Phys Dys 2

Front 1

S1 loudest?

Back 1

apex

Front 2

S2 loudest

Back 2

base

Front 3

AV valve narrowed?

Back 3

opening snap

Front 4

SL valves narrow

Back 4

ejection click

Front 5

isovolumetric cotraction

Back 5

s1

Front 6

isovolumeic relaxation

Back 6

se

Front 7

Increased A2P2 with inspiration ?

Back 7

decrease in intrathoracic pressure --> increase blood to right ventricle and longer time to eject and PV to close.

Front 8

S3 after 30?

Back 8

volume overload to ventricle (regurg valve lesions, CHF)

Front 9

s4 after 30?

Back 9

non-compliant "stiff" ventricle (concentric hypertrophy, CAD

Front 10

Cause of loud S4 after 30?

Back 10

Due to increased resistance to filling because of loss of compliance of ventricular walls (HTN, CAD) or, increased stroke volume of high output states (profound anemia, pregnancy, thyrotoxocosis).

Front 11

S3 and S4 increased by?

Back 11

venous return

Front 12

Dicrotic notch-

Back 12

aortic close

Front 13

systolic in legs compared to arms

Back 13

15-20 greater

Front 14

systolic bp on inspiration

Back 14

dec 5-10

Front 15

a wave

Back 15

produced by right atrial contraction

Front 16

x descent

Back 16

atrial relaxation, just before ventricular contraction

Front 17

c wave

Back 17

increased right atrial pressure due to TV closure due to right ventricular contraction. Stops the decrease in right atrial pressure

Front 18

X prime descent

Back 18

atrium enlarges --> decrease pressure

Front 19

V wave

Back 19

increase in right atrial pressure as atrium fills with blood

Front 20

Y descent

Back 20

drop in right atrial pressure as TV opens.

Front 21

causes of palpitations

Back 21

Cardiovascular disease, thyrotoxicosis, hypoglycemia, fever, anemia, pheochromocytoma, anxiety, hyperthyroidism, panic disorders.

Front 22

Trepopnea

Back 22

rare form of positional dyspnea. Dyspnea decreased lying on left or right side. Reason unknown.

Front 23

platypnea

Back 23

difficulty sitting up

Front 24

CHF edema?

Back 24

same both legs and worse as day goes on. Best after sleep with legs elevated.

Front 25

Cardiac causes of hemoptosis?

Back 25

mitral stenosis-because of rupture of bronchial veins which are under high back pressure

Front 26

supravalvular aortic stenosis

Back 26

. Wide set eyes, low set ears, upturned nose, hypoplasia mandible.

Front 27

Lichtstein's sign

Back 27

earlobe crease, oblique, often bilateral. Over 50 y.o. with significant CAD-NOT a reliable sign.

Front 28

high arched palate

Back 28

mvp

Front 29

Noonan's Syndrome

Back 29

pulmonic stenosis (male Turner’s; 46XY)

Front 30

turners syndrome

Back 30

neck webbing; associated with coarctation of the aorta

Front 31

phase 1 bp

Back 31

Occluded pressure falls to SBP. Clear tapping sounds

Front 32

phase 2 bp

Back 32

Occurs at pressure 10-15 mm Hg lower than phase I-tapping followed by murmurs.

Front 33

phase 3 bp

Back 33

Occluded pressure falls enough to allow large amount of blood to cross partially obstructed artery. Similar to sounds of phase 2- only tapping.

Front 34

phase 4 bp

Back 34

Abrupt muffling and decrease intensity of sounds as BP--> DBP

Front 35

phase 5 bp

Back 35

: Complete disappearance of sounds-vessel no longer compressed. No longer turbulent flow.

Front 36

aus gap

Back 36

period of abnormal silence that usually occurs during the phase 2 Korotokoff period, from 10 to 15 mm Hg.

