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Pdx
eye, ear,Thorax and lung rubric,
| Question | Answer |
|---|---|
| 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
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