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final pt 2 Flashcards

1
Q

what is JVP

A
  • reflects RA pressure that equals central venous pressure and RV end diastolic volume
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2
Q

normal JVP

A
  • < 3 cm above sternal angle
  • < 8-9 cm in total distance from RA
  • should fall with inspiration
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3
Q

increased JVP

A
  • HF
  • tricuspid stenosis
  • chronic pulm HTN
  • pericardial dz
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4
Q

kussmaul’s sign

A
  • JVP rises with inspiration

- suggests impaired filling of RV

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5
Q

hepatojugular reflex

A
  • pressure applied in RUQ causes JVP to increase
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6
Q

what are the systolic murmurs

A
  • mitral regurg
  • aortic stenosis
  • tricuspid regurg
  • pulm stenosis
  • ASD
  • VSD
  • HOCM
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7
Q

aortic stenosis

A
  • systolic murmur
  • heard best when leans forward
  • can have thrill
  • 2-3 interspace
  • radiates to carotid, down LSB, apex
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8
Q

HOCM

A
  • systolic murmur
  • heard best with squatting and valsalva
  • located in L 3 and 4 interspace
  • radiates down LSB to apex
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9
Q

pulmonic stenosis

A
  • crescendo decrescendo murur
  • systolic
  • located at L 2nd and 3rd interspaces
  • radiates to L shoulder and neck
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10
Q

mitral regurg

A
  • holosystolic murur
  • doesnt change with inspir
  • can have S3
  • located at apex
  • can radiate to L axilla
  • if loud assoc with apical thrill
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11
Q

tricuspid regurg

A
  • holosystolic murmur
  • increases with inspiration
  • lower LSB
  • if RB pressure is high and V is enlarged loudest at apex- may be confused for mitral regurg
  • radiates to R sternum, xiphoid, L midclavicular
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12
Q

ventricular septal defect

A
  • holosystolic
  • located at L 3-5 interspaces
  • wide radiation
  • smaller= louder murmur
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13
Q

aortic regurg

A
  • decrescendo diastolic murmur
  • heard best when leaning foward with exhalation
  • L 2-4 interspaces
  • if loud radiates to apex
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14
Q

mitral stenosis

A
  • diastolic decrescendo
  • opening snap after S2
  • use bell
  • heard best in LLD with hand grips and exhalation
  • usu located in apex without radiation
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15
Q

venous hum

A
  • cont humming murmur
  • loudest in diastole
  • listen with bell
  • located above medial 3rd of clavicles, esp on R
  • best heard in sitting
  • disappears in supine
  • radiates to L 1-2 interspaces
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16
Q

pericardial friction rub

A
  • sounds close to stethoscope
  • best with pt leaning fwd with exhalation
  • heard best in 3rd interspace next to sternum
  • minimal radiation
  • scratchy, scraping, grating quality
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17
Q

PDA

A
  • machine like
  • L 2nd interspace
  • radiates to clavicle
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18
Q

sequence of abdominal exam

A
  • inspect
  • auscultate
  • percuss
  • palpate
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19
Q

tests for ascites

A
  • percuss from central tympany to find dullness
  • shifting dullness
  • fluid wave
  • ballottement
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20
Q

test for shifting dullness

A
  • have pt turn to side
  • percuss and mark borders
  • with ascites tympany shifts to top
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21
Q

test for fluid wave

A
  • assistant press hands on midline
  • top one flank
  • feel opposite flank for impulse
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22
Q

ballottement

A
  • straighten and stiffen fingers
  • make brief jabbing motion
  • will displace fluid
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23
Q

scrotal masses that do not transilluminate

A
  • inguinal hernia
  • varicocele
  • testicular tumor
  • hematoma
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24
Q

