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115 Cards in this Set
- Front
- Back
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Angle of Louis
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-anatomic reference point where manubrium meets the sternum
-aortic valve on the right; pulmonic valve on the left -found at T4 on the back -place where everything bifurcates (difference between bronchial and tracheal breath sounds) |
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What are the primary muscles of respiration?
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Diaphragm
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What are the secondary muscles of respiration?
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Scalenes, SCM's, pectoralis minor, intercostals
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barrel chest
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increased anterior:posterior diameter (COPD, infancy, aging)
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pectus exavatum
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-"funnel chest"
-depression in the lower portion of the sternum -compression of heart and great vessels may cause murmurs |
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pectus carinatum
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-"pigeon chest"
-sternum is displaced anteriorly to increase anterior:posterior diamater and costal cartilages adjacent to protruding sternum are depressed |
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kyphosis
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round back
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kyphoscoliosis
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abnormal spinal curvatures and verterbral rotation deform chest
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tachypnea
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rapid breathing
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hyperpnea, hyperventilation
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rapid, deep breathing
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bradypnea
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slow breathing
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apnea
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no breathing
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Cheyne-Stokes breathing
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hyperpnea alternating with apnea
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What makes a dull sound when percussed?
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-solid organs (heart, liver)
-lung or abdominal mass -lung area with accummulated fluid (consolidated pneumonia, pleural effusion, or empyema) |
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What makes a flat sound when percussed?
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muscle or bone
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What makes a resonant sound when percussed?
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normal, healthy lung
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What makes a hyperresonant sound when percussed?
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air tapping (COPD)
pneumothorax |
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What makes a tympanic sound when percussed?
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gastric air bubble
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What conditions cause increased tactile fremitus?
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consolidated pneumonia
pulmonary edema pulmonary hemorrhage |
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What conditions cause decreased tactile fremitus?
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pleural effusion
pneumothorax COPD asthma atelectasis |
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What conditions have normal tactile fremitus?
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chronic bronchitis
L sided early failure |
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vesicular breath sounds
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-over most of the lung fields
-low-pitched -expiration<inspiration -relatively soft |
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bronchovesicular breath sounds
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-over mainstem bronchi
-medium-pitched -expiration~inspiration |
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bronchial breath sounds
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-over trachea
-high-pitched -loud -expiration>inspiration |
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crackles (rales)
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-discontinuous
-inspiratory |
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rhonchi
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-continuous
-more pronounced in expiration -lower-pitched |
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wheezes
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-continuous
-expiration>inspiration -high-pitched |
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stridor
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-continuous
-high-pitched -foreign body -inspiratory -upper airway sound |
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pleural friction rub
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-inspiration and/or expiration
-rub-grating quality |
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pericardial rubs
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-have patient hold breath to see if sound is produced by heart or lungs
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bronchophony
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clear transmission of spoken sounds through lung to the stethoscope
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whispered pectoriloquy
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louder, clearer transmission of the whispered voice
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egophony
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spoken "ee" is heard as "ay" and nasalized
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consolidation
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-dull to percussion
-bronchial breath sounds -increased tactile fremitus and transmitted voice sounds |
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hyperinflation
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-hyperresonant to percussion
-decreased to absent breath sounds -decreased tactile fremitus and transmitted voice sounds |
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4 quadrants of abdomen
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RUQ, RLQ, LUQ, LLQ
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3 divisions of midline abdomen
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epigastric, umbilical, suprapubic/hypogastric
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Order for abdominal examination
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Inspect, auscultate, percuss, palpate
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What organs are in RUQ?
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-liver and gallbladder
-pylorus -duodenum -head of pancreas -R adrenal gland -portion R kidney -hepatic flexure -portion of ascending and transverse colon |
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What organs are in LUQ?
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-L lobe of liver
-spleen -stomach -body of pancreas -L adrenal gland -portion L kidney -splenic flexure -portion of transverse and descending colon |
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What organs are in RLQ?
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-cecum and appendix
-portion of ascending colon -R ovary and salpinx -R ureter |
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What organs are in LLQ?
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-sigmoid colon
-portion of descending colon -L ovary and salpinx -L ureter |
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What organs are midline (unless distended)?
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-bladder
-uterus |
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borborygmi
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stomach growling
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What are special maneuvers for acute appendicitis?
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-rebound tenderness
-Rosving's sign -psoas sign -obturator sign |
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What is a special maneuver for acute cholecystitis?
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Murphy's sign
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Where do you listen for the aortic valve?
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R 2nd ICS
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Where do you listen for the pulmonic valve?
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L 2nd ICS
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Where do you listen for the tricuspid valve?
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lower L sternal border
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Where do you listen for the mitral valve?
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apex~ 5th ICS midclavicular line
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Do you inspect the right or left internal jugular veins?
