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Exam 2 Flashcards

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1
Q

S3 sounds

A
  • ventricular gallop
  • brief mid diastolic impulse
  • normal in kids, young adults, 3rd trimester
  • usually indicate pathologic change in ventricular compliance
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2
Q

S4 sounds

A
  • atrial gallop
  • impulse just before systolic apical beat
  • marks atrial contraction
  • d/t increased resistance to ventricular filling
  • usually indicate pathologic change in ventricular compliance
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3
Q

L sided causes of S4 sounds

A
  • HTN
  • myocardial ischemia
  • aortic stenosis
  • CMP
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4
Q

R sided causes of S4 sounds

A
  • pulmonary HTN

- pulmonic stenosis

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5
Q

heaves and lifts

A
  • felt with base of palm
  • will lift hand, indicate sustained impulses
  • produced by enlarged A or V, V aneurysms
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6
Q

thrills

A
  • use full hand to assess
  • humming vibrations
  • murmur + thrill= cardiac pathology
  • if present assess the area for murmur
  • impacts grading of murmurs
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7
Q

where are S1 sounds heard loudest

A
  • apex
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8
Q

where are S2 sounds heard loudest

A
  • base
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9
Q

adventitious breath sounds

A
  • added or superimposed sounds

- will not be heard if there is enough gas exchange

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10
Q

crackles

A
  • aka rales

- brief

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11
Q

wheezes

A
  • high pitched

- suggest narrowed airways

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12
Q

rhonchi

A
  • low pitched
  • suggest large airways
  • heard on inspiration
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13
Q

transmitted breath sounds

A
  • suggest air filled lungs have become airless/ consolidated

- bronchophony, egophony, whispered pectoriloquy

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14
Q

what are the types of breath sounds

A
  • vesicular
  • bronchovesicular
  • bronchial
  • adventitious
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15
Q

vesicular breath sounds

A
  • soft or low pitched
  • heard through inspiration
  • normal breath sounds
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16
Q

bronchovesicular breath sounds

A
  • inspiratory and expiratory breath sounds are equal in length
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17
Q

bronchial breath sounds

A
  • louder, harsher, higher in pitch
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18
Q

consolidation

A
  • airless lung
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19
Q

a wave

A
  • JVP corresponding to atrial contraction

- immediately precedes S1

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20
Q

increased a wave

A
  • increased resist to R atrial emptying
  • decreased R ventricular compliance- RVH, COPD, restrictive CMP, pulm valve stenosis
  • tricuspid stenosis
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21
Q

absent a wave

A
  • a fib

- junctional or ventricular rhythms

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22
Q

intermittent prominent a wave

A
  • cannon a waves
  • AV dissociation (complete heart block)
  • v tach
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23
Q

grade 1 murmur

A
  • very faint
  • listener must be “tuned in”
  • may not be heard in all positions
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24
Q

