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Exam 2 Flashcards

(98 cards)

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1
Q

bronchial/tubular breath sounds

A

heard at trachea

expiration longer

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2
Q

vesicular

A

heard at lung periphery

I>E, low pitched, breezy

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3
Q

bronchovesicular

A

mainstem bronchi
I=E
medium volume

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4
Q

COPD and tactile fremitis

A

feel at apex, but dec as you go to base

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5
Q

causes of dec tactile fremitis ‘99’

A

pleural effusion, obstructed bronchus, COPD, tumor, thick chest wall, pneumothorax

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6
Q

causes of increased tactile fremitits

A

PNA, consolidated tissue

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7
Q

excursion

A

chest expansion measured at costal margin

-normal 3-5 cm

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8
Q

COPD and excursion

A

decreased, trouble moving air

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9
Q

COPD notes

A

barrel chest, 1:1 ratio, dec excursion, hyperresonance with percussion, dec breath sounds, dec tactile fremitis

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10
Q

PNAs

A

adventitious sounds, inc tactile fremitis, bronchial breath sounds, dull percussion

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11
Q

egophony

A

ee will sound like ay, PNA

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12
Q

bronchocophy

A

1-2-3, will sound clearer, PNA

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13
Q

whispered pectoriloquy

A

pt whisper sounds louder, PNA

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14
Q

atypical PNAs

A

legionella (smoker, immune compromised), chlamdophlia (mild), mycopasmic (young people)

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15
Q

bronchitits

A

cough most common symptom

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16
Q

asthma

A

see if they can say full sentences

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17
Q

pneumothorax

A

unequal excursion, dec tactile, dec breath sounds, may have hyperresonance that side

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18
Q

rhonchi

A

airway is obstructed by thick secretions, muscular spasm or new growth, usually expiratory, larger airways

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19
Q

stridor

A

acute distress, foreign body, tumor, severe bronchospasm, louder in neck

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20
Q

grunting

A

trouble moving air out, expiratory sound, kiddos common

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21
Q

pleural friction rub

A

high pitchy, scratchy, unaffected by coughing, abnormally placed bronchial sounds, consolidated pnas

