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162 Cards in this Set
- Front
- Back
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normal chest shape?
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anteroposterial diameter & lateral diameter 1: 1.5
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barrel chest?
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-1:1
-chronic obstructive pulmonary disease |
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funnel chest or pigeon chest?
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-rickets, congenital disorders
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asymmetric chest?
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plueural effusion, pneumothorax, atelectasis on one side
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spinal deformities?
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kyphosis, lordosis, scoliosis, congenital disorders, osteoporosis, spinal TB
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respiratory rate?
1. norm 2. tachypnea 3. bradypnea |
1.14-10/min
2. >24, w/exertion fear, fever, pain, anemia, cardiac insufficency, acute respiratory distress, hyperthyroidism 3. <12/min after ingestion of morphine or shi alcohol |
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respiratory depth?
1. rapid & shallow 2. deep w/different rate |
1.pnuemonia, plueritis, pneumothorax, ascities, obesity
2. metabolic acidosis, diabetic acidosis, uremia/kussmaul respiration |
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respiratory rhythm?
1. cheyne-stokes 2. progressive dimminution |
1. rate & amplitude of successive cycles increase to a maximum
2. series is terminated by another apneic period, decreased excitability in respiratory center-seen in diseases of CNS, cardiac failure, uremia, drug induced respiratory depression, kids/old during sleep |
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ausultation?
1. lungs 2. clavicles |
1. diaphragm
2. bell |
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normal breath sounds?
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1. vesicular
2. bronchial 3. bronchovesicular |
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vesicular breath sounds?
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-produced in airway & to arise in the alveoli
-sounds are longer inspirator & shorter expiratory phase *heard over both lungs |
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bronchial breath sounds?
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have a shorter inspiratory phase & longer expiratory phase.
-compression of pulmonary tissue *heard in suprasternal notch & over c6, c7 & t1 , t2 post |
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bronchovesicular breath sounds?
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-intermidiate between vesicular & bronchial
-inspiratory and expiratory phases are equal in duration *can be heard over 1 & 2 interspaces |
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tracheal breath sounds?
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heard over trachea
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abnormal breath sounds?
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1. reduced or absent vesicular breath sounds
2. increased vesicular breath sounds 3. abnormal bronchial breath sounds |
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reduced or absent vesicular breath sounds?
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chronic airflow limitation, emphysema, pleural infusion, pneumonia, pneumothroax, collapse
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increased vesicular breath sounds?
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fever, acidosis, anemia, compensatory condition
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abnormal bronchial breath sounds?
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-heard over vesicular
-consolidaiton of lu, early stage pnuemonia, pulmonary tb, collapse of lu |
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vocal resonace?
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similar to vocal fremitus, but using stethoscope to hear
-more sensitive than fremitus |
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acute bronchitis?
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-2nd to respiratory infection
-no difference between r & l side of chest in notes of fremitus or resonance |
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COPD?
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-persistant cough resulting in sputum for 3+ months in at least 2 years
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asthma?
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acute episodes w/ gap, wheezing, cough,
*normal or decreased |
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lobar pneumonia?
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-abrupt shacking chills, rusty sputum
-dullness to percussion, |
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pneumothrax?
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abrupt onset & big amount of air in pleural space usually present w/dyspnea & sharp chest pain
*decreased sick area |
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pleural effusions?
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from infection, hypoalbuminemia, malignant diseases
-s/s depend on volume of fld -dullness or flatness over the fld *decreased sick area |
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atelectasis?
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obstruction from lu cancer or tb, one side is compressed which affects lu tissue collapses into airless state
-dullness over the area of atelectasis -resonace, breath sound & fremitus are reduced or absent *decreased sick area |
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emphysema?
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decreased
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consolidation?
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increased sick area
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s1?
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-first sound
-closing of tricupid valve & mitrial valve causes vibrations, which indicate the beginning of ventricular sytole |
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s2?
