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History and Physical 1 > Exam 2-abdomen, Cardio > Flashcards

Exam 2-abdomen, Cardio Flashcards

1
Q

When should auscultation of the abdomen be preformed?

A

Before percussion or palpation, because these can alter the characteristics of bowel sounds

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2
Q

What do bruits suggest when auscultations the abdomen?

A

Vascular occlusive disease

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3
Q

What are altered bowel sounds common in?

A

Diarrhea, intestinal obstruction, paralytic ileus, and peritonitis

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4
Q

A bruit in the epigastrum and upper quadrants signifies what?

A

If it has both systolic and diastolic components, strongly suggest renal artery stenosis (HTN)

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5
Q

Bruits with both systolic and diastolic components suggest what?

A

Turbulent blood flow form atherosclerotic arterial disease

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6
Q

What are friction rubs heard in?

A

Present in hepatoma, gonococcal infection around liver, splenic infarction, and pancreatic carcinoma

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7
Q

How many clicks are gurgles are heard in the abdomen per minute?

A

5-34

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8
Q

What do decreased bowel sounds mean?

A

A dynamic ileus, peritonitis

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9
Q

What do increased bowel sounds mean?

A

Diarrhea, early intestinal obstruction

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10
Q

Where do you listen for bruits?

A

Over aorta, iliac arteries, and femoral arteries

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11
Q

Grating sounds with respiratory variation

A

Friction rubs

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12
Q

What is a soft humming noise with systolic and diastolic components?

A

Venous hum

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13
Q

Where do you listen for a venous hum?

A

Epigastric and umbilical regions

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14
Q

What is a venous hum caused by?

A

Increased collateral circulation between portal and systemic venous systems; liver cirrhosis

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15
Q

What is heard in liver cirrhosis?

A

Venous hum

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16
Q

What type of breath sound has inspiratory sounds last longer than expiratory sounds?

A

Vesicular

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17
Q

Characteristics of vesicular breath sounds

A

Soft intensity, relatively low pitch, found over most of both lungs

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18
Q

What type of breath sound is inspiratory and expiratory sounds almost equal?

A

Bronco-vesicular

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19
Q

Characteristics of bronco-vesicular breath sounds

A

Intermediate intensity, intermediate pitch

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20
Q

Where are bronco-vesicular breath sounds heard?

A

Often in the 1st and 2nd interspaces anteriorly and between the scapulae

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21
Q

What type of breath sounds is expiratory sounds last longer than inspiratory ones?

A

Bronchial

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22
Q

Characteristics of bronchial breath sounds

A

Loud intensity, relatively high pitch

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23
Q

Where are bronchial breath sounds heard?

A

Over manubrium (larger proximal airways)

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24
Q

Inspiratory and expiratory are almost equal, intensity is very loud, pitch is relatively high

A

Tracheal breath sounds

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25
Q

What are adventitious or added breath sounds?

A

Crackles, Wheezes,and Rhonchi

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26
Q

Fine crackles

A

Soft-high pitched, very brief (5-10 ms)

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27
Q

Coarse crackles

A

Somewhat louder, lower in pitch (15-30 ms)

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28
Q

Crackles are continuous or discontinuous?

A

Discontinuous

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29
Q

Crackles (or rales)

A

Intermittent, nonmusical and brief breath sounds

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30
Q

Wheezes and rhonchi are continuous or discontinuous?

A

Continuous

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31
Q

Wheezes

A

Sinusoidal, musical, prolonged, like dashes in time

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32
Q

Wheeze characteristic

A

Relatively high pitches with hissing or shrill quality

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33
Q

Rhonchi characteristic

A

Relatively low pitched with snoring quality

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34
Q

What is fremitus?

A

Palpable vibrations transmitted rough bronchopulmonary tree to chest wall while speaking

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35
Q

Fremitus is decreased or absent if:

A

High pitched voice, soft voice, thick chest wall, obstructed bronchus, COPD, pleural effusion, fibrosis, air (pneumothorax), infiltrating tumor

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36
Q

Fremitus is typically more prominent in what area?

A

Interscapular area than the lower lung fields

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37
Q

Asymmetric decreased fremitus raises the likelihood of what?

