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104 Cards in this Set
- Front
- Back
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Normal thorax
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wider than it is deep; lateral diameter is larger than its anteroposterior diameter
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Funnel chest (pectus excavatum)
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Note depression in the lower portion of the sternum; compression of the heart and great vessels may cause murmurs
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Barrel chest
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increased anteroposterior diameter; this shape is normal during infancy, and often accompanies aging and COPD
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Pigeon chest (pectus carinatum)
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The sternum is displaced anteriorly, increasing the anteroposterior diameter; the costal cartilages adjacent to the protruding sternum are depressed
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Traumatic flail chest
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Multiple rib fractures may result in paradoxical movements of the thorax; as descent of the diaphragm decreases intrathoracic pressure, on inspiration the injured area caves inward; on expiration, it mores outward
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Thoracic kyphoscoliosis
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Abnormal spinal curvatures and vertebral rotation deform the chest; distortion of the underlying lungs may make interpretation of lung findings very difficult
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Normal air-filled lung breath/voice sounds
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Breath sounds are predominantly vesicular; spoken words are muffled and indistinct; spoken "ee" heard as "ee"; whispered words faint and indistinct, if heard at all; tactile fremitus is normal
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Airless lung as in lobar pneumonia
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Breath sounds are bronchial or bronchovesicular over the involved area; spoken words louder, clearer (bronchophony); spoken "ee" heard as "ay" (egophony); whispered words louder, clearer (whispered pectoriloquy); tactile fremitus increased
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Description of normal lungs
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The tracheobronchial tree and alveoli are clear; pleurae are thin and close together; mobility of the chest wall is unimpaired
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Findings in normal lungs
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Resonant percussion; trachea is midline; vesicular breath sounds (bronchovesicular and bronchial sounds over large bronchi and trachea); No adventitious sounds except maybe a few transient inspiratory crackles at base of lungs; normal tactile fremitus
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Chronic Bronchitis condition description
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The bronchi are chronically inflamed and a productive cough is present. Airway obstruction may develop
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Chronic Bronchitis findings
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Resonant percussion; trachea midline; vesicular breath sounds; no adventitious sounds or scattered coarse crackles in early inspiration and perhaps expiration; might have wheezes or rhonci; normal tactile fremitus
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Left-sided heart failure (early) condition description
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Increased pressure in the pulmonary veins causes congestion and interstitial edema (around the alveoli); bronchial mucosa may become edematous
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Left-sided heart failure (early) findings
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Resonant percussion; trachea midline; vesicular breath sounds; Late inspiratory crackles in the dependent portions of the lungs; possibly wheezes; Normal tactile fremitus
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Consolidation condition description
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Alveoli fill with fluid or blood cells, as in pneumonia, pulmonary edema, or pulmonary hemorrhage
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Consolidation findings
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Dull over airless area; trachea midline; bronchial breath sounds over involved area; late inspiratory crackles over the involved area; increased tactile fremitus over involved area with bronchophony, egophony, and whispered pectoriloquy
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Atelectasis (lobar obstruction) condition description
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When a plug in a mainstem bronchus (as from mucus or a foreign object) obstructs air flow, affected lung tissue collapses into an airless state
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Atelectasis findings
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Dull over airless area; trachea may be shifted toward involved side; breath sounds usually absent when bronchial plug persists (exceptions include right upper lobe atelectasis, where adjacent tracheal sounds may be transmitted); no adventitious sounds; tactile fremitus usually absent when the bronchial plug persists (in the exceptions listed, it may be increased)
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Pleural effusion condition description
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Fluid accumulates in the pleural space, separates air-filled lung from the chest wall, blocking the transmission of sound
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Pleural effusion findings
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Dull to flat percussion over fluid; trachea is shifted toward opposite side in a large effusion; breath sounds are decreased to absent but bronchial breath sounds may be heard near top of large effusion; no adventitious sounds except a possible pleural rub; decreased to absent tactile fremitus but may be increased toward the top of a large effusion
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Pneumothorax description
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When air leaks into the pleural space, usually unilaterally, the lung recoils from the chest wall. Pleural air blocks transmission of sound
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Pneumothorax findings
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Hyperresonant or tympanic percussion over the pleural air; trachea is shifted toward opposite side if much air; Decreased to absent breath sounds over pleural air; no adventitious sounds except a possible pleural rub; decreased to absent tactile fremitus over the pleural air
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COPD description
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Slowly progressive disorder in which the distal air spaces enlarge and lungs become hyperinflated. Chronic bronchitis is often associated
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COPD findings
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Percussion is diffusely hyperresonant; trachia is midline; breath sounds decreased to absent; no adventitious sounds or the crackles, wheezes, and rhonci associated with chronic bronchitis; decreased tactile fremitus
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Asthma description
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Widespread narrowing of the tracheobronchial tree diminishes air flow to a fluctuating degree. During attacks, air flow decreases further, and lungs hyperinflate
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Asthma findings
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Resonant to diffusely hyperresonant percussion; trachea midline; breath sounds often obscurred by wheezes; wheezes, possilbly crackles; tactile fremitus decreased
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Retraction signs in breast
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As breast cancer advances, it causes fibrosis (scar tissue). Shortening of this tissue produces dimpling, changes in contour, and retraction or deviation of the nipple. Other causes of retraction include fat necrosis and mammary duct ectasia.
