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Where is the PMI (apical impulse)?
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What closes at the S1?
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Physical Diagnosis
Midterm Exam
| Question | Answer |
|---|---|
| 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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