Hm 532 Exam Ii

Front 1

PMI, Point of Maximal Impulse

Back 1

left 5th ICS MCL, does not continue into second heart sound

Front 2

Abnormalities of PMI

Back 2

displacement due to hypertrophy, cardiomyopathy, ischemic disease, amplitude increase due to hyperthyroidism. Anemia, pressure overlaod of the left ventricle

Front 3

Pathology and PMI

Back 3

lateral → volume overload, high amplitude impuse → left ventricular hypertrophy, sustained low amplitude → dialted cardiomyopathy

Front 4

Systole

Back 4

ventricular contraction

Front 5

Diastole

Back 5

ventricular relaxation

Front 6

S1

Back 6

closure of the mitral valve followed by triscuspid valve

Front 7

S2

Back 7

closure of the aortic valve followed by the pulmonary valve

Front 8

S3

Back 8

extra heart sounds, after mitral valve opening. Rapid deceleration of blood against ventricular walls or from pathologic changes in compliance

Front 9

S4

Back 9

marks atrial contraction immediately preceding S1

Front 10

Spliting of S2

Back 10

during inspiration S2 splits into two distinct sounds, closure of the aortic and then pulmonary semi-lunar valves

Front 11

Changes with inspiration

Back 11

thoracic volume increases, intrathroacic pressure decreases, venous flow to the right heart increases, delayed closure of pulomonary valve, increased pulomary capacitance, decreased left ventricular ejection volume

Front 12

Aortic valve

Back 12

R 2nd ICS RSB

Front 13

Pulmonary Semilunar

Back 13

left 2nd/3rd ICS LSB

Front 14

Tricuspid

Back 14

left 4th/5th ICS LSB

Front 15

Mitral

Back 15

4th ICS MCL, is the PMI

Front 16

Murmur

Back 16

turbulent blood flow within the heart

Front 17

Bruit

Back 17

mumur like sound of vascular origin, external to the heart

Front 18

Thrill

Back 18

humming vibrations felt on skin overlying area of turbulent blood flow upon palpation

Front 19

Jugular Venous Pressure

Back 19

measured in cm. 3 or 5 cm is above normal

Front 20

JVP pathology

Back 20

increased pressure suggest right sided congestive heart failure, constrictive pericarditis, tricuspid stenosis, or SVC obstruction

Front 21

Grade I Murmur

Back 21

faint, tuned in

Front 22

Grade II murmur

Back 22

quiet but heart immediately after putting stethoscope on chest

Front 23

Grate III murmur

Back 23

moderately loud

Front 24

Grade IV murmur

Back 24

loud with palable thrill

Front 25

Grade V murmur

Back 25

very loud, thrill, my be heard when stethoscope is partly off chest

Front 26

Grade VI

Back 26

ery loud, thrill, heard with stethoscope entirely off chest

Front 27

Aortic Stenosis

Back 27

Right 2nd ICS parasternally, radiates into carotids,

Front 28

Aortic Regurgitation

Back 28

left 2nd to 4th ICS parasternally, Erbs Point, best heard when patient is sitting, learning forward, and breath held after exhalation

Front 29

Mitral stenosis

Back 29

apex, no radiation, use bell for presystolic low pitched rumble

Front 30

Mitral Regurgitation

Back 30

apex, radiaton to left axilla, does not become louder in inspiration

Front 31

Innocent murmur

Back 31

2nd to 4th left ICS between LSB and apex, little radiation, decreases or disappears on sitting

Front 32

Erb’s point

Back 32

left 3rd ICS, accentuates aortic murmurs

Front 33

Left lateral decubitus position

Back 33

accentuates S3, S4, and mitral murmurs

Front 34

Diaphgragm

Back 34

high pitched sounds (S1, S2, and aortic/mitral regurgitation)

Front 35

Bell

Back 35

low pitched sounds (S3, S4, mitral stenosis)

Front 36

Abdominal Quadrants

Back 36

RUQ, LUQ, RLQ, LRQ

Front 37

Abdiomnal sections

Back 37

epigrastric, umbilical, suprapubic, r/l hypochondrium, lumbar, inguinal

Front 38

What is normally palpable in the abdomen (8)

Back 38

stomach liver, spleen, bladder, aorta, masses, enlarged kidneys, pregnant uterus

Front 39

Kidney Tenderness

Back 39

percussion or palpation at costovertebral angels

Front 40

Bruits

Back 40

stenosis of renal arteries, abdominal aorta, or iliac arteries. Best place to listen is below costal margins at MCL and epigastric aorta

Front 41

Liver span

Back 41

percussion right MCL, 6-12 ccm on right MCL and 4-8 at mid sternal.