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Abnormal contours of breast
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Look for any variation in the normal convexity of each breast, and compare one side with the other. Special positioning may again be useful.
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Skin dimpling of breast
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Look for this sign with the patient's arm at rest, during special positioning, and on moving or compression the breast.
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Nipple retraction and deviation
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A retracted nipple is flattened or pulled inward. It may also be broadened, and feels thickened. When involvement is radially asymmetric, the nipple may deviate or point in a different direction from its normal counterpart, typically toward the underlying cancer.
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Edema of the skin of the breast
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Produced by lymphatic blockage. It appears as thickened skin with enlarged pores- the so-called peau d'orange (orange peel) sign. It is often seen first in the lower portion of the breast or areola
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Paget's disease of the nipple
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This uncommon form of breast cancer usually starts as a scaly, eczemalike lesion that may weep, crust, or erode. A breast mass may be present. Suspect paget's disease in any persisting dermatitis of the nipple and areola. Can present with invasive breast cancer or ductal carcinoma in situ.
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Visible signs of breast cancer
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Retraction signs- abnormal contours, skin dimpling, nipple retraction and deviation; Edema of the skin; paget's disease of the nipple
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Trichomonla vaginitis
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Caused by trichomonas vaginalis (protozoan); often but not always, acquired sexually; yellowish green or gray discharge, possibly frothy, often profuse and pooled in vaginal fornix, and may be malodorous; other sx include pruritus, pain on urination, dyspareunia; scan saline wet mount for trichomonads
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Candidal Vaginitis
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Caused by candida albicans (yeast- normal overgrowth of vaginal flora); many factors predispose, including antibiotic therapy); Discharge is white and curdy, typically thick, not as profuse as in trichomonal infection; not malodorous; other sx include pruritis, vaginal soreness, pain on urination, dyspareunia; scan potassium hydroxide (KOH) prep for branching hyphae of candida
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Bacterial vaginosis
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Caused by bacterial overgrowth probably from anaerobic bacteria; may be transmitted sexually; Discharge is gray or white, thin homogenous, malodorous, coats the vaginal walls, usually not profuse, may be minimal; unpleasant fishy or musty genital odor; vulva usually normal; vaginal mucosa usually normal; scan saline wet mount for clue cells; sniff for fishy odor after applying KOH ("whiff test"); vaginal secretions with pH > 4.5
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Adnexal masses
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most commonly result from disorders of the fallopian tubes or ovaries; 3 examples include ovarian cysts/ovarian cancer, ruptured tubal pregnancy, and PID. Inflammatory disease of the bowel (such as diverticulitis), carcinoma of the colon, and a pedunculated myoma of the uterus may simulate an adnexal mass
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Hypospadias
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A congenital displacement of the urethral meatus to the inferior surface of the penis. A groove extends from teh actual urethral meatus to its normal location on the tip of the glans
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Scrotal edema
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Pitting edema may make the scrotal skin taut; seen in congestive heart failure or nephrotic syndrome
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Peyronie's disease
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Palpable, nontender, hard plaques are found just beneath the skin, usually along the dorsum of the penis. The patient complains of crooked, painful erections
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Hydrocele
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A nontender, fluid-filled mass within in the tunica vaginalis. It transilluminates, and the examining fingers can get above the mass within the scrotum
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Carcinoma of the penis
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An indurated nodule or ulcer that is usually nontender. Limited almost completely to men who are not circumcised, ti may be masked by the prepuce. Any persistent penile sore is suspicious
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Scrotal hernia
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Usually an indirect inguinal hernia, that comes through external inguinal ring, so the examining fingers cannot get above it within the scrotum
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Cryptochordism
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The testis is atrophied and may lie in the inguinal canal or the abdomen, resulting in an unfilled scrotum. As above, there is no palpable left testis or epididymis. It markedly raises the risk for testicular cancer
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Small testis