A

Unilateral pleural effusion, pneumothorax, or neoplasms c

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38
Q

Grade 1 murmur

A

Very faint, head only after listener has “tuned in”; may not be heard in all positions

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39
Q

Grade 2 murmur

A

Quiet, but heard immediately after placing stethoscope on the chest

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40
Q

Grade 3 murmur

A

Moderately loud

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41
Q

Grade 4 murmur

A

Loud, with palpable thrill

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42
Q

Grade 5 murmur

A

Very loud, with thrill. May be heard when stethoscope is partly off the chest

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43
Q

Grade 6 murmur

A

Very loud, with thrill. May be heard with stethoscope entirely off the chest

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44
Q

How should you examine the pts thorax and lungs when they are sitting?

A

Have them fold arms across chest with hands resting on opposite shoulders, This swings scapulae laterally and increases access to lung fields

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45
Q

How should you examine the pts thorax and lungs if they are supine?

A

Allows women’s breasts to be gently displaced.

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46
Q

How should you examine a pts thorax and lungs if they cannot sit up?

A

Ask for assistant to hold pt up in sitting position, roll pt side to side

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47
Q

What is the trick to remember systolic murmurs?

A

Mr. AS tried pseudonyms

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48
Q

Mr. AS tried pseudonyms

A

Mitral regurgitate, aortic stenosis, tricuspid regurgitate, pulmonic stenosis, ASD, VSD, HOCM

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49
Q

A benign sound produced by turbulence of blood in the jugular veins (common in children)

A

Venous hum

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50
Q

Produced by inflammation of the pericardial sac

A

Pericardial friction rub

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51
Q

A congenital anomaly that persists after birth causing a left-to-right-shunt form aorta to pulmonary artery

A

PDA patent ductus arteriosus

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52
Q

What is a continuous murmur without a silent interval, loudest in diastole?

A

Venous hum

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53
Q

Where is a venous hum heard?

A

Above the medial third of the clavicles, especially on the right, often when head is turned in opposite direction, best heard if pt is in sitting position

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54
Q

When does the venous hum disappear?

A

When the patient is supine

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55
Q

Where does the venous hum radiate to?

A

Right or left 1st and 2nd interspaces

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56
Q

What is the timing of a pericardial friction rub?

A

Inflammation of the visceral and parietal pericardium from pericarditis produces coarse grating sound with 1, 2, or 3 components

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57
Q

What are the components of a pericardial friction rub?

A

Ventricular systole, ventricular filling, and atrial contraction during diastole

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58
Q

Rubs can be heard with pericarditis with and without what?

A

Pericardial effusions

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59
Q

Where is a pericardial friction rub best heard?

A

Left 3rd interspace next to sternum with patient sitting and leaning forward with breath held after forced expiration

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60
Q

What is the timing of PDA?

A

Continuous murmur in both systole and diastole, often with a silent interval late id diastole

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61
Q

When is PDA loudest?

A

In late systole, obscures S2, and fades in diastole

62
Q

Where is PDA best heard?

A

Left 2nd interspace and radiates toward left clavicle

63
Q

What is the Allen’s test for?

A

Compares the potency of ulnar and radial arteries

64
Q

How do you do the Allen’s test?

A

Compress ulnar and radial Artie’s, tell pt to open and close hand a few times to get blood out until hand is white. Release one of arteries

65
Q

Results of Allen’s test

A

Hand stays white: positive (indicates occlusion of artery thats no longer compressed)
Hand returns to red/pink: negative, normal

66
Q

When will we see changes in the hepatojugular reflex?

A

Right sided HF, passive hepatica congestion

67
Q

Hepatojugular reflex

A

JVP observed while pressure firmly applied to RUQ

68
Q

What is Kussmaul’s sign?

A

JVP that rises with inspiration

69
Q

What does Kussmaul’s sign suggest?

A

Impaired filling or right ventricle (fluid in pericardial space, poorly compliant myocardium/pericardium)

70
Q

What is primary Raynaud’s phenomenon?

A

Episodic reversible vasoconstriction in the fingers and toes, usually triggered by cold temperatures (capillaries are normal); no definable cause

71
Q

What is secondary Raynaud’s phenomenon?

A

Si/sx related to autoimmune diseases-scleroderma, systemic lupus, mixed connective tissue disease; cryoglobulinemia; also occupational vascular injury, drugs

72
Q

Where is the location of pain for Raynaud’s?

A

Distal portions of one or more fingers, pain is usually not prominent unless fingertip ulcers develop

73
Q

PAD process

A

Atherosclerotic Disease lading to obstruction of peripheral arteries causing exertional claudication and atypical leg pain

74
Q

Location of pain for PAD

A

Calf muscles, but also occurs in butt, hip, thigh, or foot. Depending on levels of obstruction; rest pain may be distal in toes or forefoot

75
Q

Acute arterial occlusion process

A

Embolism or thrombosis

76
Q

Location of pain for acute arterial occlusion

A

Distal pain, usually involving the foot and leg

77
Q

What occupies most of the anterior cardiac surface?

