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Physical Diagnosis

Midterm Exam

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
Created by: adhass
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