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Clinical Skills > Clinical examination > Flashcards

Clinical examination Flashcards

1
Q

What is S1 in the cardiac cycle?

A

Caused by blood rebounding off closed AV valves and ventricular walls

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2
Q

What is S2 caused by in the cardiac cycle?

A

The blood reverberating in the great vessels once the aortic and pulmonary valves have closed

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3
Q

What is atrial fibrillation?

A

A very rapid irregular heartbeat

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4
Q

What is the term for a high-pitched cardiac sound caused by turbulence of the blood?

A

Stenosis

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5
Q

What kind of heart sound is caused by a narrowing of the aortic valve? Where is this sound loudest?

A

Sub-aortic stenosis

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6
Q

What is pulmonic stenosis? Where is it loudest?

A

Usually a high-pitched sound induced by a narrowing of the pulmonic valve causing turbulence in the blood.
LHS

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7
Q

List all systolic heart sounds

A 
Atrial fibrillation
Sub-aortic stenosis
Pulmonary stenosis
Mitral regurgitation
Mitral valve click
Ventricular septal defect
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8
Q

What are mitral regurgitation sounds caused by?

A

Inefficient closing of mitral valve permits backflow of blood, causing a mid-pitched sound

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9
Q

What is a mitral valve click caused by? Where is it loudest?

A

Thickening of mitral valve

LHS

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10
Q

What is a patent ductus arteriosus, and when is it of clinical significance?

A

A continuous murmur caused by the ductus arteriosus failing to close (therefore normal in puppies younger than 2do)
Abnormal sound if heard in animals older than 2d

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11
Q

What is a patent ductus arteriosus, and when is it of clinical significance?

A

A continuous murmur caused by the ductus arteriosus failing to close (therefore normal in puppies younger than 2do)
Abnormal sound if herad in animals older than 2d

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12
Q

What is a ventricular septal defect? Where is this sound loudest?

A

A low-pitched murmur caused by failure of ventricular septum to close
RHS

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13
Q

What are ventricular premature contractions? And how is this affected by mitral regurgitation?

A

Extra heart sounds caused by extra, abnormal ventricular contractions due to turbulence of blood in the ventricle.
Mitral regurgitation exacerbates this with blood regurgitating back through the mitral valve

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14
Q

What are ventricular premature contractions? And how is this affected by mitral regurgitation?

A

Extra heart sounds caused by extra, abnormal ventricular contractions due to turbulence of blood in the ventricle.
Mitral regurgitation exacerbates this with blood flowing back through the mitral valve

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15
Q

What are ventricular premature contractions? And how is this affected by mitral regurgitation?

A

Extra heart sounds caused by extra, abnormal ventricular contractions due to turbulence of blood in the ventricle.
Mitral regurgitation exacerbates this with blood flowing back through the mitral valve

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16
Q

With normal tracheal sounds, how do the inspiratory and expiratory sounds compare?

A

The expiratory sound is louder, and has both a higher pitch and longer duration than the inspiratory sound

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17
Q

Which normal tracheal sound has the longer pause?

A

Expiratory pause

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18
Q

How do vesicular and tracheal sounds compare normally?

A

For vesicular sounds the inspiratory sounds are louder, of higher pitch and longer duration; whereas tracheal sounds are loudest on expiration.
Both expiratory pauses are considerably longer than the inspiratory sounds

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19
Q

When are vesicular lung sounds best heard?

A

When breathing is exaggerated

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20
Q

Which lung sounds can also be heard alongside heart sounds?

A

Broncho-vesicular lung sounds

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21
Q

What are broncho-vesicular lung sounds?

A

A combination of tracheal and vesicular sounds, with acoustic characteristics between the two

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22
Q

Where would you auscultate for broncho-vesicular lung sounds?

A

Primarily over the central portions of the chest, on both front and back.

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23
Q

What sounds are commonly detected in normal newborn puppies?

A

High respiratory rate, loud inspiratory phase, and irregular breathing patterns

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24
Q

What sounds are commonly detected in normal newborn puppies?

A

High respiratory rate, loud inspiratory phase, and irregular breathing patterns

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25
Q

Name the features of abnormal bronchial lung sounds.

A

Expiratory phase is louder and lasts longer than inspiratory phase
High-pitched and harsh quality to expiratory phase
Tachypnea is present
Heart sounds are audible with occasional dysrhythmia

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26
Q

Where do abnormal bronchial lung sounds occur from?

A

From regions of pneumonia

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27
Q

Where do abnormal bronchial lung sounds occur from?

A

From regions of pneumonia

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28
Q

What is a polymorphic wheeze?

A

A ‘musical’ wheezing sound that is often heard in patients with asthma

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29
Q

Does the pitch of a polymorphic wheeze change, and if so when?

A

Yes - pitch is higher during inspiration than expiration

30
Q

In asthmatics, when can a polymorphic wheeze be detected?

A

Often during either or both phases of respiration

31
Q

What is the term for wheezing sounds that are presumed to originate from a single site?

A

Monophonic wheeze

32
Q

What abnormal lung sounds are likely to originate from the friction of inflamed pleural surfaces moving against one another?

A

Pleural friction rub

33
Q

What sound is pleural friction rub likened to?

