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Physical Diagnosis > PD Crammin for Exam 2 lol > Flashcards

PD Crammin for Exam 2 lol Flashcards

lord help me

1
Q

Superior lobes of the lung are easier to ascultate on the ___, inferior lobes are easier to auscultate on the _____

A

anterior, posterior

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2
Q

Horizontal fissure of lung is marked by what palpable structure?

A

Right 4th-5th rib moving medial to lateral

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3
Q

Right oblique fissure of lung is marked by what palpable structure?

A

5th to 6th rib moving lateral to medial

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4
Q

Directly behind the body of sternum sits the….

A

…right ventricle of the heart

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5
Q

Left oblique fissure of lung is marked by what palpable structure?

A

6th rib

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6
Q

RALS system

A

Determines the orientation of the pulmonary arteries in the hilus of the lung, with the right lung having anterior placed pulmonary artery to the main bronchus and the left lung having superior 2 placed pulmonary artery to the main bronchus

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7
Q

Objects entering the hilus of the lung

A

Left and right main bronchus, 1 pulmonary artery on each side, 2 pulmonary veins exiting on each side, tiny bronchial arteries entering, 2 on the left and one on the right

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8
Q

Inspection of the thorax

A

shape and symmetry, accesory breathing muscles, A/P to lateral ratio (pectus excavatum and carinatum or barrel chest), scoliosis, kyphosis, skin for cynaosis, breath odor, respiratory rate pattern

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9
Q

Palpation of the thorax

A

Feel around for pulsations, bulges, depression or crepitus on both anterior and posterior side, demonstrate tactile fremitus and respiratory excusrion

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10
Q

Tactile fremitus

A

Have patient cross arms, pallpate with ulnar side of hands the posterior wall starting high and going down and medial around the shoulder blade asking them to say 99 at each point, do same thing atneriorally between pecs and sides

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11
Q

Decreased bilateral tactile fremitus indicates…

A

….obstruction, copd, pleural effusion, fibrosis, or pneumothroax

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12
Q

Assymetric decreased fremitus indicates…

A

…unilateral pleural effusion

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13
Q

Asymmetric increased tactile fremitus indicates….

A

…consolidated tissue thru unilateral pneumonia

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14
Q

Ventilary excursion

A

Have patients cross arms, place hands on mid lower back and have take deep breath, watch for thumbs to grow in distance between them, anteriorally place thumbs near xyphoid process and do same thing

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15
Q

Percussion of thorax

A

Tap back going left to right across the back below the scapula listening for dullness, resoonance, or hyperresonance in a ladder pattern, do same on front, then move to diaphragmatic excursion

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16
Q

Hyperresonance during thorax percussion indicates….

A

…copd and asthma

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17
Q

Diaphragmatic excursion

A

Have patient roll shoulders forward, tap to find level of diaphragm during quiet respiration (where downward is dull and above is resonant, mark that point), then have patient inspire and hold, percuss down until dull, mark that point, have patient fully expire and hold percuss up until resonance, mark that point, should be 3-5cm diff between inspiration and expiration

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18
Q

Auscultation of thorax

A

Have patient cough a few times, bend head forward and fold arms over anterior chest, follow same pattern as percussion with stethoscope having them take an open mouth deep breath each time you move, same for front, listen for bronchophony, egophony, and whispered pectriloquiy

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19
Q

Vesicular breath sound

A

Long inspiratory and short expiratory, low pitch, heard over most of lungs

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20
Q

Bronchial breath sound

A

Short inspiratory and long expiratory, high pitch, heard over manubrium best

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21
Q

Bronchovesicular breath sound

A

Equal length inspiratory and expiratory medium pitch, heard best between scapula

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22
Q

Rales

A

Adventitious breath sound involving packing paper pop, indicative of pneumonia, pulmonary fibrosis, ateclasis

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23
Q

Wheezes

A

Adventitious breath sound involving higher pitched hissing, increased in asthma, copd, bronchitis

