Block 2- Clinical Skills

Front 1

What is this an XR of?

Back 1

pneumothorax

Front 2

Describe where you would find the apex of the lung anteriorly.

Back 2

about 2-4cm above the inner 1/3 of the clavicle.

Front 3

At what level is the lower border of the scapula?

Back 3

rib 7/7th intercostal

Front 4

What is this an XR of?

Back 4

Plueral effusion

Front 5

Normal respiratory rate for adults

Back 5

14-20 breaths per minute

Front 6

Normal respiratory rate for children?

Back 6

<2 mos = <60
2-12 months= <50
1-5yrs= <30
5-12yrs= <25

Front 7

AP diameter changes with..? Also what is it called in pathologic states?

Back 7

-age
-COPD, emphysema

called "barrel chest"

Front 8

"pink buffers" and "blow bloaters"?

Back 8

Pink buffers refers to pts with emphysema
Blue bloaters refers to pts with chronic bronchitis

Front 9

Hoover's sign

Back 9

paradoxiclal movement during breathing (chest inward on inspiration, anbdomen outward) because of inward instead of downward movement of the diaphragm; a/w COPD, nl in newborns

Front 10

Pectus excavatum

Back 10

caved in (funnel) chest

Front 11

Pectus carniatum

Back 11

Pidgeon chest

Front 12

Back 12

kyphosis; can be in combination with scoliosis and = thoracic kyphoscoliosis

Front 13

Causes of asymmetric chest wall expansion?

Back 13

-paralyzed hemidiaphram
-endobronchial mass obstructing air flow
-pleural effusion
-pneumothorectomy

often best appreciated when standing at foot of bed

Front 14

Superior Vena Cava Syndrome

Back 14

- direct obstruction the SVC by malignancies such as compression of it by R upper lobe tumores or mediastinal lypmphadenopathy; most common cause = bronchogenic carcinoma; sxs= SOB, swelling in face/arm

Front 15

Cyanosis

Back 15

blueish coloring, sign of hypoxemia
Central cyanosis (see in lips) vs acrocyanosis (extremities)

Front 16

Clubbing indicative of

Back 16

chronic pulmonart, cardiac, liver diseases

Front 17

Back 17

Sign of Leser-Trelat
appearance of seborrheic keratosis in xmas tree pattern on the back, highly indicative of cancer

Front 18

6% of pts in ER with chest pain who had costochondritis (inflammation of the costal cartilage) had what?

Back 18

an acute MI

Front 19

Percussion..what fingers

Back 19

3rd plexor strikes the DIP of the other 3rd pleximeter

Front 20

5 sounds on percussion

Back 20

Flat- thigh
Dull- liver
Resonant- healthy lungs
tympanitic- puffed of cheek
Hyperrresonant- kronigs

Front 21

Kronigs sign

Back 21

Absence of one of the 2 hyperresonant strips between the neck and shoulders (over the shoulders); suggest disease in the apical lung to pleura on that side

Front 22

Diaphragmatic excursion usually...

Back 22

should be symmetric and 5-6cm
abnormally high diaphragm can suggest plueral effusion, atelectasis, diaphragm paralysis

Front 23

How would a pleural effusion sound on percussion? What about fremitus?

Back 23

dullness over aran of fluid collection, hyperresonant area just above it- "Skodaic resonance". No fremitus over area

Front 24

Auscultation--what in general produces high or low frequencies?

Back 24

high frequencies are air moving through narrowed spaces (ex wheezes, stridor)
low frequencies is air moving through water (ex: rhonchi

Front 25

Breath sounds are usually louder where?

Back 25

lower posterior lung fields

Front 26

pectoriloquy

Back 26

when whispered sounds sound louder than normal on auscultation; indicative of consolidation

Front 27

egophany

Back 27

eee to ay change on ausculation; consolidation

Front 28

Pneumonia

Back 28

-increased fremitus
-egophany, pectoriloquy
-bronchial or bronchiovesicular sounds (broncial=pause between insp and exp, predominantly ex)

Front 29

rales

Back 29

aka crackles
sounds like hair between fingers
early inspiratory- coarse rales: chronic brochitis, asthma
late inspiratory- fine rales: pneumonia, CHF pulmonary fibrosis

Front 30

rhonchi

Back 30

low frequencies sounds, secretions

Front 31

Still's murmur

Back 31

most common midsystolic murmur heard in children, ceased by carotid compression

Front 32

differences in thorax of an infant

Back 32

rounder, thinner musculature, xiphoid protrudes

Front 33

Normal RR for infants

Back 33

30-40 breaths per min alternating with periodic breathing

Front 34

split S2 best heard on

Back 34

inspiration

Front 35

Persistent S2?

Back 35

ASD, indicate R ventricular volume overload

Front 36

Smoking and "5 A's"

Back 36

23% of US adults smoke
ask, advise, assess, assist, arrange f/u

Front 37

Heart rate

Back 37

-Adults normal 55-90
Children 1-2: 110
2-6: 100
6-10: 95

Front 38

5 korotkoff sounds

Back 38

1) 1st tapping noise (systolic)
2) soft lung sounds
3) louder sounds
4) muffled sounds
5) disappeared sound (diastolic)

Front 39

BP cuff

Back 39

-should be 40% of arm width, 80% arm length
-2.5 cm over cubital space
-too loose? will give low reading on small arm, high reading on large arm
-too small: give high reading

Front 40

LOEx pulse much lower than upper extremity?

Back 40

coarctation of the aorta

Front 41

JVP

Back 41

Reflects R atrial pressure which in turn reflects ventral venous pressure and R ventricular end diastolic pressure; use R internal jugular, bed at 30; biphasic (can see a and v waves), disynchonrous with arterial. Should be no more than 4cm above sternal angle

Front 42

a,c,v waves

Back 42

a- atrial contraction
c- AV valve closure
v- ventricular contraction

Front 43

bruits

Back 43

normal sounds of turbulence in kids, arterial obstruction in adults

Front 44

PMI

Back 44

5th intercostal space, MCL, 4-5cm from sternum

Front 45

LSSB is what part of heart?

Back 45

R ventricle

Front 46

Erb's point

Back 46

3rd intercostal space, can hear both aortic and pulmonary valves here

Front 47

S1

Back 47

-represents AV valves closing (end diastole early systole)
-Split can be heard best LLSB (M1 then T1)
-high pitch
-louder at apex than base

Front 48

S2

Back 48

-closure of aortic and pulmonary valves
-split S2 can be heard on inspiration
-louder at base than apex

Front 49

S1 path?

Back 49

softer S1? mitral insufficiency, long PR, L ventric dysfunction
louder S1? mitral stenosis, short PR, high CO
wide split S1- RBBB

Front 50

ejection click

Back 50

opening of aortic or pulmonary valve, abnormally heard
Pulmonary- softer with ins LUSB
Aorta- doest not alter with resp, RUSB and apex