Front 37

cause of aus gap

Back 37

when there is a decrease in blood flow in the extremities (HTN, aortic stenosis, atherosclerosis).

Front 38

wide aus gap

Back 38

. Systolic hypertension in elderly (loss of arterial pliability)
2. Drop in diastolic pressure (Chronic severe AI)

Front 39

narrow gap

Back 39

1. Pulsus paradoxus with cardiac tamponade
2. Constrictive cardiac events

Front 40

supravaluvlar AS

Back 40

difference in BP in arms. HTN right arm; left arm can be hypotensive.

Front 41

coarctition of aorta?

Back 41

Lower leg BP < arm BP -->

Front 42

Paradoxical pulse (pulsus paradoxus)-exaggeration of normal inspiratory fall in SBP.
Normal fall in SBP is approx. 5 mm Hg with inspiration
Difference in fall > 10 mm Hg = marked pulsus paradoxus
is for what

Back 42

Cardiac tamponade, large pericardial effusions, constrictive pericarditis, asthma, emphysema

Front 43

anacrotic

Back 43

AS

Front 44

walterhammer

Back 44

AR

Front 45

bisferiens

Back 45

AR Combo AS/AR

Front 46

alternans

Back 46

CHF

Front 47

paradoxical

Back 47

COPD, tamponade, constrictive pericarditis

Front 48

JVD normal 45 and 30 degrees

Back 48

45- 4-5, 30- >6

Front 49

neck vein dis, when pt is 90deg. pressure?

Back 49

15

Front 50

jvd clinical correlation?

Back 50

Right sided heart failure
Less common-Constrictive pericarditis, tricuspid stenosis, SVC obstruction

Front 51

when do pts with obstructive dz have inc venous pressure

Back 51

expiration

Front 52

edema 1+

Back 52

Slight pitting, no visible distortion ; disappears rapidly

Front 53

edema 2+

Back 53

Deeper than 1+ but no detectable distortion and it disappears in 10-15 secs

Front 54

edema 3+

Back 54

Noticeably deep pit that may last more than a minute; looks fuller and swollen

Front 55

edema 4+

Back 55

Very deep pit that lasts as long as 2-5 mins; dependent extremity grossly distorted

Front 56

what do you hear with bell

Back 56

low pitched sounds-gallop, AV stenosis murmurs

Front 57

hear with diaphragm?

Back 57

high pitched sounds-valve closure, regurg murmurs, systolic events

Front 58

what can you hear supine?

Back 58

S1 and S2 all areas, systolic sounds

Front 59

What can you hear Left lateral decub-bell

Back 59

diastolic events at apex

Front 60

upright hear?

Back 60

S1 and S2 all areas; systolic and diastolic sounds

Front 61

Upright leaning forward-diaphragm?

Back 61

diastolic at base

Front 62

what do you listen to when they are upright and forward

Back 62

have patient exhale and hold breath-use diaphragm and listen at base for high pitched diastolic murmur -right and left 2nd and 3rd ICS (AR)

Front 63

When do right heart murmures inc

Back 63

with inspiration

Front 64

best hear pericardial friction murmurs?

Back 64

sitting, leaning forward, holding breath.

Front 65

murmur 1

Back 65

lowest intensity; barely audible in quiet room

Front 66

murmur 2

Back 66

low intensity; quiet but clearly audible

Front 67

murmur 3

Back 67

medium intensity without thrill; moderately loud

Front 68

murmur 4

Back 68

loud, associated with a thrill

Front 69

murmur 5

Back 69

very loud, thrill easily palpable

Front 70

murmur 6

Back 70

very loud, audible with stethoscope not in contact with chest, thrill palpable and visible

Front 71

HTN raises....

Back 71

Raises aortic systolic pressure --> loud A2 of S2

Front 72

calcification or fibrosis of SL valve?