grade 2 murmur

A
  • quiet but immediately heard
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25
grade 3 murmur
- mod loud
26
grade 4 murmur
- loud with palpable thrill
27
grade 5 murmur
- very loud with thrill | - may be heard with stethoscope slightly off chest
28
grade 6 murmur
- very loud with thrill | - may be heard with stethoscope entirely off chest
29
list the systolic murmurs
- mitral regurgitation - aortic stenosis - tricuspid regurg - pulmonic stenosis - HOCM - ASD - VSD - "mr. AS tries pseudonyms"
30
when do systolic murmurs occur?
between S1 and S2
31
when do diastolic murmurs occur
- between S2 and S2 | - listen with diaphragm
32
what does S1 indicate
- mitral and tricuspid valve closing | - systole
33
what does S2 indicate
- blood is ejected out of L ventricles - aortic and pulmonic valves close - diastole - immediately precedes carotid upstroke
34
PMI
- apical impulse - found at 5th IC space, 1 cm medial to MCL - should be less than 2.5 cm with brisk tap - if cannot find, put pt in LLD position
35
special tests for ascites
- shifting dullness - fluid wave - ballottement
36
test for shifting dullness
- have pt turn on side - percuss and mark boarders of dullness - in pts with ascites, tympani will shift to top when pt changes to lateral position
37
test for fluid wave
- have pt press side of hands down the midline of their abdomen - tap on one flank - pos for ascites= fluid wave felt on opposite flank
38
ballottement
- straighten and stiffen fingers, make brief jabbing motion to displace fluid - test for ascites
39
special tests for appendicitis
- McBurney's point - Rovsing's sign - psoas sign - obturator sign
40
McBurney's point
- 2 in from ASIS on diagonal line to umbilicus - check for guarding, rigidity, or rebound tenderness - sign of appendicitis
41
Rovsing's sign
- press in LLQ - pos= pain in RLQ - sign of appendicitis
42
psoas sign
- place hand above pts R knee and have them do SLR against resistance - turn pt on L side and extend R leg at hip - pos= abdominal pain - sign of appendicitis
43
obturator sign
- flex pts R hp with knee bent and then IR leg - pos= pain in R hypogastric region - sign of appendicitis
44
special tests for cholecystitis
- murphy's sign
45
murphy's sign
- hook fingers under R costal margin - ask pt to take a deep breath while you press up and in - pos= sharp increase in tenderness and sudden stop of inspiration - test for cholecystitis
46
crunch test
- test for ventral hernia - have pt raise head/ shoulders off table - if pt has hernia it will bulge
47
what are the different types of abdominal pain
- visceral - parietal - referred
48
visceral pain
- distention/ stretching of hollow abdominal organs - typically palpable near midline - gnawing, burning, cramping, aching pain - sweating, pallor, n/v, restlessness when severe
49
parietal pain
- abd wall inflammation, parietal inflammation - steady aching pain- usually worse than visceral - more precisely localized over structures, pt can point to pain - aggravated by movement or coughing, pt prefers to lie still
50
referred pain
- pain felt at distant sites that are innervated at roughly same spinal level - may be felt superficially, or deeply - usually localized
51
where is pain in abdomen usually referred from
- chest - spine - pelvis
52
normal findings for tactile fremitus
- feel vibrations
53
decreased tactile fremitus
- obstructed bronchus - COPD - pneumothroax - pleural effusion - fibrosis - tumor
54
increased tactile fremitus
- pneumonia
55
normal JVP
- < 3 cm above sternal angle - < 8/9 cm in total distance from right atria - normally falls with inspiration
56
increased JVP causes
- HF - tricuspid stenosis - chronic pulmonary HTN - pericardial disease
57
Kussmaul's sign
- JVP rises with inspiration | - suggests impaired filling of RV
58
hepato-jugular reflex
- when pressure is applied in RUQ JVP rises
59
primary Raynaud phenomenon
- episodic reversible vasoconstriction in fingers and toes - triggered by cold temps - no definable cause - capillaries are normal - distal portion of fingers - usually only painful if ulcers present - numbness and tingling common
60
secondary Raynaud phenomenon
- si/sx related to autoimmune diseases | - can be d/t occupational vascular injury or drugs
61
peripheral arterial disease
- atherosclerotic disease -> obstruction of peripheral arteries - exertional claudication, may progress to sx at rest - atypical leg pain - usually found in calf - can occur in buttock, hip, high, foot depending on level of obstruction - rest pain in distal toes or forefoot
62
acute arterial occlusion
- d/t embolism or thrombosis | - distal pain usually in foot and leg
63
surgical abdomen
- pain prior to vomiting
64
sternal angle land marks
- aka angle of louis - T4 - Rib 2
65
where is the inferior angle of the scapula
- posterior of rib 7
66
what is normal AP diameter of the chest
- 1:2 | - may increase with age or chronic bronchitis
67
what is another word for chest expansion
- lung excursion
68
what is the normal liver size
- 6-12 cm at midclavicular line in males
69
aortic stensosis
- systolic murmur - found at 2nd and 3rd interspaces - radiates to carotid and apex - harsh quality - heard best when pt is sitting and leaning forward
70
HOCM
- systolic murmur - found at 3rd and 4th interspaces - radiates to apex - medium intensity - decreases with squatting and valsalva release - increases with standing and valsalva strain
71
pulmonic stenosis
- systolic murmur - found at 2nd and 3rd interspaces - radiates towards L shoulder and neck - crescendo decrescendo - harsh quality
72
mitral regurgitation
- systolic murmur - found at apex - radiates to L axilla - does not change with inspiration - holosystolic
73
tricuspid regurgitation
- systolic murmur - blowing, holosystolic - found at lower L sternal boarder, if RVD then may be heard at apex - increases with inspiration
74
ventricular septal defect
- systolic murmur - heard at 3rd, 4th and 5th interspaces - intensity increases with smaller defect - pitch is higher with smaller defect - holosystolic
75
aortic regurgitation
- heard at L 2nd, 3rd and 4th interspaces - radiates to apex if loud - heard best with diaphragm - blowing decrescendo - heard best when pt is sitting, leaning forward, with breath held after exhalation
76
mitral stenosis
- usually limited to apex without radiation - decrescendo low pitched rumble - presystolic accentuation - use bell to hear - heard best in LLD position - mild exercise (handgrip) may worsen
77
venous hum
- continuous murmur without silent interval - loudest in diastole - heard above medial third of clavicles esp on right - obliterated when pressure applied to IJV - heard best with bell
78
pericardial friction rub
- heard best in 3rd interspace next to sternum when pt is sitting and leaning forward - superficial sound that seems "close to stethoscope" - scratchy, scraping quality - heard best with diaphragm
79
patent ductus arteriosus
- found at 2nd left interspace - radiates to L clavicle - usually loud, machinery like

Physical exam (3 decks)

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