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-2nd
-closing of pulmonic valve & aortic valve causes vibrations, which indicates the beginning of venricular distole |
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c3 & c4?
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-occasionally heard in kids or ht failure
-heard as a gallop |
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cardiac murmurs?
-3 situations |
vibrations in ventricular wall, valves & vessel walls
1. bld flow speeds up 2. bld flow passes through a narrow orfice 3. bld flow regurgitates or goes the abnormal way -2 types: sytolic, diastolic |
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systolic?
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appear at ventricular systolic stage
-low pitched, blowing & appear between s1 & s3 |
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diastolic?
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ventricular diastolic stage
-high pitched, rumbling or low pitched, blowing & appear between s2 & s1 |
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apex/mitral valve area?
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5th interspace on L side of sternum
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pulmonary valve area?
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2nd interspace on L side of sternum
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aortic valve area?
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2nd interspace on R side of sternum & 3rd interspace on L side of sternum
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tricupsid valve area?
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4th or 5th on L side of sternum
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increased s1?
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mitral stenosis, fever, hyperthroid
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decreased s1?
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cardiac infraction, cardiac muscle disease
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increased s2?
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systemic or pulmonary hypertension
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grades of murmurs?
1 |
very faint, heard only with high concentration
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grades of murmurs?
2 |
quiet, heard immediatly after placing on chest
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grades of murmurs?\
3 |
mod. loud, no thrill
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grades of murmurs?
4 |
loud, thrill, palpable
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grades of murmurs?
5 |
very loud, heard w/stetho partly off chest, thrill palpabale
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grades of murmurs?
6 |
heard with stetho entirely off chest
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mitral stenosis?
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-pulmonary edema
-diastolic in mitral area -si increased |
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mitral regurgitation?
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-sob, fatigue
-systolic in mitral area |
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aortic stenosis?
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-dyspnea, angina, synscope
-systolic in aoritc area |
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aortic regurgitation?
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-palpitation, hypotension
-diastolic in aortic area |
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atrial septal defect?
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-S murmurm on L of sternum
-no thrills -L atrium to R atrium |
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ventricular septal defect?
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-SM 3rd & 4th L of sternum
-thrills -L ventrical to R ventrical |
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patent ductus arteriousus?
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fetal
-aorta to pulmonary artery -SM & DM 2nd on L -thrills |
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enlargement of lv?
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hepatitis, cancer lv, R ht failure
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enlargement of sp?
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cirrhrosis lv, R ht failure, lymphoma
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Murphys point?
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-mid clavicular line
-gb disease |
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mcburneys point?
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-inner 2/3 and outer 1/3 line from umbilicus to ASIS
-rebound tenderness appendicitis |
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bowel sounds?
increased |
acute enteritis, intestinal obstruction
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bowel sounds?
decreased |
constipation in aged, peritonitis, paralytic intestinal obstruction
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acute peritionits?
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-2nd to gastrointestianl perforation
-abdominal tension, tenderness, rebound pain *shifting dullness appears when some fld exists in abdominal cavity |
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angina pectoris ecg?
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show ischemic st-t change or + treadmill test
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acute myocardiac infraction?
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ecg shows typical changes of ht attack including deeper q wave, elevated st & reversed t wave
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intestinal obstruction?
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-post operative adhesions
1. mechanical-severe pain 2. paralytic-infection, no pain, distention |
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viral hepatitis?
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fever, chills, w/or w/out jaundice
-enlargement of lv |
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cirrhosis of lv?
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-viral hep, alcoholism
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acute pancreatitis?
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-gall stones, alcohol, idiopathic
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acute diverticlitis?
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infammation of colonic diverticulum, saclike mucosal out-pouching
-LLQ abdominal pain, diarrhea/constipation |
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types of joints?
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1. synovial
2. cartilaginous 3. fibrous |
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synovial?
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bones dont touch, articuates freely movable, knee shoulder
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carilaginous?