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In adults, testicular length is usually less than or equal to 3.5 cm. Small, firm testes in klinefelter's syndrome, usually are less than or equal to 2 cm. Small, soft testes suggesting atrophy are seen in cirrhosis, myotonic dystrophy, use of estrogens, and hypopituitarism; may also follow orchitis
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Acute orchitis
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The testis is acutely inflamed, painful, tender, and swollen. It may be difficult to distinguish from epididymis. The scrotum may be reddened. Seen in mumps and other viral infections; usually unilateral
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Tumor of the testis (early)
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Usually appears as a painless nodule. Any nodule within the testis warrants investigation for malignancy
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Tumor of the testis (late)
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As a testicular neoplasm grows and spreads, it may seem to replace the entire organ. The testicle characteristically feels heavier than normal
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Spermatocele and cyst of the edididymis
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A painless, movable cystic mass just above the testis suggests a spermatocele or a epididymis cyst. Both transilluminate. The former contains sperm, and the latter does not, but they are clinically indistinguishable.
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Varicocele of the spermatic cord
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Refers to varicose veins of the spermatic cord, usually found on the left side. It feels like a soft "bag of worms" separate from the testis, and slowly collapses when the scrotum is elevated in the supine patient. Infertility may be associated
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Acute epididymitis
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An acutely inflamed edidymis is tender and swollen and may be difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed. It occurs chiefly in adults. Coexisting urinary tract infection or prostatitis supports the dx
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Torsion of the spermatic cord
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produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. the scrotum becomes red and edematous. there is no associated UTI. Torsion, most common in adolescents, is a surgical emergency because of obstructed circulation
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Tb epdidymis
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The chronic inflammation of Tb produces firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens
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Phimosis
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Tight prepuce that cannot be retracted; causes "ballooning" of the prepuce during urination; seen in pts who report painful erection, hematuria, recurrent UTIs, preputial pain or weakened urinary stream
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Paraphimosis
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Once the prepuce is retracted, it cannot be returned; causes painful swollen glans in uncircumsized pt; seen in: children/debilitated pts whose prepuce has been forcefully retracted or who forget to reduce foreskin after bathing/voiding; after vigorous sexual activity
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Balanitis
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Inflammation of the glans penis
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Balanoposthitis
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Inflammation of the gland and prepuce of penis; can lead to phimosis; risk factors- poor personal hygiene, chemical irritants, strep, G/C, syphilis, HPV, penile CA
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Hypospadias
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Congenital, ventral displacement of the urethral meatus of the penis
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Reducible hernia
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Contents can be pushed back up into abdominal cavity (spontaneous or manually)
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Incarcerated hernia
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Contents cannot be returned to the abdominal cavity; non-reducible; vascular supply of the bowel is not compromised; bowel obstructions are common
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Strangulated hernia
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non-reducible hernia in which the bowel vascular blood supply is compromised secondary incarceration of hernia contents; associated with N/V, tenderness; surgical emergency (4-6 hours)
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Referred pain in abdomen
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Felt in more distant sites innervated at approximately the same spinal levels; may be felt superficially or deeply; pain may be referred from chest, spine, or pelvis
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Pain from hollow viscera
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Crampy; often poorly localized; related to peristalsis; pt writhing on exam table
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Pain from peritoneal irritation
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Steady or constant; often localized; pt typically lies with knees up
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6 F's for diffuse abdominal distension
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Fat (obesity), fluid (ascites or obstructed viscera filled with fluid), flatus (air) from intestinal obstruction of pseudoobstruction, feces (constipation), fetus (pregnancy), fatal cancer
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Assessing for appendicitis
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Check for involuntary guarding and rebound tenderness in RLQ; Check for rovsing's, psoas, and obturator sign; perform a rectal exam in both sexes and a pelvic exam in women
