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Assessment test 2

thorax, lungs, cardiac, abd, peripheral vascular

Land marks for thoracentesis T7-8 interspace
Which intercostal space used for insertion of needle for tension pneumothorax? 2nd intercostal space
What is the lower margin of ET tube on chest x-ray? T4
This causes episodic dyspnea during rest and exercise, hyperventilation, and rapid shallow breathing. Anxiety
Caused by partial airway obstruction r/t secretions, tissue inflammation of asthma, or foreign body. Wheezing
Most common cause of acute cough Viral URI
Acute bronchitis, pneumonia, L ventricular heart failure, asthma, or foreign body cause _______ cough. acute
Post-infection, bacterial sinusitis, and asthma cause ________ cough. subacute
Post-nasal drip, asthma, GERD, chronic bronchitis, bronchiectasis cause _______ cough. chronic
causes large volumes of foul-smelling purulent sputum anaerobic lung abcess
high pitched wheeze, ominous sign of upper airway obstruction in larynx or trachea Stridor
causes of asymmetrical expansion: pleural effusion, chronic fibrosis, lobar pneumonia
COPD, obstructed bronchus, effusions, fibrosis, pneumothorax, or infiltrating tumor _______ fremitus. decrease
percussive dullness is normal over ______. it is heard over _____ abnormally when filled with fluid in disease states such as pneumonia, effusions, hemothorax, empyema, or tumor. visceral organs, lungs
percussive sound of healthy lungs Resonant
bilateral Hyper-resonance is typically heard in diseases such as: COPD & asthma
unilateral hyper-resonance is possibly a: pneumothorax or large air-filled bulla
Hair on the chest can cause false sounds of: crackles
Breath sounds: hear over most of lung, inspiratory sounds are longer than expiratory, soft intensity, low pitch vesicular
Breath sounds: heard over 1st and 2nd interspaces and between scapula, inspiratory and expiratory are equal duration, intermediate intensity and pitch Broncho-vesicular
Breath sounds: heard over manubrium, expiratory sounds are longer than inspiratory, loud intensity and high pitch Bronchial
Breath sounds: heard over trachea, equal inspiratory and expiratory, loud and high pitched tracheal
fine late inspiratory crackles that persist suggest: abnormal lung tissue
Rhonchi suggest secretions where: large airways
Louder voice sounds when saying "ninety-nine" during auscultation bronchophony
Louder, clear whispered sounds whispered pectoriloquy
symmetrical lung expansion, resonant, vesicular breath sounds, diaphragm descends 4 cm bilaterally; indicates: normal findings
thorax symmetrical moderate kyphosis, increased anteroposterior diameter, decresed expansion, hyper-resonant, breath sounds distant with delayed expiratory phase, scattered expiratory wheezes, decreased fremitus, diaphragm descends 2cm; this suggests: COPD
productive cough, possible scattered crackles, may have wheezes or rhonchi; indicates chronic bronchitis
edematous bronchial mucosa, late inspiratory crackles in dependent lungs, possible wheezing; indicates: L-sided heart failure
Dull percussion, bronchial sounds over involved area, late inspiratory crackles of involved area, increased fremitus with bronchophony, egophony, and whispered pectoriloquy Consolidation: alveoli fill with blood or fluid. ie pneumonia, pulmonary edema, pulmonary hemorrhage
dull percussion, trachea shifted to involved side, usually absent breath sounds and fremitus of affected side. atelectasis
dull percussion, trachea shifted to opposite side, breath sounds and fremitus decreased or absent effusion
hyper-resonant or tympanic percussion, trachea shifted to opposite side, breath sounds and fremitus decreased to absent pneomothorax
resonant to diffusely hyper-resonant, breath sounds obscured by wheezes, possible crackles, decreased fremitius. asthma
name that murmur: midsystolic, 2nd-4th intercostal, little radiation, soft/medium pitch, grade 1-3, disappears when sitting innocent murmur
name that murmur: midsystolic, s2 possibly decreased, 2nd R intercostal, radiates to the carotid, soft or loud intensity, crescendo-decrescendo, harsh quality aortic stenosis
name that murmur: mid-systolic, 3rd & 4th interspace, radiates LSB, variable intensity, harsh, medium pitch, decreased with squatting, presence of S4 Hypertrophic cardiomyopathy
name that murmur: mid-systolic, 3rd & 4th interspace, radiates when loud to L shoulder/neck, harsh quality, medium crescendo-decrescendo pitch pulmonic stenosis (RARE)
name that murmur: pansystolic, heard at apex, radiates to axilla, apical thrill, medium high pitch, harsh Mitral regurgitation
name that murmur: lower LSB, radiates to right of sternum, variable intensity, medium pitch, blowing, increased intensity with inspiration. tricuspid regurgitation
name that murmur:diastolic, 2nd to 4th intercostal, radiates if loud, no thrill, high pitched, grade 1-3, best heard while pt sitting leaning forward, and holding breath after exhalation aortic regurgitation
name that murmur: diastolic, apex, no radiation, grade 1-4, decrescendo, low pitch, turn pt left lateral, heard best during exhalation, opening snap preceding s2 mitral stenosis
unpleasant awareness of breathing dyspnea
unpleasant awareness of heart beating palpitations
Sounds like "Tennessee" S4
Sounds like "Kentucky" S3