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22
Q

acute cough

A

< 3 weeks, Hx: ACE, GERD, URI, COPD

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23
Q

precordium

A

apex, LLSB, base left, base right

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24
Q

pulsations

A

common at apex, shouldn’t feel at base

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25
lifts/heaves
assoc with left vent hyper, pulsations so great it lifts your hand
26
thrusts
l vent hypertrophy
27
thrills
will also hear murmurs
28
cardiac site pneumonic
all patients take meds
29
aortic
2nd intercostal right of sternum, “right base”
30
aortic stensosis
may radiate to carotids, LSB or apex, associated with thrill
31
pulmonic
2nd intercostal space left of sternum, “left base”
32
tricuspid
4th and 5th intercostal space to the left sternal border
33
apex/mitral area
5th intercostal space at the midclavicular line
34
erbs point
3rd interspace at left sternal border, murmurs
35
s1 'lub'
mitral and tricuspid closing, heard at apex, beginning of systole
36
accentuated s1
fever, exercise, anemia, mitral stenosis
37
dim s1
conduction defect
38
normal split s1
mitral then tricuspid, stuttering sound, listen over tricuspid area or LLSB
39
abnormal split s1
BBB
40
s2 'dub'
aortic and pulmonic closing, heard at base
41
accentuated s2
HTN, inc peripheral vascular resistance
42
dim s2
shock
43
normal split s2
varies with inspiration, hear at pulmonic area
44
abnormal split s2
BBB
45
s3
failing heart, not normal after age 30, 1-2-3, kentucky, heard at apex with bell
46
s4
stressed heart, late diastole with atrial kick | 4-1-2, tennessee, apex with bell, sit lateral recumbent
47
s4 can be caused by
atherosclerosis, HTN, CAD, late diastolic filling sound associated with atrial kick
48
murmurs
turbulent flow within the heart, can be normal in kids and young adults
49
bruits
turbulent flow outside the heart in the arteries
50
physiologic murmurs
caused by temporary increase in blood flow (anemia, fever, pregnancy, hyperthyroidism), heard at 2nd-4th interspaces between LSB and apex
51
systolic murmurs
innocent, MV prolapse, mitral regurg, aortic stenosis, hypertrophic cardiomyopathy, pulmonary stenosis
52
mitral regurg
heard at apex, may radiate to L axilla or LSB
53
tricuspid regurg
heard at LSB, may radiate to R of sternum or xyphoid area.
54
aortic stenosis
heartd at aortic/pulm area, often loud & associated with thrill.
55
diastolic murmurs are never innocent
aortic regurg or mitral stenosis
56
grade 4-6 mumurs
not normal, feel thrill at 4
57
rubs
high pitched, scratchy, pericarditis, best heart at left lateral sternal border with diaphragm with pt leaning forward, systolic/diastolic sound  Pt at risk for cardiac tamponade
58
click
systolic sound, hearing valves open
59
mitral valve prolapse
high pitch, heard at apex
60
snaps
opening of mitral or triscupid, diastolic sound heard at apex, caused by mitral stenosis
61
left lateral recumbiant
best for s4 and s3
62
leaning forward
pericardial friction rub
63
PMI details
felt at apex, should be less than 2cm
64
JVP
shouldn't be greater than 3cm
65
carotids
check bruits and feel thrills
66
HTN
>140/>90
67
venous insufficiency
+ pulses, + edema, heavy, stasis ulcers at ankles, skin is leathery and thick, brownish and cyanotic, normal temp
68
arterial insufficiency
diminished or absent pulses, little to no edema, + pain, cold feet, shiny thin and hairless skin, wounds on toes (gangrene), pallor with elevation, dusky red when dependent
69
ABI test
normal 1, can't do in diabetics
70
allens test
fist, compress arteries, see pallor and then return of color
71
CHF
inc JVP and s3 gallop
72
edema
measure JVP to see if cardiac cause
73
stable angina
persistent, recurring chest pain that usually occurs with exertion, could feel like indigestion, might spread to arms/back, can be triggered by stress
74
prizmetals/variant angina
caused by coronary artery spasm, usually at rest, often severe, relieved by angina meds/Ca channel blockers
75
MI
can radiate to back, neck, jaw, shoulders and arms (esp left) - Last more than a few min, goes away and comes back, varies with intensity
76
RLQ
appendix
77
RUQ
liver, pancreas
78
LUQ
stomach, spleen
79
normal ab percussion
tympany
80
normal liver
6-12 at midclav line, or 4-8 at midsternal, scratch test
81
spleen palpated
LUQ
82
spleen percussed
Left axillary line, resonance changes to dullness with deep breath, left lateral recumbinant
83
kidneys
CVA, pain with patting can be pyelonephritis
84
normal aorta size
2.5-3 cm
85
hepatomegaly
varicose or distended veins
86
hepatic and splenic friction rub
tumor, gonococcal infection
87
cullens sign
bruised umbilicus, intraperitoneal bleed
88
gray-turners sign
bruised flank
89
dissecting triple a
back pain
90
appendicitis pain
umbilicus first them RLQ
91
diverticulitis pain
LLQ
92
kidney infection pain
flank pain
93
jaundice
dark urine, clay stool
94
rebound tenderness
peritoneal irritation
95
+ murphys
arrest of inspiration while palpating RUQ, could be cholecystitis, pancreatitis, hepatitis, peptic disease
96
+ obturator test
pain with internal thigh rotation
97
+ psoas
lay on side and pull right leg back and pain
98
+rovsigs sign
pain in RLQ when LLQ palpated, appendicitis

Advanced Health Assessment (3 decks)

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