
36
Aortic stenosis murmur radiates where? What maneuver decreases it by increasing afterload?
Carotids
| Handgrip
37
HCM is a ______ murmur that is accentuated by _____ and ______
midsystolic
valsalva and standing
38
What is the name for alternate reddening and blanching of the nailbed with each heartbeat?
Quincke's sign
39
Mitral stenosis is best heard with the ______
Bell
40
What is an Austin Flint murmur?
Severe aortic regurg causes turbulent mixing of antegrade mitral flow and retrograde aortic flow
41
Regurg is generally best heard with the ______.
| Stenosis and gallops are best heard with the _______/
Diaphragm
| Bell
42
A PDA causes what murmur?
Constant, harsh, machinery like w/ a thrill @ L2ICS
43
Aortic area and pulmonic areas will have what murmurs?
Stenosis, regurg, and PDA @ pulmonic
44
Erbs point will have what type of murmurs?
Aortic and Pulmonic regurg
45
JVP bed w/ hypovolemia = ____ degrees. Hypervolemia _____ degrees
0
| 60-90
46
Failure of left ventricle may present with what lung findings? Right sided cardiac pathology buys palpation of what organ?
Fine inspiratory crackles of pulmonary edema
Liver
47
Sternal angle is next to what rib?
2nd
48
Inferior tip of the scapula is next to what rib?
7th
49
Lower border of the lung crosses what ribs?
6th @ MCL and 8th @ MAL anterior
post = Around T10
50
At what thoracic vert. level and angle level does the trachea bifurcate?
Sternal angle and T4
51
Parietal pleura is innervated by the what?
Costal and phrenic nerves
52
Describe the division of the main bronchi
Lobar --> segmental --> Bronchioles --> Alveoli
53
What are the accessory muscles of inspiration?
Scalenes
Parasternal intercostal muscles
Sternocleidomastoids
54
Chronic cough is measured as ____ weeks or greater
8 weeks
55
What are the normal respiratory rates for:
Adults
Children
Newborn
Adults: 12-20 (F>M)
Child : 20-30
Newborn : 30-60
56
Describe the characteristics of normal breathing
Nasal, diaphragmatic, slow, and imperceptible
Insp: 1.5-2s
pause: 2s
Exp: 1.5-2s
57
Describe Kussmaul breathing
Deep, labored sighing respirations. Compensatory to metabolic acidosis (DKA)
58
Describe Cheyne-Stokes breathing
Cyclic hyperventilation followed by compensatory apnea
59
Describe hyperpnea or hyperventilation
Any breathing pattern that reduces CO2 due to increased rate and depth of respiration
60
Define platypnea
Dyspnea worse with upright posture (Pericarditis)
61
Pectus excavatum results in what?
Compression of the heart and great vessles. May cause murmurs
62
Describe the ABCDEEFG of melanoma
```
Asymmetry
Border irregularity
Color variations
Diameter >6mm
Evolving or changing
Elevated
Firm
Growing progressivley
```
63
List reasons for increased fremitus
Pneumonia
64
List reasons for decreased fremitus
Anything that causes sepration of lung tissue from body wall or prevents transmision
Effusion
Pneumothorax
COPD
Thickened chest wall
65
Percussion only penetrates ______ cm into the chest
5-7
66
Percussion sounds
1. Flatness
2. Dullness
3. Resonance
4. Hyperresonance
5. Tympanic
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
Vesicular lung sounds are heard over most of the lungs. Inspiratory is _____ than expiratory
Longer
68
Bronchial breath sounds are heard over the _____ (if at all) and inspiratory is _____ than expiratory
Manubrium
Shorter
69
Tracheal breath sounds are loud and high pitch darth vader noises. Inspiratory is _____ to expiratory
equal
70
Bronchophony is when a patient repeats words while being auscultated. What findings can we have with pneumonia or lung cancer?
Voice remains loud at the periphery of the lungs (not normal) or sounds louder than usual over a distinct area of consolidation.
71
Whispered pectoriloquy is valuable in detecting early _____, _____, and ________
Pneumonia, infarction, atelectasis
72
Egophony is a form of broncophony where what happens? What does this indicate?