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24
Q

Ronchi

A

Adventitious breath sound rough coarse snoring on exhalation, increased in asthma, copd, bronchitis

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25
Q

Friction rub

A

Adventitious breath sound, pleura rubbing together in a mechanical grating

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26
Q

Bronchophony

A

Amplification of sound by fluid in a certain space, heard when ascultating by having a patient say 99, it will be louder where there’s consolidation

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27
Q

Egophony

A

Alteration of sound heard when auscultating by having a patient say eeee and you may hear aaaa if egophony is present, indicative of lung or pleural disease

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28
Q

Whispered pectoriloquy

A

Loudness due to consolidation tranmission of sound by having a patient whisper 99 while ausculatating, should be barely heard in healthy lungs

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29
Q

Lymphadenitis

A

Swollen, tender, and erythematous lymph nodes

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30
Q

Thoracic duct

A

Receives overwhelming majority of lymphatic drainage from the entire left side and bottom right side of body, travels up the left side of the abdomen and thorax to empty where the left internal jugular and left subclavian vein meet

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31
Q

Right lymphatic duct

A

Responsible for minimal lymphatic drainage from the body, just the right upper extremity and right side of the head, travels to empty into the junction where the right internal jugular and right subclavian vein meet

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32
Q

Cisterna chyli

A

Dilated lymph vessels in the lumbar spine marking the beginning of the thoracic duct

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33
Q

What are the indications for performing a lyphatic exam?

A

Every patient, easy and important, palpating provides info about possible presence of malignant or inflammatory process

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34
Q

What lymphatic regions can be clinically examined?

A

Cervical head and neck, axillary, epitrochlear, inguinal, popliteal

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35
Q

Horizontal inguinal lymph nodes

A

Travel along th einguinal canal and drain the lower abdomen and buttocks, external genitalia (minus testes) scrotum, anal, and lower vagina

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36
Q

Vertical inguinal lymph nodes

A

Travel along the line of the great saphenous vein and drain portions of the leg corresponding

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37
Q

Testes lymphatic drainage

A

Separate pattern from horizontal and vertical inguinal lymph nodes going to paraoritc lymph nodes following testicular arteries deep into abdomen

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38
Q

Inspection lymphatic exam

A

Lopoking for swelling, erythema, streaking, lesions, rubor, calor, dolar, tumor

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39
Q

General palpation lymphatic exam

A

Gentle circular motion making note of shape, delimination (boundaries), mobility, consistency, tenderness, or pulsation (meaning its not a lymph node)

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40
Q

Neck palpation lyphatic exam

A

Pre and post auricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical along anterior edge of traps, deep cervical chain down scm, supraclavicular deep to clavicle

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41
Q

Axillary palpation lymphatic exam

A

Have patient grasp your upper arm, palpate with patient seated supine wearing gloves, apical, lateral medial, anteior and posterior lymph nodes

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42
Q

Epitrochlear palpation lymphatic exam

A

Hold patients wrist and palpate above olecranon for nodes

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43
Q

Popliteal palpation lymphatic exam

A

Flex knee and palpate in popliteal fossa

44
Q

Palpating infraclavicular nodes or supraclavicular nodes are indicative of…

A

…breast cancers or other axillary cancers

45
Q

When it comes to palpating a lymph node, what things are bad signs?

A

Stiff, hard, or nontender nodes.

46
Q

Virchow’s node

A

Left supraclavicular node indicative of stomach, intestineal, breast, or lung cancers

47
Q

Aortic area (cardiac exam)

A

Right 2nd intercostal space

48
Q

Pulmonic area (cardiac exam)

A

Left 2nnd intercostal space

49
Q

Tricuspid area (cardiac exam)

A

4th left intercostal space

50
Q

Mitral area or apex area (cardiac exam)

A

5th left intercostal space, midclavicular line

51
Q

Erb’s point (cardiac exam)

A

Left 3rd intercostal space, left sternal border

52
Q

Point of maximal impulse is typically located where?

