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possible test 2

Advanced Physical Assessment

1. Dyspnea - murmur
2. pneumothorax and p. effusion_______ and atelectasis and tumor________ push away- pull towards
3. Rhonchi - cleared by cough
4. Sputum putrid and rusty- also bronchitis
5. Hemoptysis - scant is bronchitis
6. Chest pain questions - mix and match
7. Respiratory distress - tachypnea- same with pneumonia- xr
8. Kussmals (acidosis) and Cheyne stokes (hyperventilation/apnea)  we continue breathing d/t CO2, acidosis/central chemoreceptors and hypoxia/peripheral chemoreceptors
9. Inspection of the chest diaphragm descends during inspiration- active process, and exhalation is a passive process- paradox is (Pigeon) during inspiration the chest goes out and abdomen goes in
10. SQ crepitus is something you feel- Patients with subcutaneous crepitus should all be assumed to have-a PNEUMOTHORAX unless it has been excluded
11. Tactile fremitus- vibration and pneumonia
12. Tracheal deviation - he was supposed to ask this the last time- caused by pneumothorax or pleural effusion, or left sided atelectasis- airway collapse- more room- lung tumors- mass
13. Pleural effusion - dull to percussion d/t fluid beneath- all other percussion/resonance has no significance
14. Bronchovesicular and bronchial breath sounds abnormal when detected over periphery- bronchovesicular and bronchial breath sounds develop whenever there is a ↓ in the air/water ratio of the pulmonary parenchyma/consolidation- pneumonia, atelectasis, pulmonary edema, pulmonary fibrosis
15. Lung auscultationTopography  mix and match?
16. Wheeze- expiratory- no wheeze is bad
17. Wheezes, crackles, etc… mix and match???
18. Stridor- emergency obstruction
19. Late inspiratory crackles indicate the presence of interstitial edema (heart failure or pneumonia) or interstitial scarring (pulmonary fibrosis)
20. Bronchophony, egophony, whispered pectoriloquy present in consolidation/pneumonia
21. Low pitch and high pitched crackles bronchitis vs pulmonary fibrosis (Velcro) and pneumonia/edema
22. Test question- “In pneumonia, you will also find normal lung on one side and consolidation on the other side”
23. Diaphragmatic excursion is reduced to 2-3cm in copd/p. fibrosis when normally it’s 3-6
24. Consolidation  pneumonia and left ventricular failure- atelectasis
25. Atelectasis refers to the process where a segment of lung collapses because air contained within it is reabsorbed into the blood stream. Atelectasis increases water density of lung tissue and produces consolidation
26. Pulmonary embolism- acute dyspnea, hx
27. JVD- 2 prominent bulges- a wave in pulmonary HTN-– absent in atrial fibrillation- too much pressure- and the v wave- tricuspid regurgitation, ASD pericarditis
28. Test question- Decrescendo usually diastolic murmurs as AR & mild MS- loud S1, opening snap- use bell- left lateral w/prego
29. When to use the bell for s3, s4, mitral stenosis murmur- open snap- low pitched sounds
30. Systole MT close (S1) and then AP open Diastole
31. Possible Test question- Hand grip increases the afterload- for regurgitations-will make it louder- goes in an abnormal direction- mitral regurgitation
32. Hand grip will put more blood in the heart for MR, AR and VSD- amyl nitrate does the opposite
33. You hear a systolic murmur over the apex- what are 2 conditions MR ASS Mitral regurg and atrial stenosis- ask pt to squeeze his hand
34. Squatting and leg raise increase preload for thus all murmurs except MVP&HOCM
35. Splitting S2 the right side gets filled with inspiration- the pulmonic will have more work to do and closes late because there’s too much pressure- heard on inspiration- longer and louder
36. Test ?- Wide split- abnormalities of S2 any condition that increases the pressure or volume on the right side of the heart- pulmonary htn- pulmonic condition happens later and aortic happens earlier so it widens the split.