A

Right ventricle

78
Q

Where odes the inferior border of the RV lie?

A

Below the unction of the sternum and xiphoid process

79
Q

Where does the RV join the pulmonary artery?

A

At the base of the heart at the sternal angle

80
Q

A PMI >2.5cm suggests what?

A

LVH from HTN or aortic stenosis

81
Q

Displacement of PMI lateral to midclavicular line or >10cm lateral to midsternal line occurs when?

A

LVH and ventricular dilation from MI or HF

82
Q

To assess the amplitude and contour of the carotid pulse, how should the patient be?

A

Supine with head of bed elevated to about 30 degrees

83
Q

Never palpate both carotid arteries at same time, why?

A

Can decrease blood flow to brain and induce syncope

84
Q

What it’s he amplitude of the carotid pulse?

A

This correlates reasonably well with the pulse pressure

85
Q

The carotid pulse during cardiogenic shock

A

small, thready, or weak

86
Q

Carotid pulse is bounding in what

A

Aortic regurgitation

87
Q

The carotid upstroke is delayed in what?

A

Aortic stenosis

88
Q

What is the contour of the carotid pulse?

A

The speed of the upstroke, the duration of its summit, and the speed of the downstroke.

89
Q

The normal contour of the carotid pulse

A

Upstroke is brisk, smooth, rapid and follows S1 almost immediately.
Summit is smooth, rounded, and roughly midsystolic
Downstroke: less abrupt than upstroke

90
Q

What is pulses alternans?

A

Bite I almost pulse that varies beat to beat, a paradoxical pulse varies with respiration

91
Q

What does pulses alternans almost always indicate?

A

Severe left ventricular dysfunction

92
Q

How is pulsus alternans best felt?

A

By applying light pressure on radial or femoral arteries.

93
Q

What is paradoxical pulse?

A

Greater than normal drop is systolic BP during Inspiration, can suspect cardiac tamponade

94
Q

Where is PMI found?

A

Apex of heart, midclavicular line in 4th or 5th interspace

95
Q

What are heaves and lifts?

A

Sustained impulses that rhythmically lift fingers

96
Q

What are thrills?

A

Buzzing or vibratory sensation on the hand

97
Q

Where is the pulmonic area?

A

Left 2nd interspace

98
Q

Where is the aortic area?

A

Right 2nd interspace

99
Q

What are S1 and S2 sounds best heard with?

A

Diaphragm of stethoscope

100
Q

What is the best position to hear mitral stenosis?

A

Left lateral decubitus

101
Q

Where and how should you listen for mitral stenosis?

A

With bell of stethoscope on apical impulse

102
Q

How should pt be oriented if checking for aortic regurgitation?

A

Pt sitting up, lean forward, exhale completely, hold breath

103
Q

How should aortic regurgitation be heard?

A

Listen with diaphragm at left sternal border and apex

104
Q

What is a protuberant abdomen with bulging flanks a suspicion for?

A

Ascites

105
Q

Ascites reflects what in cirrhosis?

A

Increased hydrostatic pressure in cirrhosis, HF, constrictive pericarditis, or IVC or hepatic vein obstruction

106
Q

What special test is used for ascites?

A

Check for central tympani

107
Q

How do you test for central tympany?

A

Percussion abdomen, anterior abdomen will be tympanic, the flanks will be dull with ascites

108
Q

How do you test for shifting dullness?

A

Percuss the border of tympany and dullness with pt supine, then ask to roll onto one side. Percuss and mark borders again

109
Q

Shifting dullness test for ascites

A

Without ascites: the border between tympany and dullness usually stays relatively constant

110
Q

Shifting dullness positive for ascites

A

Dullness shifts to the more dependent side, whereas tympany shifts to the top

111
Q

How do you test for a fluid wave?

A

Ask pt to press edges of both hands firmly down midline of abdomen, while you tap one flank sharply with fingers, feel on opposite flank for an impulse transmitted through fluid

112
Q

An easily palpable impulse from the fluid wave test suggests what?

A

Ascites

113
Q

What is ballottement?

A

A brief jab over an organ, the quick movement often displaces fluid so that fingers can briefly touch the surface of the organ (with ascites)

114
Q

Appendicitis is twice as likely in the presence of?