Front 42

Inaccurate liver span

Back 42

COPD, right pleural effusion, gas in colon

Front 43

Spleen

Back 43

percussion of lowest intercostal space in left anterior axillary line of a supine pt. resonant or tympanic sound, dull sound →splenomegaly

Front 44

Rebound tenderness

Back 44

peritoneal inflammation, deep and slow palpation in the abdomen away from suspected site. If pain is felt when hand is removed→ contralateral imflammation

Front 45

Rovsing’s sign

Back 45

appendicitis, pressing deeply and evenly in LLQ then quickly removing figures, + if RLQ pain during left sided pressure

Front 46

Psoas Sign

Back 46

irritation of psoas muscle by inflamed appendix , right knee and ask to rasie thigh against pressure or flex leg at hip on left side

Front 47

Murphy’s sign

Back 47

acute cholecysttis, hook fingers under pts right cosdtal margin and ask pt to take deep breath, + if pain during inspiration while palpating the liver margin

Front 48

Ascites

Back 48

free fluid in abdomen, indication of underlying heart failure, liver disease, nephritic syndrome or metastases. Elecvated hydrostatic pressure and decreased osmotic pressure

Front 49

Shifting dullness

Back 49

sensitive sign for ascites. Tympanic percussion will shift to superior position

Front 50

Bulging flanks

Back 50

fluid in abdomen will move to flank region in supine position in ascetic t

Front 51

Flank dullness

Back 51

percussion should be tympanic but will be dull with ascites

Front 52

Prominent fluid wave

Back 52

fluid wave when pt compresses subcut fat in abdomen upon flick from doc

Front 53

Epitrochlear

Back 53

LN on medial surface of arm

Front 54

Lateral Axillary

Back 54

LN in the lateral axillary area, drains radial side of arm and hand

Front 55

Horizontal Group

Back 55

LN superficial inguinal, underlies inguinal ligament

Front 56

Vertical Group

Back 56

LN superficial inguinal, proximal segment of greater saphenous vein

Front 57

Deep

Back 57

LN small saphenous vein at the popliteal space, drains heel and outer foot

Front 58

Radial Pulse

Back 58

radial side of palmar surface of wrist

Front 59

Brachial pulse

Back 59

medially just under tendon of bicepts at the antecubital crease

Front 60

Femoral pulse

Back 60

femoral triangle below the inguinal ligament and about midway between ASIS and symphysis pubis

Front 61

Popliteal pulse

Back 61

flex pts knee, fingertips just meet midline behind the knee and press deep into, not easily palpable

Front 62

Dorsalis pedis

Back 62

between first and second metatarsals on dorsum of foot, not easly palpable

Front 63

Posterior tibialiss

Back 63

behind and below the medial malleolus, absent in 15% of healthy individuals

Front 64

Allen test

Back 64

determine arterial insufficiency in the upper extremity by ensuring patency of ulnar artery. Tight fist and compress both radial and ulnar arteries → release pressure over ulnar. Palm will flush in seconds if artery is patent

Front 65

Major veins of the lower extremity

Back 65

femoral vein, great saphenous vein, small saphenous vein, popliteal vein, communicating vein

Front 66

Pitting edema

Back 66

increased peripheral venous pressure, depression caused by pressure from thumb

Front 67

Non-pitting edema

Back 67

stasis of lymph fluid in the tissues

Front 68

Orthostatic edema

Back 68

pitting, swollen foot, returns to normal upon postural changes

Front 69

Lymphedema

Back 69

firm, non pitting edema, leathery skin

Front 70

Lipedema

Back 70

deposition of fat, non pitting, no swelling

Front 71

Edema of advance chronic venous insufficiency

Back 71

soft pitting with lesions, can become hard, skin thickening and pigmentation, swelling of foot

Front 72

Internal rotation

Back 72

anterior surface of limb inward

Front 73

External rotation

Back 73

anterior surface of limb outward

Front 74

Supination

Back 74

rotation of hand so palmar surface is upward

Front 75

Pronation

Back 75

rotation of hand so palmar surface faces down

Front 76

Abduction

Back 76

movement away from midline

Front 77

Adduction

Back 77

movement towards midline

Front 78

Inversion

Back 78

plantar surface of foot inward

Front 79

Eversion

Back 79

planar surface of foot outward

Front 80

Biceps tendon reflex

Back 80

C5C6

Front 81

Triceps tendon reflex

Back 81

C6C7C8

Front 82

Brachioradialis tendon reflex

Back 82

C5C6

Front 83

Patella

Back 83

L2L3L4

Front 84

Achilles

Back 84

S1S2

Front 85

4+

Back 85

brisk, hyperactive, with clonus

Front 86

3+

Back 86

brisker than average, not indicative of disease

Front 87

2+

Back 87

average, normal

Front 88

1+

Back 88

somewhat diminished, lower than average

Front 89

0

Back 89

reflex absent

Front 90

Clonus

Back 90

involuntary contractions of muscles between flexion and textion that occurs in conditions of increased tone

Front 91

5

Back 91

active movement against gravity with full resistance without evident fatigue

Front 92

4

Back 92

active movement against gravity with some resistance

Front 93

3

Back 93

active movement against gravity

Front 94

2

Back 94

cannot act against gravity

Front 95

1

Back 95

slight contraction detected

Front 96

0

Back 96

no contraction

Front 97

venous thromboembolism

Back 97

blood clot or deep vein thrombosis, can lead to pulmonary embolism

Front 98

Clinical paramaters of venous thromboembolism

Back 98

active cancer, paralysis, pareisis, cast in lower extremities, bedridden, localized tenderness along distribution of deep venous system, entire leg swelling, calf swelling, pitting edema. Collateral superficial veins