A

Creaking of a gate

34
Q

How does the sound of pleural friction rub alter if the patient’s breathing pattern and body position remain the same?

A

The sound is monotonously repetitive; though this sound changes usually when the body position changes

35
Q

What abnormal lung sound can crackles be likened to? How do they differ?

A

Crackles originating from the lung are similar in sound to a pleural friction rub;
Pleural friction rub is lower in pitch.

36
Q

What abnormal lung sound can crackles be likened to? How do they differ?

A

Crackles originating from the lung are similar in sound to a pleural friction rub
Pleural friction rub is lower in pitch

37
Q

What is stridor?

A

There is marked respiratory distress accompanied by a high-pitched tone during both inspiration and expiration, caused by a narrow aperture between the vocal chords

38
Q

What happens towards the end of stridor lung sounds?

A

During the end of expiration there is an abrupt reduction in the pitch of the expiratory tone

39
Q

Where might cavernous lung sounds be heard?

A

Over a lung cavity

40
Q

What component of cavernous lung sounds is similar to tracheal lung sounds?

A

The loud exaggerated expiratory phase

41
Q

What component of cavernous lung sounds is similar to tracheal lung sounds?

A

The loud exaggerated expiratory phase

42
Q

State the features of cavernous lung sounds

A

Loud exaggerated expiratory phase
Audible over a lung cavity
Both phases of cavernous breathing have a higher pitch than normal tracheal sounds
Heart sounds also audible

43
Q

Describe the sounds produced by fine to medium crackles/rales

A

These sounds begin approximately mid-inspiration and intensify towards the end of expiration
Coarse crackles are also audible in the early expiratory phase of some of the breaths

44
Q

Describe the sounds produced by fine to medium crackles/rales

A

These sounds begin approximately mid-inspiration and intensify towards the end of expiration
Coarse crackles are also audible in the early expiratory phase of some of the breaths

45
Q

What are ronchi?

A

Very low-pitched repetitive sounds

46
Q

When are coarse crackles present as lung sounds?

A

During inspiration and expiration

47
Q

When do coarse crackles present as lung sounds?

A

During inspiration and expiration

48
Q

What is heard with coarse crackles/rales with ronchi?

A

Coarse crackles occur during both inspiration and expiration
Some ronchi are heard
Some high-pitched squeaks can also be heard against the background of bronchial breath sounds

49
Q

Describe the lung sounds made by coarse crackles/rales.

A

Coarse crackles that establish at the onset of inspiration, diminishing in intensity and prevalence towards its end

50
Q

Which phase is not audible during coarse crackles/rales?

A

Expiration

51
Q

Which phase is not audible during coarse crackles/rales?

A

Expiration

52
Q

What is pulmonary oedema characterised by?

A

Medium and coarse crackles appearing towards the end of inspiration and continuing into expiration

53
Q

What do the acoustics associated with pulmonary oedema mean?

A

All acoustics are consistent with respiratory distress and pulmonary congestion

54
Q

What forms the subjective assessment of a patient?

A

Signalment, history, BCS, demeanour, posture, gait

55
Q

What scales are used for assessing condition of domestic species? And what are the ideal scores?

A

BCS from 1-9
Dogs: 4/5
Cats: 5

56
Q

What is stertor?

A

Inspiratory noise

57
Q

What objective assessments of the head are made?

A 
Musculature
Submandibular lymph nodes
Oral cavity - teeth, tongue, pharynx, mm, lips
CRT, mm colour
Nose and airflow
Eyes - gross, ophthalmoscope
Ears - gross, auroscope
58
Q

What is examined in the nexk region?

A 
Laryngeal cartilages and trachea
Retropharyngeal and prescapular lymph nodes
ROM
Upper respiratory tract
Jugular veins
59
Q

How do you perform a tracheal pinch test?

A

Palpate laryngeal cartilages and trachea - if this elicits a cough, it is a + result

60
Q

What does a + tracheal pinch test indicate?

A

This is suggestive of irritation or compression of the large airways

61
Q

What different techniques are performed to assess the thorax?

A

Palpation
Auscultation
Percussion

62
Q

At which ribspaces should the heart be auscultated?

A

3rd - pulmonary valve
4th - aortic and tricuspid valve
5th - mitral valve

63
Q

Which valves can be auscultated on the LHS? And the RHS?

A

The pulmonic, aortic and mitral valves are heard on the LHS; tricuspid valve on RHS

64
Q

In which species are gallop cardiac sounds normal?

A

Horse

65
Q

What causes S3 in small animals?

A

Reduced ventricular compliance

66
Q

What sound is generated by ventricular stiffening?

A

S4 cardiac sounds

67
Q

Which organs should be palpable in the abdomen?

A 
Caudal liver
Spleen
Kidneys
Intestines
Bladder
68
Q

What is pleural effusion?

A

Excess fluid that accumulates in the pleural cavity surrounding the lungs

69
Q

What is a pneumothorax?

A

The presence of air or gas in the cavity between the lungs and chest wall, causing collapse of the lung

70
Q

What is a blepharospasm?

A

Involuntary tight closure of the eyelids

71
Q

What is strabismus?

A

Abnormal alignment of the eyes

72
Q

What is nystagmus?

A

Rapid involuntary movements of the eyes

Clinical Skills (8 decks)

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