Back 72

Softening of closure --> decreased S2

Front 73

Any condition that delays right ventricular systole-electrical or mechanical -->
delay P2

Back 73

widened split S2
a. Right bundle branch block
b. Pulmonic stenosis

Front 74

Any condition that shortens left ventricular systole --> A2 to occur earlier -->

Back 74

a. mitral regurgitation
b. VSD-ventricular septal defect
c. PDA
wide splitting.

Front 75

Any condition, electrical or mechanical that delays left ventricular emptying -->

Back 75

paradoxical split of S2

Paradoxical --> P2A2). Also, inspiration--> narrowed split and expiration --> paradoxical widening.
a. left bundle branch block
b. aortic stenosis
c. left ventricular failure
d. severe HTN

Front 76

Fixed S2 split

Back 76

Auscultatory hallmark of ASD-atrial septal defect
The split is wide and doesn't change with respiration.

Front 77

ejection clicks

Back 77

High pitched sounds early in systole at onset of ejection. Produced by opening (not normally heard) of deformed semilunar valves (pulmonic, aortic stenosis)

Front 78

mid systolic clicks

Back 78

Occurs during middle of systole. Single or multiple (MVP, tricuspid valve prolapse)

Front 79

diastolic opening clicks

Back 79

Opening (not normally heard) of deformed AV valve. Sound is sharp and high pitched.
*S2-OS interval-interval between S2 (close semilumar valves) and shortens as severity increases (mitral stenosis, tricuspid stenosis)

Front 80

Acute gallbladder (cholecystitis RF

Back 80

Right shoulder, right chest

Front 81

Renal colic (stones)

Back 81

testicular pain

Front 82

Appendicitis

Back 82

umbilical, testicular

Front 83

Angina-

Back 83

mid-epigastric

Front 84

Pleuritic

Back 84

flank

Front 85

gastric ulcers

Back 85

epigastric pain 1/2-1 hr after eating

Front 86

duodenal ulcers

Back 86

• Duodenal-pain 2-3 hr after eating or before next meal

Front 87

intestinal obstruction vomit

Back 87

feculent

Front 88

common area of muscle loss in abd dz

Back 88

hands,

Front 89

Telangiectasias lips and tongue

Back 89

Osler-Weber-Rendu Syndrome

Front 90

Melanin deposits-oral cavity, buccal mucosa

Back 90

Peutz-Jeghers Syndrome

Front 91

Moon facies, buffalo hump

Back 91

-Cushing's

Front 92

cullens sign

Back 92

bluish discoloration of umbilicus from hemoperitoneum of any cause (hemorrhagic pancreatitis, ruptured ectopic)

Front 93

Grey Turner's sign

Back 93

eccymoses of flank--> hemorrhagic pancreatitis

Front 94

most sensitive for ascites

Back 94

shifting dullness

Front 95

most specific for ascites

Back 95

fluid wave

Front 96

Rovsing's Sign

Back 96

pain in RLQ during left sided pressure--> positive sign--> appy

Front 97

murphys

Back 97

Sign of acute GBD (cholecystitis)
Pain on palpation of RUQ during inspiration due to inflammation of GB hitting fingers of palpating hand.

Front 98

Kehr

Back 98

abdominal pain radiating to left shoulder is sign of splenic rupture spleen rupture, renal calculi, ectopic pregnancy

Front 99

RA in stroke

Back 99

contraction of rectus abdominis muscles and pulling of umbilicus toward stroked side

Front 100

aaron

Back 100

appendicitis

Front 101

balance

Back 101

peritoneal irritation

Front 102

blumberg

Back 102

peritoneal irritation; appendicitis

Front 103

markel (heel jar)

Back 103

peritoneal irritation, appendicitis

Front 104

romberg-howship

Back 104

strangulated obturator hernia

Front 105

Upper half of anal canal

Back 105

autonomic control-insensitive to pain

Front 106

Lower half of anal canal

Back 106

somatic sensory nerves-painful to stimuli.

