| Question |
Answer |
| Where is the PMI (apical impulse)? |
Left ventricule at 5th inter-space, 7-9 cm from mid-sternal line (mid-clavicular) |
| What closes at the S1? |
Mitral and Tricuspid Valve |
| When is systolic? |
Between S1 and S2 |
| What are four systolic extra heart sounds? |
Aortic stenosis, pulmonic stenosis, HTN, and MVP Click |
| What are four diastolic extra heart sounds? |
Mitral stenosis, physiologic S3, pathologic S3 or gallup, S4 or atrial gallop |
| What could cause an S3 or gallop? |
Myocaridal failure, tricuspid or mitral regurg. |
| What could cause an S4 or atrial gallop? |
HTN, CAD, Atrial Stenosis, Cardiomyopathy, delayed AV conduction |
| Where is physiologic splitting of S2 best heard? |
2nd or 3rd left interspace |
| What indicated pathologic splitting? |
No change with respiration; should normally only be heard on inspiration |
| Where is the place to hear a pericardial friction rub? |
3rd space at left sternal border |
| Where is the place to hear a patent ductus arteriorsus? |
2nd Left space (congenital opening between aorta and pumonary artery |
| What are common sites for bruits? |
Temporal, Subclavian, Carotid, Abdominal aorta, Femoral aorta |
| What are the three P's of occlusion? |
Pain, Pallor, Pulselessness |
| What are types of venous obstruction or insufficiency? |
Thrombosis, Edema, Varicose Veins |
| What is evidence of thrombosis? |
Redness, thickening and tenderness along superficial vein... Homan's sign positive for DVT |
| What are general sx of vascular problems? |
Leg pain/cramps, dizziness, headaches, swollen ankles |
| What does sternal angle mark? |
Bifurcation of trachea |
| Name inspiratory muscles? |
External intercostals, Scalenes |
| Name expiratory muscles? |
Internal Intercostals, Rectus Abdominus |
| What is a normal respiratory rate? |
12-20 |
| What is Stridor? |
Upper airway, high pitched, mostly inspiratory |
| What is Wheezing? |
Lower airway, high pitched, mostly expiratory |
| What are causes of Stridor? |
Croup, FB, trauma, COPD |
| What are the causes of Wheeze? |
Asthma, pulmonary edema, COPD, infection, FB |
| Where should you place your thumbs to test expansion? |
10th rib level |
| What does decrecreased fremitus indicate? |
Pulmonary edema, emphysema |
| What does increased fremitus indicate? |
Consolodation, solid mass |
| What is normal length for diagphramatic excursion? |
3-5cm |
| What kind of breathing is heard over most lung fields? |
Vesicular, inspiration > expiration |
| What kind of breath is heard only over the trachea? |
Bronchotracheal, expiration > inspiration |
| Describe crackles |
discontinuous, heard with inspiration, not cleared by coughing |
| Describe rhonchii |
Continuous, fog horn, usually clears with coughing, can be due to secretions or a tumor |
| What do increased transmission of sound on special lung tests indicate? |
Airless lung |
| What is normal JVD? |
normal is no more than 4 cm if measured from sternal angle |
| Flat, circumstrcibed change in color of skin that is less than 1 cm and examples |
Macule, freckles, nevi |
| Flat, circumscribed change in color of skin that is greater than 1 CM |
Patch, mongolian spots |
| Elevated, firm, circumscribed, less than 1CM |
Papule, wart, elevated nevi, seborrheic keratosis |
| Elevated, firm, circumscribed, over 1 CM |
Plaque |
| Elevated, irregular shaped, area of cutaneous edema |
Wheal; Hives, insect bites |
| Elevated, firm, circumscribed, deeper in dermis |
Nodule; Lipoma |
| Elevated, solid, deep in dermis, >2cm |
Tumor |
| Elevated, circumsribed, not in dermous, filled with clear fluid, less than 1cm |
Vesicle; Varicella, Herpes Simplex |
| Elevated, circumscribed, superficial, filled with clear fluid, greater than 1cm |
Bulla, blister |
| Elevated superficial with purulent material |
Pustule, impetigo, acne |
| Cyst |
Elevated, circumscribed, encapsulated, fluid or semi-solid |
| Fine, irregular, capillary dilation |
Telangiectasia; rosacea |
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