A

Apical pulse, can shift indicative of pathology

53
Q

Precordium

A

Chest wall that sits directly anterior to the heart

54
Q

S1 heart sound

A

Closure of mitral and tricuspid valves beginning of systole, the lub sound

55
Q

S2 heart sound

A

Closure of aortic and pulmonic valvees, end of systole start of diastole, the dub sound

56
Q

S2 splitting

A

Occurs upon inspiration and delays closure of pulmonic valve creating a2 and p2

57
Q

S3 heart sound

A

Early diastolic sound heard after S2 sounding like an extra little slap “kentucky”

58
Q

S3 associated pathology

A

While normal in some young, typically ventricular dysfunction, heart failure, a large ventricle undergoing rapid ventricular filling

59
Q

S4 heart sound

A

A late diastolic sound heard right before S1

60
Q

S4 associated pathology

A

Due to atrium pushing blood into stiff ventricle creating atrial gallop, often due to diastolic dysfunction or LV hypertrophy

61
Q

Systolic vs diastolic heart murmurs

A

Systolic are often benign and present in 60% of people, diastolic is always pathology

62
Q

Aortic regurgitation is a ….

A

diastolic murmur

63
Q

Aortic stenosis is a….

A

systolic murmur

64
Q

Pulmonic regurgitation is a…

A

diastolic murmur

65
Q

Pulmonic stenosis is a…

A

systolic murmur

66
Q

Mitral regurgiation is a…

A

systolic murmur

67
Q

Mitral stenosis is a…

A

diastolic murmur

68
Q

Tricuspid regurgitation is a…

A

systolic murmur

69
Q

Tricuspid stenosis is a…

A

diastolic murmur

70
Q

Inspection of the heart

A

First assess jugular venous pulsations, if not seen put pressure on liver via hepatojugular reflex, measure jugular venous pressure using 2 ruler technique, above 3 cm is considered elevated

71
Q

Palpation of the heart

A

FIRST listen to the carotids before palpating in case of bruits, then take carotid pulse, then move patient to sitting position, inspect precordium, palpate pmi with haeel of hand for lifts, use ball of hand to test for thrills

72
Q

Auscultation of the heart

A

Auscultate aortic, pulmonic, erbs, tricuspid, and mitral points using diaphragm, have patient lean forward and listen with diaphragm for murmur of aortic insufficiency, place patient supine flat, inspecte, palpate, auscultate with diaphragm and bell along diff heart positions, move into left lateral decubitus position and auscultate mitral area with bell

73
Q

Erbs point

A

An auscultory point at the left sternal border of the 3rd intercostal space that allows to hear a 2nd pulmonary area

74
Q

A Wave (jugular venous pulsations)

A

Atrial contraction prior to S1, appears as an upward pulsation

75
Q

X descent (jugular venous pulations)

A

Atrial relaxation, collapse between s1 and s2

76
Q

V wave (jugular venous pulsations)

A

Atrial filling

77
Q

Y descent

A

Tricuspid valve opening, atrium emptying

78
Q

Murmur scale

A

1-4 diastolic, 1-6 systolic
1 very faint
2 loud enough to be obvious
3 louder than 2
4 has thrill
5 heard with stethoscope partially off chest with thrill
6 heard with stethoscope completely off chest with thrill

79
Q

Most important factor for risk of breast cancer

A

Age

80
Q

Inspection of breasts

A

Full exposure of breast initially, sitting position, looking for symmetry, contours, and retraction in 4 views (hands on hips, arms overhead, arms at sides, and leaning forward)

81
Q

Palpation of the breasts

A

Lay patient on back, expose just one breast, use pads of 2nd-4th fingers keeping them slightly flexed and follow striped pattern, ask patient to roll onto opposite hip and place hand on forehead keeping shoulder flat and palpate in the axilla, palpate nipple lightly and express with index finger, have patient sit up and palpate the axilla with their arm down, pres fingers in and down