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vertabrae, sl. movable , seperated by fibrocartilaginous discs
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fibrous?
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bones held together by fibrous tissue or cartilage, almost in direct contact, immovable, ie skull
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kyphosis?
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spinal tuberculosis, rheumatoid spondylitis degeneration, crush fracture of vertebrae caused by osteporosis,
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1. cervial
2. lumbar |
1. flex-45, extension-45, bending-45, rotat-60
2. flex-60, ext-35, bending-30, rotat-45 |
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spine?
1. tenderness 2. percussion pain |
1. spinal process & around muscles one by one
2. direct or indirect *+ in vertebral TB, fracture & herniation of intervertebral disc |
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four limbs?
1. acropachy 2. acromegaly |
1. chronic resp. or card diseases
2. higher secretion of growth hormone of pit. gland tumor in adults |
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varus/valgus of knees or feet?
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rickets, congenital def., sequela of poliomyelitis
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muscle atrophy?
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paralysis, sequela of poliomyelitis, progressive myatrophy
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edema?
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pitting in renal disease/ht failure, non pitting edema in hypothyoroid
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varicosis?
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congenital. low limbs
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flat foot?
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congenital
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wrist joints?
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cystolic, round, non tender swelling in ganglia, solid, round & tender swelling in rhuematoid, arthristis
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finger joints?
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symmetrical swelling & deformiites in rheumatoid arth. or osteoarthritis in aged, claw hand i progressive myatrophy or some congenital disease
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knee joints?
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symmetrical redness, swelling, warmness, & pain in acute rheumatic arth, asymmetrical in other inflammation.
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knee tests?
1. bulge 2. balloon |
if + both can show floating patella in effusion of joint capsule
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shoulder movement?
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flex-90, ext-45, abd-90, add-reach mid line, ext. rot-30, int. rot-80
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elbow movement?
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flex-first finger can reach shoulder, ex-180
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wrist movement?
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flx-50-60, ext-40, abd-15, add-30
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finger joint movement?
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flex-make fist, ext-spread fingers
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hip joint movement?
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flex-thigh can reach abd, back ext-30, abd-60, add-25, ext & int
rot-45 |
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osteoarth?
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-slow progress, symmetric joint pain, stiffness, aggravated w/activity or weather
-joint tenderness & bone enlargment of joint, crepitation on motion & limiation of joint motion -+ autoimmune antibodies |
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gout?
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-lower ext. middle aged men, esp first metatarsal,
-joint red, warm swollen -+serum uric acid, 25% have kd stone, |
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rheumatoid arth?
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-symmetric inlammatory polyarth.
-starts small joints spreads to other joints -morning stiffness, swelling, pain, progress to diformities, -nodules often appear near lu & joints, many organs can be affected -+ serum rheumatoid factor to dx |
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osteoprorosis?
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-metabolic bone disease
-may be asympotlmiatic unless results in fracture\fall |
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periodic paralysis?
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-flaccid paralysis of skeletal muscles related to the serum potassium changes, eps hypokalemic
-autosomal dominate disease, some have no family history -hypertyroid -attacks begin by adolesence, triggered-exersice, sleep, stress, meal high in carbs/sodium -weakness/heaviness start legs to arms last 3-24hrs -bradycardia, premature ht beat, U wave in ECG common, Low serum pot K |
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myasthenia gravis?
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-autoimmune disorder, pathogeinci auto-antibodies block the transmission of electrical impoluse form nerve to muscle through acetylcholine receptor xu at motor end plate
-bilateral ocular muscle weakness is often first & assocaited w/ptosis & diplopia -severe cases swallowing muscles imparied, involved, 2/3 have thymus enlargement, some have thymoma, -increased acetycholine receptor antibody, + anti-cholinesterase |
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knee joint movement?
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flex-gastroneimus can reach back of thigh, ext-180, small range of motion
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ankle joint movement?