femoral hernias

A
  • more common in women

- point of origin below inguinal ligament

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25
indirect hernia
- most common hernial for all ages and sexes - point of origin above inguinal ligament - can often enter scrotum - on exam will touch fingertip
26
direct hernia
- more common in men > 40 - point of origin above inguinal ligament close to pubic tubercle - on exam will bulge anteriorly and push side of finger forward
27
hydrocele
- nontender - fluid filled mass within tunica vaginalis - transilluminates
28
cryptorchidism
- testis is atrophied | - lies outside scrotum in inguinal canal, abdomen, or near pubic tubercle
29
small testis
- adults: length < 3.5 cm - small firm testes < 2 cm suggests klinefelter - small testis often suggests atrophy
30
causes of testicular atrophy
- cirrhosis - myotonic dystrophy - use of estrogen - hypopituitarism - can follow orchitis
31
acute orchitis
- testes is inflamed, tender, painful, swollen - hard to distinguish from epididymis - scrotum may be reddened - seen in mumps or other viral infx - unilat
32
testicular tumor
- painless nodule | - as enlarges feels heavier than normal
33
spermatocele and cyst of epididymis
- painless movable cystic mass - just above testis - both transilluminate - spermatocele has sperm, cyst does not
34
acute epididymitis
- indurated, swollen, tender epididymis - hard to distinguish from testis - scrotum may be reddened and vas deferens inflamed
35
tuberculosis epidymitis
- chronic inflam of Tb -> firm enlargement of epididymis, +/- tender thickening/ beading of vas deferens
36
varicocele of spermatic courd
- often on L side - soft bag of worms - disappears in supine
37
torsion of spermatic cord
- acutely painful, tender, swollen testicle - often retracted up into scrotum - cremasteric reflex absent
38
prostate anatomy
- lies against anterior rectal wall - 2.5 cm long - normally feel lateral lobes and median sulcus
39
phimosis
- tight prepuce that cannot be retracted over glans
40
paraphimosis
- tight prepuce that once retracted cannot be returned - causes edema - medical emergency
41
balanitis
- inflammation of glans penis
42
breast anatomy
- overlies pec major and serratus anterior - tail of spence extends into anterior axillary fold - extends from clavicle/ 2nd rib to 6th rib, sternum across midaxillary line
43
cystocele
- bulge of upper 2/3 of anterior vaginal wall | - d/t weakened ant supporting tissues
44
urethral caruncle
- small red benign tumor - post urethral meatus in females - postmenopausal women - usu asymptomatic
45
bartholin gland infx
- acutely appears tense, hot, very tender abscess - chronically nontender cyst that may be large or small - d/t trauma, gonococci, anaerobes
46
cystourethraocyele
- entire vaginal wall, together with bladder and urethra prod bulge - +/- groove defines boarder between urethrocele and cystocele
47
prolapse of urethral mucosa
- forms swollen red ring around urethral meatus | - often occurs in kids before menarche or after menopause
48
rectocele
- herniation of rectum into post wall of vagina | - d/t weakness or cleft in endopelvic fascia
49
female breast provocative maneuvers
- arms at side - arms above head - hands pressed on hips - leaning fwd with arms extended
50
shoulder dislocation
- disarticulation - usu anterior - to reduce muscles must be relaxed- can try versed - best maneuver- fried
51
shoulder subluxation
- temporary and partial - can reduce on its own - joint instability - may report shoulder rolls out of socket
52
shoulder dislocationsx
- popping noise - poor ROM - A LOT of pain
53
apprehension sign
- knee placed in 30 degrees of flexion - lateral pressure applied - medial instability results in pt apprehension
54
primary wound closure
- within 6-12 hours of injury - wound edges are neatly approximated - rapid return to function - good cosmetic outcome
55
delayed primary closure
- used in situations where primary closure is inappropriate- i.e. infx, contamination - allows for secondary healing to occur before closure- 48-96 hours
56
phases of wound healing
- hemostasis - inflammation - proliferation - remodeling
57
hemostasis phase of wound healing
- immed after wound healing - platelet plug forms and vasoconstriction occurs - thrombus dev to seal wound
58
inflammation phase of wound healing
- 2-3 d after injury | - WBC remove necrotic tissue and control infx
59
proliferation phase of wound healing
- begins on day 2/3 after injury - lasts 2-4 weeks - fibroblasts proliferate in wound -> structural proteins - new capillaries form and epithelial cells migrate across top of wound- granulation tissue
60
remodeling phase of wound healing
- new capillaries atrophy - collagen changes from type III to type I - myofibroblasts cause scar contracture - forces acting on wound shape remodeling process- best if force is uniaxial
61
suture removal for scalp
- 6-8 days
62
suture removal for face
- 4-5 days
63
suture removal for turnk
- 8-10 days
64
suture removal for extremities and hands
- 8-10 days
65
suture removal feet
- 12-14 days
66
absorbable sutures
- dissolved by enzymes or hydrolysis - tend to prod more pronounced scar - often used under the skin - plain cat gut - chromic gut - monocryl - vicryl - polydioxanone - panacryl
67
nonabsorbable sutures
- remain in place until removed - less tissue reactive so not as much scarring - best on skin - ethilon - prolene - nurolon - permhand silk - stainless steel
68
staples
- used for linear lacerations with edges that are well aligned - avoid in cosmetic areas or if pt needs CT/ MRI - scalp
69
dermabond
- skin adhesive - can be used on face, extremities, torso - use with SQ sutures if in area of high tension - dont use over joints, if infx or in mucosal area
70
steristrips
- used for superficial linear clean edges - no damage to nerves or vessels - can be reinforcement for sutures - dont use over joints or areas that get wet
71
1% lidocaine
- blocks pain stimuli | - leaves pressure and touch intact
72
2% lidocaine
- blocks all awareness of stimuli including pressure and touch
73
what is the max dose of lidocaine
- 4 mg/kg
74
where should you not use epi
- digits - nose - ears - penis
75
plaster for splinting
- takes 2-8 min to set | - more time to mold than orthoglass
76
orthoglass for splinting
- lighter - longer wear - more expensive - less molding time
77
steps for splinting
- stockinette without folds - webril- 50% overlap - extend padding slightly past area of splinting - measure/ cut plaster or orthoglass - dip in room temp* water - apply - place webril over plaste (prevents sticking to ace) - ace bandage - mold - a lot of webril to bony prominances
78
how should you wrap for splinting
- distal to proximal
79
what are some explanations for small head circumference
- abnormal brain dev | - premature fusing of skull- craniosynostosis
80
history for altered mental status and possible SC injury
- "A MUST" - A: AMS - M: mechanism - U: underlying conditions - S: sx - T: timing
81
significant missed SC injuries
- C1-C2 injuries - missed on cross table lateral xray - odontoid or open mouth view recommended
82
how do you confirm tube placement
- NOT with CXR - watch tube pass through cords - look for chest rise symmetrically - listen over epigastric aea
83
what hand do you use to intubate
- L hand
84
straight blade for intubation
- miller
85
curved blade for intubation
- mcintosh

physical exam II (5 decks)

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