37. Test ?- fixed splitting of s2 the same thing, in inspiration and expiration, it’s the same- asd- atrial septal defect
38. Opening snap- diastolic- (MS)- early diastole- LLSB-click
39. Aortic ejection click- aortic stenosis- heard at the base/everywhere clicks during systole because that’s when it opens and it’s stiff- mitral stenosis is early diastole because that’s when it opens
40. Mitral valve prolapse click- mid systole- leaflets loose when there’s less blood in the heart- blood goes back the other way- the jacket is big when you lose wt- mid systole (closes)- high pitch
41. An S1 or S2 caused by a mechanical valve (following MVR or AVR respectively), will acoustically sound similar to a click- An absent mechanical valve click =valve dysfunction
42. Abnormal systolic click MVP, aortic ejection click
43. S3 has very high specificity but low sensitivity for LV failure, S4 is nothing
44. PDA continuous and mechanical
45. Test question left ventricular gallop S3
46. Gallop word for s3- heart failure- order lasix
47. Test question- Unusually tall woman marfan- loose connective tissue- aortic regurgitation- lean forward- fist grip- decrescendo- blowing-
48. MVP click/mitral valve prolapse leaflets loose when there’s less blood in the heart- blood goes back the other way- the jacket is big when you lose wt- mid systole (closes)- high pitch- vasalva and standing= you hear better
49. Pericarditis treat with nasids- pr interval depression on ecg- ST segment elevation in the majority of leads
50. Hypertrophic obstructive cardiomyopathy (HOCM) (decreased murmur intensity) systolic murmur like AS but more blood makes AS more loud but not this one (squatting, leg raise or supine)→ echo
51. AS murmur radiate to the carotid arteries MR murmur radiates to the axilla
52. Grade 4 you can feel vibration of murmur
53. mitral regurgitation caused by HTN and ischemia
54. Quality of murmurs MS quality- rumbling MR quality- musical blowing AR quality- blowing AS quality- harsh PDA quality- machine-like Still’s Murmur- musical vibratory
55. a-fib synchronized cardioversion except for v-fib
56. You hear a systolic murmur over the apex- what are 2 conditions MR ASS Mitral regurg and atrial stenosis- ask pt to squeeze his hand
57. SYSTOLIC MURMUR WHICH RADIATES TO THE AXILLA MRASS- MR, if he wants you to say aortic, he would chose the carotid
58. VSD- VSD/ventricular septal defect is a hole between the left ventricles-If left untreated, the Lt to Rt shunt (red)can --NOT CYANOTIC HERE BUT can turnninto Rt to Lt one (blue) and the patient becomes cyanotic- too late (Eisenmenger syndrome)
59. Ankle brachial pressure BP higher in the legs- for pt with pain in the leg when walking- do left ABI and Rt ABI legs/arm pressure should be 0.9 or greater- do 2x for the average
60. young female with chest pain MVP
61. malleolous below is arterial and above is venous
62. Superficial Venous Thrombosis (Superficial Thrombophlebitis) causes DVT? no but is does contribute to varicose veins- give NSAIDS
63. Varicose veins will get worse use compression stockings
64. Chronic venous insufficiency know s/s above medial malleoli, associated with edema, varicose veins, Hyperpigmentation, possible cyanosis, especially when legs are dependent, in venous stasis ulcers-above ankles- virchows triad- stasis/trauma, hypercoagulability/dehydration
65. Alarming- lymph nodes that do not hurt firm is bad- doesn’t move- malignant
66. Matted lymph nodes bad- also, they do not pulsate-
67. virchows node is bad- a palpable left supraclavicular node is a significant clue to thoracic or abdominal malignancy
68. S1 you can hear it sometimes higher than normal mild mitral stenosis- cannot even hear the murmur- may miss it
69. Pulmonary htn abnormal S2 1) 2nd heart sound is loud 2) 2nd heart sound is widely split because the pulmonic component occurs late- loud P2- valve closes late- higher pressure
70. Test question- S3 and S4 diastolic heart sounds heard with the bell- also mitral stenosis murmur- low pitched sounds- he will ask “all these sounds are low pitched except”---
71. S3 has high_____ but low_________ specificity, sensitivity- you can say pt has chf if s3 is present, but if not present, you cannot exclude chf
72. Left ventricular gallop s3 is softer during inspiration because we put more blood on the right side- ask pt to exhale to hear better
73. Ventricular Septal Defect in child systolic- recurrent respiratory infections- If left untreated, the Lt to Rt shunt turns into Rt to Lt one and the patient becomes cyanotic (Eisenmenger syndrome)
74. 2 major complications of DVT are PE and chronic venous insufficiency- Virchow’s triad (stasis, trauma, hypercoagulability/dehydration)- pain and swelling
75. Abdominal aorta abdominal pain and pulsating abdominal mass- evident in family hx- An AAA is an expansible mass that pushes the examiners hands apart- unlikely to be under belly button
76. Dissecting aneurisms of thoracic aorta Produce excruciating, tearing, anterior chest pain- hoarseness, while pressure on the superior cervical ganglion may cause a Horner syndrome
77. Syndrome of sudden arterial occlusion embolism/thrombotic- sudden- loss of sensation- 5 Ps- pain, pallor, paresthesia, loss of pulses, paralysis- Microemboli to the lower extremities cause the "blue toe syndrome".
78. Syndrome of Chronic Arterial Occlusion intermittent claudication- Viagra does not help-thickened toenails, shiny skin, loss of hair, absence of both pedal pulses, cutaneous ulcers
79. Test question- Raynaud's phenomenon vasospasm of arteriolar smooth muscle- fingers/toes distal to the MCP/MCT pass into 3 stages- Pallor: d/t cold= vasospasm→ Cyanosis: oxygen desaturation, finally Redness: d/t vasodilation- throbbing in digits
80. Chronic venous insufficiency Incompetent valves within the deep venous system cause blood to flow back -Cutaneous edema and "brawny induration," prominent just above the medial malleolus- stasis dermatitis (ulcer)
81. Virchow node bad- a palpable left supraclavicular node is a significant clue to thoracic or abdominal malignancy
82. Painless lymphadenopathy look for leukemia or lymphoma- s/s- fever, wt loss and nt sweats- bed sheets 2x night
83. Prominent ”a” waves pulmonary HTN and absent in a-fib
84. Maneuvers that affect/increase the Preload (venous return) Squatting/Leg raise: increase venous return, thus increase all murmurs except MVP&HOCM
85. Valsalva/Standing: decrease venous return, thus decrease all murmurs except MVP&HOCM
86. Maneuvers that affect the Afterload (Systemic vascular [arterial] resistance) Handgrip: ↑ afterload, thus ↑ regurgitation murmurs, and ↓/not affecting stenotic murmurs, decreases MVP, HOCM, nothing to MS
87. Amyl nitrate decreases afterload, thus decreasing regurgitation murmurs, and increasing/not affecting stenotic murmurs, increases MVP and HOCM, nothing to MS
88. V waves seen in tricuspid regurgitation, ASD pericarditis
Created by: arsho453
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