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dorsi-35, plant- 45, ext & int rot-35
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structure of spine?
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-7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccyx
-4 curves of spine: cervical, thoracic, lumbar, sacral, coccyx -intervertebral disc between 2 vertebral bodies |
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vertebral foreman?
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spinal cord
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intervertebral foremans?
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spinal nerves
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transverse forman?
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spinal arteries/veins
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CNS?
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brain, spinal cord
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brain?
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-cerebrum, diencephalon, brain stem, cerebellum
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cerebrum?
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L & R hemi, sensory, motor, visuual, auditory, olfactory, taste, speech, written & memory fx
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diencephalon?
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between cerebral hemi & brain stem, contain hypothalamus & pitutary, homeostasis, autonomic nervous system
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brain stem?
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connects cerebrum & diencephalon, with spinal cord, main-medulla oblongata-resp. ht rate
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upper motor neuron?
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brain spinal cord, increase muscle tone/deep tendon reflex, pathological reflexes may be +
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lower motor neuron?
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ant. horn cell-muscle & cerebellum, decreased muscle tone/deep tendon reflexes, -pathological reflexes
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muscle strenght?
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resistance against your movement
0-none 1-barely 2-active movement of body w/gravity elilminated 3-" " against gravity 4-" " " " & some resistance 5-normal |
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muscle tone?
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resistance to passive strength
1. increased resist-upper motor neuron paralysis 2. decreased-lower motor paralysis or cerebellar disease |
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sensory fx?
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1. superficial-tests pain, temp, light touch
2. deep-position, vibration 3. complex-stereognosis, # identification, point location, extinction |
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deep tendon reflex?
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-center is spine
-increased in UNP -decreased in LNP & other cerebellar diseases, periodic paralysis |
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bells palsy?
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unilateral LMN facial paralysis of face
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carpal tunnel?
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females at mid age, median nerve is compressed, pain may radiate to forearm & shoulder
-not pinky 1. tinels sign-hit center of wrist 2. phalens sign-put hands palm to palm, |
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sciatica?
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herniation of interverteral disc (l5-si1) w/compression or traction of nerve roots, person under 50,
1. + lasegues sign-raising straight leg will cause pain |
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Guilliain barre syndrom?
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-automimmune, demyelinating inflammatory disease following infection spinal roots involved
-flaccid paralysis of 4 limbs, some cranial nerves & autonomic nerve system involved 1. PE-muscle tone & deep tone reflexes decreased 2. CSF test-increased protein & normal # of cells |
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cerebral vascular accidents?
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stroke
1. schemic-cerebral thormbosis 2. hemorrhagic stroke-intraceretral hemorr & subarachnoid hemorr |
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cerebral thrombosis?
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32%, main cause atherrosclerosis, during sleep or morning, consciousness usually not lost, central hemiparalysis, better prognosis
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intracerebral hemorrhage?
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20%, hypertension & atherlsclerosis, during emotional stress/physical exertion, consciousness lost/disturbance , more severe
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spinal cord?
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contains motor & sensory nverve pathways
-mediate reflex activity of the deep tendon (or spinal nerve) reflexes |
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cerebellum?
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behind brain stem, maintain muscle tone, cord of voluntary muscle movement, balance
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cranial nerves?
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12 pairs emerge from brain, limited to general motor/sensory fx
-head, neck -smell, vision, hearing |
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spinal/peripheral nerves?
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carry to and from the cord, 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal
-contain both sensory & motor fibers |
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autonomic nervous system?
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central, sympathetic, parasympathetic, spread into ht, vessels other organs & glands to regulate fx
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tremor?
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rhythmic oscillatory movements
-park, cerebral athreoscelerosis in ages, hyperthyroid |
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chorea?
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-movements are brief, rapid, irregular, unpredictable
-face, head, low arms, hands -children rheumatic nervous diseae |
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tetany?
