exam 2-Health assessment-lungs-heart
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| anteriorally papalted rib | 10th
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| palapted posterior "floating" ribs | 11th and 12th
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| prominent posterior vertebra | C7 & T1
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| accessory muscles | abd, sternocleiodmastoid, trapezius, ICs
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| normal anterioposterior diameter | 1:2 to 5:7
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| kyphosis | humpback
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| lordosis | lumbar curve, occurs during pregnancy
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| scoliosis | lateral curve
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| where palpation of the chest begins | above clavicle
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| palpation feels like bubble wrap | subcutaneous emphysema
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| normal thoracic expansion | 3-5cm
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| posterior placement of hands for thoracic expansion | T10, about 1-3inches apart
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| tactile fremitus/ vocal fremitus best felt here | trachea, 2nd ICS, T1 & T2, less over lung
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| sound over lungs | resonant
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| sound over muscle | dull
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| sound over bone | flat
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| hyperresonant sounds | thin adults, children, asthma, emphysema
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| percussion started here on lateral thorax | directly below axilla
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| normal diaphragmatic excursion | 3-5 cm
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| normal bronchial breath sounds | heard over trachea, longer on exhalation
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| normal bronchovesicular breath sounds | heard over manubrium, equal on inspiration and exhalation
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| normal vesicular breath sounds | heard over base of lungs, longer on inspiration
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| crackles | rales
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| wheezes | musical sounding
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| rhonchi | whistling or snoring sound
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| stridor | harsh vibrating sound
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| pleural friction rub | leathery sounding
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| bronchophony | "99"
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| egophony | "ee"
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| whispered pectoriloquy | whisper "99"
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| retraction | caving in of various regioing of chest
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| Kussmaul's respirations | abnormal, slow ,deep breathing
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| sound producing S1 | closing of mitral and tricuspid valves
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| S1 heard loudest at | apex of heart
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| sound producing S2 | closure of aortic and pulmonic valves
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| split S1 or S2 | valves do not close together
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| S2 heard loudest at | base of heart
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| S3 sound | caused by ventricle filling
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| S4 sound | heard at end of diastole
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| grading of murmurs | intensity, duration, timing, location
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| aortic area | 2nd ICS to right of sternum- aortic valve and S2 sounds best heard here
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| pulmonic area | 2nd ICS to left of sternum- pulmonic valve and split S2 best heard here
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| right ventricular area | 4th ICS left of sternal border- tricuspid valve and S1 best heard here
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| apical/ left ventricular area | 5th ICS medial to the MCL- mitral valve and S1 sounds best heard here
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| nomral JVD | 2cm or less
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| precordium | chest wall situated over the heart
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| normal PMI size | 2cm
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| order of auscultation | A, P, E, R, A
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| S3 sound | "kentucky" seen in CHF, caused by rapid ventricular filling, occurs after S2, heard at apex, "ventricular gallop", use bell to assess, best heard in side lying position
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| S4 sound | "tennessee", heard before S1, caused by a stiff ventricle, seen in HTN and post MI, heard at apex, "atrial gallop". heard best in side lying position
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| murmur | produced by turbulent blood flow
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| pan-systolic/ hollow systolic | heard throughout systole
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| ejection click | abnormal systolic sound due to opening of valve
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| opening snap | abnormal diastolic sound due to opening of valve
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| 5cm | amount added to JVP to calculate CVP
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| pulse pressure | SBP-DBP
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| ausculatory gap | disappearing and reappearing BP sound
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| pulse deficit | apical- radial SBP
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| linea alba | line from sternum to symphisis pubis
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| scaphoid abd | concave
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| protuberant abd | convex
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| Colin's sign | bluish tint around umbilicus, may be blood in abd
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| normal bowel sounds | 5-35 clicks in 1-2min
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| liver dullness span | 6-12cm
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| spleen dullness span | 6-8cm
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| tail of spence | part of breast towards axilla
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| Montgomery Tubercles | sebaceous glands on the nipple that lubricate the area
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| gynecomastia | benign tumor of the breast
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| galactorrhea | secretions from a non-lactating breast
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| position for breast examination | supine, or leaning forward for larger breast
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| prolactin | lactating hormone
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