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Umbilical hernia
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A protrusion through a defective umbilical ring is most common in infants but also occurs in adults. In infants, but not in adults, it usually closes spontaneously within 1 to 2 years
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Diastasis recti
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Separation of the 2 rectus abdominis muscles, through which abdominal contents form a midline ridge when the pt raises head and shoulders. Often seen in repeated pregnancies, obesity, and chronic lung disease. It has no clinical consequences
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Incisional hernia
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A protrusion through an operative scar. Palpate to detect the length and width of the defect in the abdominal wall. A small defect, through which a large hernia has passed, has a greater risk for complications than a large defect
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Epigastric hernia
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A small midline protrusion through a defect in the linea alba occurs between the xiphoid process and umbilicus. With the pt's head and shoulders raised (or with pt standing), run your fingerpad down the linea alba to feel it
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Lipoma
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Common, benign, fatty tumors usually in the subcutaneous tissues almost anywhere in the body, including the abdominal wall. Small or large, they are usually soft and often lobulated. Press your finger down on the edge of a lipoma. The tumor typically slips out form under it.
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Increased bowel sounds
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can occur in diarrhea or early intestinal obstruction
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Decreased bowel sounds
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adynamic ileus and peritonitis. before deciding that bowel sounds are absent, sit down and listen for 2 min or even longer
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High-pitched tinkling sounds in abdomen
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suggest intestinal fluid and air under tension in a dilated bowel
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Rushes of high-pitched sounds coinciding with an abdominal cramp
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Indicate intestinal obstruction
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Bruits
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A hepatic bruit suggests carcinoma of the liver or alcoholic hepatitis. Arterial bruits with both systolic and diastolic components suggest partial occlusion of the aorta or large arteries. Partial occlusion of a renal artery may explain hypertension
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Venous hum in abdomen
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rare; a soft humming noise with both systolic and diastolic components. Indicated increased collateral circulation between portal and systemic venous systems, as in hepatic cirrhosis
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Friction rubs in abdomen
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rare; grating sounds with respiratory variation. indicate inflammation of the peritoneal surface of an organ, as in liver cancer, chlamydial or gonococcal perihepatits, recent liver biopsy, or splenic infarct. When a systolic bruit accompanies a hepatic friction rub, suspect carcinoma of liver
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Abdominal wall tenderness
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When the pt raises the head and shoulders, this tenderness persists, whereas tenderness from a deeper lesion (protected by the tightened muscles) decreases
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Visceral tenderness
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Usually the discomfort is dull with no muscular rigidity or rebound tenderness. A reassuring explanation to the pt may prove quite helpful
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Acute pleurisy
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Acute pleural inflammation; when unilateral, it may mimic acute cholecystitis or appendicits. Rebound tenderness and rigidity are less common; chest signs are usually present
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Acute salpingitis
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Frequently bilateral, the tenderness of acute salpingitis (inflammation of the fallopian tubes) is usually maximal just above the inguinal ligaments. Rebound tenderness and rigidity may be present. On pelvic exam, motion of the uterus causes pain
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Acute cholecystitis
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Signs are maximal in the right upper quadrant. Check for murphy's sign
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Acute pancreatitis
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Epigastric tenderness and rebound tenderness are usually present, but the abdominal wall may be soft
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Acute appendicitis
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Right lower quadrant signs are typical but may be absent early in the course; explore other portions of right lower quadrant as well as the right flank
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Acute diverticulitis
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Most often involves the sigmoid colon and then resembles a left-sided appendicitis
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Structures in right upper quadrant
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Pylorous, duodenum, liver, right kidney/adrenal gland, hepatic flexure of the colon, head of the pancreas