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-in fingers & facial muscle is hypocalcemia
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central (upper motor neuron) paralysis?
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from cerebral cortex to spinal cord
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peripheral (lower motor neuron) paralysis?
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ant horn cell of spinal cord to peripheral nerves or cranial nerves & muscles
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panplegia?
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paralysis of 4 limbs
-cervical spine & guilain-barre syndorme |
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hemiparalysis?
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paralysis of one side of arm & leg
-stoke, brain tumor |
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paraplegia?
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paralysis of 2 legs
-injury of lumbar spinal cord, acute myelitis |
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monoplegia?
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paralysis of 1 leg
-sequela of poliomyelitis |
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cordination?
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total integration of movements
-fx of cerebellar system -impaired is called ataxia |
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alt. movement?
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pt turn hand over & over strike on thigh
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point-point movement?
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finger to nose, finger to finger
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gait?
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pay attention to rate, rhythm of walk
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romberg test?
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pt stand w/feet together, eyes open then close both eyes for 20-30 seconds
-note pt ability to maintain upright position |
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deep tendon reflexes?
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-increased response in UMN paralysis
-decreased response in LMN paralysis -diseases like cerebelar & periodic paralysis |
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biceps reflex?
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strike biceps tendon at elbow with hammer strike finger
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triceps reflex?
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flex pt arm strike triceps tendon
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radius reflez?
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pronate forearm strike radius 1 to 2 inch above wrist, lu7 ish
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knee reflex?
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strike patellar tendon
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abdominal reflex?
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stoke each side of abdomen
-none in spinal injury, deep coma |
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plantar response?
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stoke lateral aspect of sole from heel to ball, curving med.
-flexion of toes is normal -expansion + babinski sign |
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babinski sign?
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stoke lateral aspect of sole from heel to ball, curving med.
+ indicates nervous system disease |
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ankle clonus?
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support knee in partly flexed. with hand dorsiflex then plantar flex 3 times pull up hard on 4th
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brudzinski sign?
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pt supine & limbs extended, passively flex neck, rigidity or resistance is abnormal, flex of hips is + brudzinnkskis indicates menigeal disease
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kernings sign?
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flex pt leg at both hip & knee & then streghten knee, resistance/pain indicates meningeal diseae
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exam paranasal sinuses?
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1. frontal sinus-medial areas above orbitals
2. ethmoid-between nasal roots and innter canthi 3. maxilary-both sides of checks 4. sphenoid-located inside and can not be examined |
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exam breath sounds?
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1. vesicular-heard over most area of lung
2. bronchial-first around sterno notch, then over c6, c7, t1, t2 |
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exam ht valve sounds?
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1. apex/mitral-5th L, under nipple and .5 to 1 centimeter med
2. aortic-2nd R 3. pulmonary-2nd L 4. 2nd aortic-3rd L 5. tricupsid-4th or 5th L |
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palpation lv?
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-use deep slipping palp
-1 cm below the right costal margin on midclavical line -push down and under rib -dont need to push in |
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palpation sp?
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-cannot be touched in normal person
-L side mid claival under rib -same as lv but right side & push in |
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percussion shifting dullness?
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-lay hand on abdomen umblicul line
-tap middle finger -do mid, side, then turn pt on side and tap sides again -if fld inside will sound like flatness |
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murphys sign?
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R side-midclavical line use L hand put 4 finger on chest/ribs push thumb into flesh under ask pt to breath deep if pain gallstones
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mcburneys sign?
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R-line from Ant. Iliac to umbilical, 1/3 from lat. push and release if rebound pain appendisitis
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exam kidney tenderness?
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find angle of spine and rib, put hand flat and hit with fist, both sides
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bugle sign?
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med side of knee, push fld up 3x and hold then push lat side of patella
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balloon sign?
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-push fld together with both hands over patella
-hold fld and use R index finger to push top of patella |
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knee deep tendon relex?
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-with hammer hit patella tendon
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