Front 107

Internal hemorrhoids cause

Back 107

dilation of vein/venous plexus in zona hemorrhoidalis

Front 108

External hemorrhoids

Back 108

dilation of venous plexus that drains into inferior rectal veins.

Front 109

Prostatic (posterior) portion

Back 109

common ejaculatory duct and prostatic
ducts enter this portion.

Front 110

Membranous portion

Back 110

external urethral sphincter; Cowper's bulbourethral glands.

Front 111

Cavernous (anterior) portion

Back 111

longest; Cowper's ducts enter

Front 112

testes blood supply

Back 112

Testicular artery; Pampiniform plexus ( venous drainage

Front 113

testes lymph nodes

Back 113

Pre-aortic and pre-caval nodes, NOT inguinal adenopathy.

Front 114

testes referred pain

Back 114

ipsilateral ureter

Front 115

MC pyuria?

Back 115

cystitis, prostatitis

Front 116

initial hematuria?

Back 116

problems with urethra

Front 117

distal hematuria

Back 117

problems with bladder neck, posterior urethra

Front 118

Phimosis

Back 118

constriction of the preputial orifice so foreskin cannot
be retracted.

Front 119

Paraphimosis

Back 119

retracts but gets caught

Front 120

Balanoposthitis

Back 120

inflammation of the glans and prepuce. Phimosis
may predispose patient.

Front 121

Balanitis

Back 121

inflammation of the glans penis alone

Front 122

Impulse at side of finger

Back 122

direct

Front 123

Impulse at tip of finger

Back 123

indirect hernia

Front 124

Most common cause of acute scrotal swelling

Back 124

Epididymitis

Front 125

female external genitalia blood supply

Back 125

Internal pudendal arteries

Front 126

Internal female genitalia drain

Back 126

pelvic and paraaortic nodes and are NOT accessible to inspection and palpation.

Front 127

Vulva and lower one third of vagina drain

Back 127

in to inguinal nodes.

Front 128

Vagina blood supply

Back 128

internal iliac, uterine, middle hemorrhoidal arteries

Front 129

uterine blood supply

Back 129

uterine and ovarian arteries

Front 130

lympm lower 1/3 vag

Back 130

Inguinal nodes

Front 131

lymph upper 2/3s vag

Back 131

Hypogastric/Sacral nodes

Front 132

uterine fundus drainage

Back 132

--> lumbar nodes

Front 133

Catamenia

Back 133

1. Age at menarche
2. Cycle length
3. Duration of flow

Front 134

*Molimen:

Back 134

Any recurrent, mid-cyclic symptom associated with menstrual period (breast tenderness, bloating).

Front 135

*Molimen: specific or sensitive

Back 135

specific

Front 136

leading cause of menorrhagia

Back 136

uterine fibroids

Front 137

mittelschmerz

Back 137

lower abd pain at ovulation

Front 138

severe pelvic pain and spasm with labia touch

Back 138

vaginismus

Front 139

Virilization

Back 139

extensive hirsutism associated with receding temporal hair, deepening of voice, clitoral enlargement. Due to androgen excess

Front 140

neuro incontinence Female cause

Back 140

ms

Front 141

overflow incontinence female casue

Back 141

atrophy db

Front 142

skin of vulva uniform reddened, smooth, shiny appearance. Most common in postmenopausal women, but can be seen in all ages

Back 142

Kraurosis vulvae

Front 143

blue cervix in preg sign?

Back 143

chadwicks

Front 144

Small, white or yellow, raised, round areas on the cervix. Retention cysts of the endocervical glands.

Back 144

nabothian cysts

Front 145

cystocele

Back 145

anterior vaginal wall--> urinary symptoms-frequency, stress incontinence

Front 146

rectocele

Back 146

posterior vaginal wall--> bowel symptoms-constipation tenesmus, incontinence

Front 147

Uterine Prolapse called?

Back 147

procidentia