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Structures at midline of abdomen
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Urinary bladder and urethra (female)
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Structures in left upper quadrant
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stomach, spleen, left kidney/adrenal gland, splenic flexure of colon, body of pancreas
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Structures in right lower quadrant
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cecum, appendix, right ovary and fallopian tube (female), right ureter and lower kidney pole, right spermatic cord (male)
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Structures in left lower quadrant
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Sigmoid colon, left ovary and fallopian tube (female), left ureter and lower kidney pole, left spermatic cord (male)
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Olecranon bursitis
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Swelling and inflammation of the olecranon bursa may result from trauma or may be associated with rheumatoid or gouty arthritis. The swelling is superficial to the olecranon process
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Arthritis of the elbow
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Synovial inflammation or fluid is felt best in the grooves between the olecranon process and the epicondyles on either side. Palpate for a boggy, soft, or fluctuant swelling and for tenderness
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Rheumatoid nodules
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Subcutaneous nodules may develop at pressure points along the extensor surface of the ulna in pts with RA or acute rheumatic fever. They are firm and nontender, and are not attached to the overlying skin. They may or may not bet attached to the underlying periosteum. They may develop in the area of the olecranon bursa, but often occur more distally
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Lateral epicondylitis
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(tennis elbow)- follows repetitive extension of the wrist or pronation-supination of the forearm. Pain and tenderness develop 1 cm distal to the lateral epicondyle and possibly in the extensor muscles close to it. When the pt tries to extend the wrist against resistance, pain increases
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Medial epicondylitis
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(pitcher's, golfer's, or little league elbow)- follows repetitive wrist flexion, as in throwing. Tenderness is maximal just lateral and distal to the medial epicondyle. Wrist flexion against resistance increases pain
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Acute RA
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Tender, painful, stiff joints in RA, usually with symmetric involvement on both sides of the body. The PIPs, MCPs, and wrist joints are the most frequently affected. Note the fusiform or spindle-shaped swelling of the PIPs in acute disease
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Chronic RA
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note the swelling and thickening of the MCPs and PIPs. ROM becomes limited and fingers may deviate toward ulnar side (ulnar deviation). The interosseus muscles atrophy. The fingers may show "swan neck" deformities. Less commonly is a "boutenniere deformity" which is persistent flexion of the PIPs with hyperextension of the DIPs. Rheumatoid nodules are seen in acute or chronic stage
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OA (degenerative joint disease)
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Heberden's nodes- bony overgrowth of DIPs; usually hard and painless, affect middle-aged or elderly; often associated with arthritic changes in other joints. Flexion and deviation deformities may develop. Bouchard's nodes- bony overgrowth of PIPs (less common). MCPs are spared
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Chronic tophaceous gout
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The deformities can mimic RA and OA. Joint involvement is usually not as symmetric as in RA. Acute inflammation may be present. Knobby swellings around the joints ulcerate and discharge white chalklike urates.
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dupuytren's contracture
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The first sign is thickened plaque overlying the flexor tendon of the ring finger and possibly the little finger at the level of the distal palmar crease. Subsequently, the skin in this area puckers, and a thickened fibrotic cord develops between palm and finger. Flexion contracture of the fingers may gradually ensue
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trigger finger
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Caused by a painless nodule in a flexor tendon in the palm, near the metacarpal head. The nodule is too big to enter easily into the tendon sheath during extension of the fingers from a flexed position. With extra effort or assistance, the finger extends and flexes with a palpable and audible snap as the nodule pops into the tendon sheath. Watch, listen, and palpate the nodule as the pt flexes and extends the fingers
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thenar atrophy
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suggests median nerve disorder such as carpal tunnel syndrome. hypothenar atrophy suggests ulnar nerve disorder
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Ganglion
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ganglia are cystic, round, usually nontender swellings along tendon sheaths or joint capsules, frequently at the dorsum of the wrist. flexion of the wrist makes ganglia more prominent; extension tends to obscure them. ganglia may also develop elsewhere on the hands, wrists, ankles and feet
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