82
Q

The most important risk factor for cervical cancer

A

Persistent infection with high risk HPV subtypes, HPV 16 or 18

83
Q

Inspection of female pelvis

A

Examine the female genitalia, will need to touch and separate and inspect the labia minora, clitorus, urethral meatus, insert speculum and perform papsmear, inspect vagina on way out, continue on to perform bimanual examniation and rectovaginal examination if indicated

84
Q

Bimanual examination

A

Standing insertion of two lubricated fingers into vagina while the other hand palpates structures on the abdominal surface to try to capture different organs, must palpate cervix, uterus, and ovaries

85
Q

Rectovaginal examination

A

The introduction of index finger into vagina and middle finger into rectum, have patient strain down to relax anal sphincter, press the fingers together while putting downward pressure with hand on abdomen

86
Q

Inspection of the abdomen

A

Inspect for scars, bulging, peristalsis, pulsations, cullen/grey turn’er sign

87
Q

Cullen or grey turner’s sign

A

Purplish coloration indicative of retroperitoneal hemorrhage or acute pancreatitis

88
Q

Ausculatation of the abdomen

A

Listen for bowel sounds in all 4 quadrants, listen over aorta for bruits

89
Q

Percussion of the abdomen

A

Percuss for areas of tympany, percuss liver, bladder, and spleen

90
Q

Palpation of the abdomen

A

Palpate all around superficially then do it again with knees flexed for deep palpation, capture liver, spleen, and kidneys

91
Q

Order of exam on abdomen

A

Inspect and auscultate before percussing and palpating In that order

92
Q

CVAT test

A

costal vertebral angle test, place ball of hand on costovertebral angle and strike with ulna to detect pain

93
Q

Abdominal wall mass test

A

Ask patient to raise head/shoulders to see if mass remains palpable to see if abdominal wall or cavity based

94
Q

Roysing’s sign

A

Press deeply in LLQ, pain in RLQ with pressure in LLQ or with RLQ rebound tenderness is positive for appendicitis

95
Q

Psoas sign

A

Flex right hip to test for appendicities

96
Q

Obturator sign

A

Flex right thigh at hip with knee bend, internally rotate hip, positive if pain for appendicitis

97
Q

Murphy’s sign

A

Ask patient to exhale, place hand below costal margin on right side of midclavicular line, have patient inspire, if sharp pain then positive test for acute cholecystitis

98
Q

Patient’s hands need to be where during abdominal exam?

A

At their sides

99
Q

List all the definable pulses

A 
carotid
radial
brachial
aorta
femora
popliteal
dorsal pedis
posterior tibial
100
Q

5 p’s of PAD

A

Pain, pulselessness, pallor, paralysis, parasthesia, poikilothermia

101
Q

Virchow’s triad

A

Intimal trauma
coagulopathy, hypercoagulable state
venous stasis

102
Q

Arterial claudication

A

Indicative of atherosclerotic disease, pain in defined group of muscles relieved with rest

103
Q

Neurogenic claudication

A

Indicative of spinal stenosis, improves leaning forward

104
Q

Subclavian steal syndrome

A

Stenosis of subclavian artery causing syncope

105
Q

Rest pain

A

Waking up with pain, laying legs over side of bed and pain goes away, indicative of PAD

106
Q

ABI Index

A

Measurement of systolic blood pressure with doppler ultrasound in each arm then in dorsal pedis and posterior tibial, should get higgher ankle pressure than arm by dividing ankle/arm, .9-1.3 is normal, .410.9 is mild pvd, 0-.41 is severe pvd

107
Q

How to record pulse

A 
4- boudning
3- increased
2- brisk
1- weak
0- abscent

Physical Diagnosis (10 decks)

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