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Pdx

eye, ear,Thorax and lung rubric,

QuestionAnswer
When inspecting the eye specifically look for... ptosis, entropion, ectropion, exopthalmos, thinning of outer 1/3 eyebrow, strabismus(crossed eye), hypotropia(down), hypertropia (up), exotropia (out), esotropia (in)
what are you looking for when inspecting inflammation, crusting, edema, or masses (4) Sty - gland infx, Blepharitis - red inflamed lid margins (often with crusting) Seborrheic dermatitis – scaling Xanthelasma- slightly raised, yellowish, well-circumscribed plaques that appear along the nasal portions of eyelid(s) =
what are you looking for when inspecting conjunctivas and sclera Conjunctivitis (bacterial, viral, allergic) Subconjunctival hemorrhage (trauma, bleedingdisorders, cough) Acute glaucoma (conjunctival injection, cloudy cornea) Jaundice- yellow sclera
When observing the cornea and lens look for? Glaucoma = cloudy cornea; cataract = opaque of the lens visible through the pupil
When completing PERRLA, what do unequal pupils or dialated pupils indicate? Unequal pupils = anisocoria; dilated pupils = trauma, drugs
When inspectin ear, be on look out for (2 things) Tophi (chonic tophaceous gout) may present as hard nodules on the helix or anti-helix. Basal cell carcinoma is a raised nodule w/ lustrous surface & telangiectatic vessels
when inspecting ear drum look for... cerumen, foreign bodies, discharge, scales, erythema or swelling. Check for color, perforations, shape & position of eardrum
what will a healthy eardrum look like? transparent, pearly-grey, tympanic membrane. The cone of light is anterior inferior off the Umbo
in webers test where does conductive hearing loss and sensorineural hearing loss lateralize? Sound will lateralize to the “bad” ear in conductive hearing loss Sound will lateralize to the “good” ear in sensorineural loss
In Rinne test where is conductive loss heard longer? heard longer through bone than through air
During schwabach test, what do you suspect if patient hears longer than dr? Or if Dr hears longer than patient? If the patient hears longer than the doctor conductive loss is suspected. If the normal doctor hears longer than the patient sensorineural loss is suspect Longer duration = conductive; shorter duration = sensorineural
What do Late inspiratory fine crackles indicate? Interstitial lung disease (i.e., fibrosis), early CHF
General, lip & fingernail colors look for... Cyanosis of the lips, skin, or fingernails -diffuse interstitial lung disease (fibrosis, connective tissue disease) Clubbing of the nails - pulmonary or cardiac disease. Yellow nails -pleural effusion, lymphedema, bronchiectasis, nicotine staining
What do Midinspiratory & expiratory fine crackles indicate? bronchiectasis
fine crackles are the predominant sound in... pneumonia (80%)
Early inspiratory (sometimes expiratory) coarse crackles indicate... chronic bronchitis, asthma
wheezes indicate... Asthma, chronic bronchitis, COPD, CHF
Rhonchi indicate... Bronchitis, COPD, pneumonia (rarely)
Stridor indicates... Partial obstruction of the larynx or trachea
Pleural Rub indicates... Pleurisy, pneumonia (20%), pulmonary embolism
Mediastinal Crunch “Hamman’s Sign” indicates... Precordial crackles synchronous with heart beat (best heard in left lateral position) Mediastinal emphysema
percussion: resonant; breath sounds: vesicular; adventitious sounds: crackles in early inspiration & perhaps expiration; or wheezes or rhonchi? what's your DDX? bronchitis
respiration: prolonged expiration; percussion: resonant-diffusely hyperresonant; breath sounds: often obscured by wheezes; adventitious sounds: wheezes, possibly crackles; tactile fremitus: decreased think... asthma
respiration: prolonged expiration; percussion: diffusely hyperresonant; breath sounds: decreased-absent; adventitious sounds: none, or the crackles, wheezes & rhonchi associated with chronic bronchitis... think COPD
normal auscultation findings; tenderness to the chest wall; tenderness overlying the costochondral junctions. think... costochondritis
percussion: dull RML; breath sounds: bronchial over RML; adventitious sounds: late inspiratory crackles RML; tactile fremitus: increased over involved area, with bronchophony, egophony & whispered pectoriloquy thnk... RML pneumonia
percussion: hyperresonant; trachea: shifted toward opposite (left) side; breath sounds: decrease-absent R; adventitious sounds: none, except a possible pleural rub; tactile fremitus: decreased-absent R think... right pneumothorax
perc:dull-flat L; contralateral trachea in a large effusion; breath sounds: decreased-absent, but bronchial breath sounds may be heard near top of large effusion; adventitious sounds: none, except a possible pleural rub; tactile fremitus: decreased-absent left pleural effusion
General findings include abnormal percussion, breath sounds changes, moist rales (when pneumonia happens); endobronchial obstruction may result in a localized wheeze; lobar collapse may result in an area of decreased breath sounds & dullness to percussion bronchiogenic carcinoma
Created by: abva