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115 Cards in this Set

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