E-->A transition. "Bleating" quality. Pneumonia
73
```
Ronchi = snore
crackles = crackles
wheeze = wheeze
```
Ronchi - bronchitis/secretion
Wheezing - narrowing COPD, Bronch, Asthma
Crackles - Heart, Fibrosis, pneumonia, (FIne or coarse)
74
Lungs extend 2-3cm over what
Each clavicle
75
______ nodes are the most palpable
Central
76
Who should be vaccinated
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
```
What is the
Percussion note
Trachea position
Breath sounds
Adventitious sounds
```
OF
Lobar pneumonia
Percussion - Dull (airless area)
Trachea - midline
Breathsounds - bronchial over area
Adventitious - late inspiratory crackles
78
```
What is the
Percussion note
Trachea position
Breath sounds
Adventitious sounds
```
OF
Left sided heart failure
Percuss - Resonant
Trachea - midline
Breath - vesicular
Adventitious - late inspiratory crackles in dependant lungs, maybe wheeze
79
```
What is the
Percussion note
Trachea position
Breath sounds
Adventitious sounds
```
OF
Pleural effusion
Percuss - Dull to flat over fluid
Trachea - shifted away
Breath sounds - decreased to absent. Possible bronchial at top
Adventitious - none, possible pleural rub
80
```
What is the
Percussion note
Trachea position
Breath sounds
Adventitious sounds
```
OF
Pneumothorax
Percussion - Hyperresonant or tympanic
Trachea - shifted away
Breath sound- none/decreased
Adventitious- none, possible pleural rub
81
```
What is the
Percussion note
Trachea position
Breath sounds
Adventitious sounds
```
OF
Asthma
Percussion - Resonant to diffusely hyperresonant
Trachea position - midline
Breath sounds - Obscured by wheezes
Adventitious - wheezes, crackles
82
What are the main organs of the RUQ?
```
Liver and gallbladder
Pylorus and Duodenum
Head of pancreas
Superior right kidney
Hepatic flexure
```
83
What are some important LUQ organs?
```
Left lobe of liver
Spleen
Stomach
Pancreas body
Left adrenal gland/sup left kidney
Splenic flexure
```
84
List the LLQ organs
Lower L kidney
Sigmoid colon
Left ureter
Left ovary and tube
85
List the RLQ organs
Lower R kidney
Cecum and Appendix
Ascending colon
R ovary/R ureter
86
Smooth muscle of the bladder holds around ______ml before being stimulated to contract
300
87
With peritonitis, patients tend to lie ____. With obstruction, patients tend to ________
Still
Constantly move
88
Flanks of the abdomen bulge with ________
ascites
89
Describe umbilical hernia.
Protrusion through defective umbilical ring.
Most common in infants.
Dont close on own.
Protrude more with raise head or shoulders
90
An incisional hernia is a protrusion of what through what? WHat can cause size increase?
Fat, bowel, omentum through operative scar.
Rase head or shoulders
91
Fascial dehiscence can cause 2 things.
1. After hernia repair
2. After abd surgery
1. Recurrent hernia
| 2. future incisional hernia
92
Describe diastasis recti
Sep. of two rectus abdominis muscles. ABD contents form ridge w/ head and shoulder raise.
Preg, obesity, chronic lung disease
No signifigance
93
Normal bowel sounds are present at what rate? How long should you listen before declaring absent?
5-34
2 minutes
94
Bowel sounds
1. tinkling
2. rushes of high pitched w/ cramp
3. decreased
1. dilated bowel
2. intestinal obstruction
3. Ileus and Peritonitis
95
If a bruit has systolic and diastolic components (Renal) think what?
Renal Artery Stenosis
96
If a bruit over iliac or femoral arteries has systolic and diastolic component, what should you think
Partial arterial occlusion
| Arterial insufficiency
97
Loss of liver dullness could be what?
Pneumoperitoneum
98
List liver sizes @ MCL and MSL
MCL - 6-12 cm
| MSL - 4-8
99
Involuntary rigidity of abd may indicate what?
Peritoneal inflammation
100
Normal aorta for people over 50 is how wide?
less than 3 cm
101
What are the risk factors for AAA?
Over 65
Smoker
Male
1st degree relative
102
Rupture of AAA is more likely for who?
>5cm size
103
How should aorta be examined?
Palpation followed by ultrasound
104
Describe the normal liver edge
Soft, sharp and regular w/ smooth surface
105
Tenderness @ Mcburney's point will be present if appendix is where?
In the iliac fossa
106
Retrocecal appendicitis might present with what instead of RLQ pain
Flank pain
107
If you think a patient may have appendicitis, what should you do?
```
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
Psoas sign is indicative of what?
Abnormality in retroperitoneum
** Such as retrocecal appendicitis
109
Obturator sign is indicative of what?
Pelvic appendicitis
| Or other pelvic issue