A

RLQ tenderness, Rovsing sign, psoas sign and McBurney point tenderness

115
Q

Where is the classic “McBurney point”

A

Lies 2 inches from the ASIS of ilium

116
Q

What is Rovsing’s sign?

A

If you press on the left side of the abdomen, and the pt feels pain in RLQ (appendicitis)

117
Q

What is the psoas sign?

A

Extension of the psoas muscle, have the pt lay on left side and extend the hip

118
Q

What is a positive psoas sign?

A

Increased abdominal pain on either maneuver, suggests irritation of the psoas muscle by an inflamed appendix

119
Q

What is the obturator sign?

A

Flex the right thigh at the hip with the knee at 90 degrees, and rotate the up internally

120
Q

What is a positive obturator sign?

A

Right hypogastric pain, form irritation of the obturator muscle by an inflamed appendix. Sign has low sensitivity

121
Q

What is the heel tap test?

A

Forcefully stroke bottom of foo twitch hand, strike heels forcibly from standing position

122
Q

When do you assess Murphy’s sign?

A

When RUQ pain and tenderness suggest acute cholecystitis

123
Q

What is a positive Murphy’s sign?

A

A sharp increase in tenderness with inspiratory effort

124
Q

How do you preform Murphy’s sign?

A

Palpate the liver at midclavicular line, tell pt tp inhale deeply, sudden increase in pain is positive

125
Q

How do you assess ventral hernias?

A

Ask pt to raise both head and shoulders off table (do a crunch), look for obvious bulge or increase in size of lesion

126
Q

What is visceral abdominal pain?

A

With dissension/stretching of hollow organs, difficult to localize and has a varying quality

127
Q

What is parietal abdominal pain?

A

More precisely localized over involved structure, aggravated by movement or coughing, steady, aching pain

128
Q

What is referred abdominal pain?

A

Follows dermatomes, area of referred pain is usually non-tender to palpation

129
Q

What is the abdominal exam sequence?

A 
IAPP
Inspection 
Auscultation
Percussion
Palpation- light touch, deep touch
Special Tests
130
Q

What is the “a” wave for JVP?

A

Corresponds to atrial contraction

131
Q

What do absent a waves mean?

A

AFIB, junctional/ventricular arrhythmias

132
Q

What are increased a waves?

A

Increased resistance to RA emptying

133
Q

What is an “x” descent

A

Corresponds to atrial relaxation

134
Q

What is prominent x descent?

A

Constrictive pericarditis, restrictive CMP, pericardial tamponade

135
Q

What is decreased/absent x descent mean?

A

Severe tricuspid regurgitation, AFIB

136
Q

What is the “c” wave

A

Represents bulging of tricuspid valve during systole; not present in every pt

137
Q

What is the “v” wave?

A

Increased atrial pressure as venous tree turn increases after systole

138
Q

What is “y” descent?

A

Reduced pressure observed with tricuspid valve opening and atrial emptying during diastole

139
Q

How do you measure the JVP?

A

Identify meniscus fo right internal jugular vein, measure height in relation to sternal angle, add 5cm to number

140
Q

What is a normal measured JVP?

A

<9cm, if >9cm: indicates increased right atrial volume

141
Q

What suggests a normal size spleen?

A

Lateral tympany on generalized splenic percussion

142
Q

How do you perform generalized splenic percussion?

A

Percuss left lower anterior chest wall at Traube’s space

143
Q

What is Traube’s space?

A

Start percussion from border of cardiac dullness at 6th rib to anterior axillary line and down to costal margin

144
Q

What does tympany at full inhalation suggest for spleen?

A

Normal size spleen

145
Q

What is a positive splenic percussion sign?

A

A change in percussion note form tympany to dullness on inspiration

146
Q

What part of the stethoscope is used to hear gallops?

A

Bell

147
Q

What are causes of left sided S4 gallops?

A

HTN heart disease, aortic stenosis, ischemic and hypertrophic CMP

148
Q

What are the causes of right sided S4 gallops?

A

Pulmonary HTN and pulmonic stenosis

149
Q

What is the pathologic cause of a S3 gallop?

A

Caused by high LV filling pressures and abrupt deceleration of inflow across mitral valve @ end of diastole

150
Q

What causes and S3 gallop?

A

Decreased myocardial contractility, HG, aortic regurgitation; mitral regurgitation, left-to-right shunts

151
Q

Who can get and S3 gallop?

A

Physiologic in children, young adults, reign any women in 3rd trimester

152
Q

Who can get S4 gallop normally?

A

Sometimes in trained athletes and older people

History and Physical 1 (6 decks)

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