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Right
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What is normal R atrial pressure?
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7-10 mm water
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What are 3 causes of elevated R atrial pressure?
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-R sided CHF
-tricuspid stenosis -constrictive pericarditis |
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What to assess for the PMI?
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Size
Amplitude Location Impulse Duration |
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What makes S1 heart sound?
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closure of mitral and tricuspid valves
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What makes S2 heart sound?
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closure of aortic and pulmonic valves
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What is physiologic splitting of S2?
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when on inspiration, S2 is split because the aortic and pulmonic valves close at different times- this is normal if during expiration they close at the same time
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What causes S3 sound?
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when blood flows into overfilled, noncompliant L ventricle
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If present, when is S3 heard?
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Early diastole, right after S2
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What causes S4 sound?
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when atrial contraction pushes blood into an abnormally stiff ventricle
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If present, when is S4 heard?
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Late diastole, right before S1
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What causes pericardial friction rubs?
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movement of heart against inflamed pericardial sac
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What causes an innocent murmur?
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increased flow across normal valve
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What causes a pathological murmur?
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blood flow across structurally abnormal valve or opening
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What murmurs occur in systole?
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-aortic stenosis
-mitral insufficiency |
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What murmurs occur in diastole?
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-mitral stenosis
-aortic insuffiency |
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Where do most AAA occur?
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inferior to renal arteries
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Arterial insufficiency
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-pale color
-painful -diminished pulse -cold -edema sometimes -ulcers on tips of toes -gangrene |
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Venous insufficiency
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-blue/purple
-fatigue -normal pulses -warm -edema -brawny |
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dysphonia
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impairment in the volume, quality, or pitch of the voice
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dysarthria
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a defect in the muscular control of the speech apparatus; slurred or indistinct words, but language intact
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aphasia
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disorder in producing or understanding language
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what information is carried to the brain in the ventral columns of the spinal cord?
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pain, temperature, touch
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What information is carried to the brain in the posterior columns of the spinal cord?
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position sense, vibration sense, fine, localized touch
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macule
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small flat spot up to 1 cm
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papule
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solid elevation of skin less than 1 cm
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vesicle
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small collection of clear fluid, blister
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putule
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small elevation of the skin containing pus
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nodule
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marble-like lesion larger than .5 cm
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bulla
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1 cm or larger filled with serous fluid
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patch
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flat spot 1 cm or larger
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plaque
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elevated superficial lesion 1 cm or larger, often formed by a coalescence of papules
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wheal
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smooth, slightly elevated, edematous area that is redder or paler than the surrounding skin; irregular, relatively transient, localized skin edema
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erosion
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nonscarring loss of the superficial epidermis; surface is moist but does not bleed
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ulcer
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a deeper loss of epidermis and dermis; may bleed and scar
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excoriation
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linear or punctuate erosions caused by scratching
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scale
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a thin flake of dead exfoliated epidermis
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crust
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dried residue of skin exudates such as serum, pus or blood
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fissure
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a linear crack in the skin, often resulting from excessive dryness
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lichenification
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visible and palpable thickening of the epidermis and roughening of the skin with increased visibility of the normal skin furrows (often from chronic rubbing)
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scar
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connective tissue that arises from injury or disease
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atrophy
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decrease in size or wasting away of skin
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petechiae
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small, pinpoint hemorrhage
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purpura
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merging ecchymoses and petechiae over any part of the body
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ecchymosis
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bluish-black mark on the skin (bruise)
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telangiectasia
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an abnormal dilation of red, blue, or purple superficial capillaries, arterioles, or venules typically located just below the skin's surface (spider vein)
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myopia
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near-sightedness; difficulty seeing distances
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hyperopia
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far-sightedness; difficulty seeing near
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presbyopia
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aging vision; difficulty seeing near
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miosis
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constriction of pupils
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mydriasis
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dilation of pupils
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anisocoria
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pupillary inequality of <0.5 mm
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ptosis
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drooping of the upper lid
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ectropion
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margin of lower lid turned outward exposing palpebral conjunctiva
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entropion
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inward turning of lid margin
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nystagmus
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fine rhythmic oscillation of the eyes
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strabismus
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misalignment of the eyes/ deviation that cannot be overcome
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amblyopia
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reduced vision in an otherwise normal eye
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pterygium
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a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from nasal side
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xanthalasma
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slightly raised, yellowish, well-circumscribed plaques that appear along nasal portions of one or both eyelids
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hordeolum
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a painful, tender red infection in a gland at the margin of the eyelid
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chalazion
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a subacute nontender and usually painless nodule involving a meiobomian gland
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corneal arcus
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a thin, grayish-white arc or circle not quite at the edge of the cornea
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hyphema
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hemorrhage into the anterior chamber of the eye
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papilledema
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engorgement and swelling of the optic disc as a result of venous stasis
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