Pain: occurs when hollow organs contract forcefully or are distended, stretching of capsule of solid organs, difficult to localize, stimulated by ischemia, described as gnawing, burning, cramping. can be associated with sweating, pallor, n/v, and restles Visceral
Pain: occurs r/t inflammation, steady aching pain, aggravated by movements esp. coughing, precisely located over involved structures parietal
Pain: occurs in distant sites that are innervated by the same spinal level, develops as initial pain increases, can be superficial or deep referred
visceral pain in the RUQ may result from liver distention against its capsule in alcoholic hepatitis
_______ is a subjective negative feeling that is nonpainful and can include bloating nausea upper abd fullness adn heartburn discomfort
burning pain/sensation in epigastric chest, after fatty meals, worse when lying down or being physically active. Antacids, theophylline, and CCB releive. may have wheezing and cough GERD
epigastric pain that radiates to the back, gnawing burning aching, wakes pt up at night, present for weeks disappears for months reappears. Relieved by food. sx: n/v bloating heart burn weight loss peptic ulcer and dyspepsia
pain in "cardia" and GE junction, slow persistent, aggravated by food, not relieved by food or antacids. sx: anorexia, nausea, early satiety, weight loss, bleeding Stomach Ca
periumbilical pain followed by RLQ pain mild to severe w/ cramping, aggravated by movement or cough, low fever, n/v anorexia acute appendicitis
epigastric or RUQ radiates to R scapula, steady achy, not colichy, rapid onset last several hours resolves gradually, recurrent, SX: anorexia, n/v, restlessness biliary colic
RUQ or upper abd, radia to right scapula, steady aching, gradual onset, aggravated by deep breathing and jarring, SX: anorexia n/v, fever acute cholecystitis
steady pain in epigastric radiating to back or other abd areas, poorly localized, acute onset, persistent, aggravated by lying supine, relieved by flexing truck and leaning forward, SX: n/v abd dist, hx etoh abuse acute pancreatitis
steady deep pain in the epigastric area radiating to the back, chronic, aggravated by etoh or heavy fatty meals. lessened by flexing trunk but usually intractable. SX: steatorrhea, DM chronic pancreatitis
deep epigastric pain radiates to back, persistent relentlessly progressive, pt flex trunk for relief, usually unretractable, sx: anorexia, n/v, jaundice depression pancreatic CA
crampy steady LLQ pain, gradual onset, "left sided appendix", sx: fever constipation diverticulitis
cramping of periumbilical or upper abd, sx: vomiting of bile and mucus or fecal material small bowel obstruction
cramping of periumbilical or generalized abd, Sx: ob stipation, vomiting late in disease colon obstruction
cramping then steady pain of periumbilical or diffuse abd, abrupt onset, persistent pain Sx: vomiting, diarrhea sometimes bloody, constipation, shock mesenteric ischemia
chronic or recurrent discomfort or pain centered in the upper abd dyspepsia
difficulty with solid foods r/t mechanical narrowing ex: mucosal rings and webs, esophogeal strictures, esophogeal CA esophageal dysphagia
difficulty swallowing r/t motor disorders affecting the pharyngeal muscles oropharyngeal dysphagia
difficulty swallowing solids and/or liquids ex: diffuse esophageal spasm, scleroderma, achalasia motor disorders
increased abd pressure causes bladder pressure to exceed urethral resistance, poor urethral tone, momentary leakage of small amount of urine with coughing, laughing, and sneezing stress incontinence
4 drugs that cause constipation anticholinergics, Ca++ channel blockers, iron, opiates
6 disease states associated with constipation diabetes, hypothyroidism, hypercalcemia, MS, parkinson's, systemic sclerosis
incontinence: urgency is followed by immediate involuntary leakage due to uncontrolled detrusor contractions that overcome normal urethral resistance urge incontinence
incontinence: detrusor contractions are insufficient to overcome urethral resistance, neurological disorders or anatomical obstruction limit bladder emptying until bladder overdistedned overflow incontinence
incontinence: inability to get to the toilet functional incontinence
kidney pain, fever, chills= acute pyelonephritis
a sharp increase in tenderness when stopping inspiration is a positive murphy's sign
functional change in frequency or form of stool, unknow pathology; diarrhea predominant, constipation predominant, mixed. >3mo of abd pain, improvement with defecation, onset with change in stool frequency, onset with change of stool form/appearance IBS
progressive narrowing of bowel lumen, associated with diarhea, abd pain, bleeding, occult blood in stool, weight loss, pencil shaped stools Rectal CA
watery stool w/o blood, pus, or mucus. lasting a few days associated w/ n/v, periumbilical cramping pain, slight fever, often travel related, food source, or epidemic secretory infection acute diarrhea
loose watery stool w/ blood, pus, or mucus, varying duration, associated with lower abd pain/cramping, rectal urgency, tenesmus, and fever inflammatory infection acute diarrhea
inflammation of mucosa of rectum and colon with ulceration, soft/ watery stools often contain blood, may awaken at night mild cramping, lower or generalized abd cramping, anorexia, weakness, often in young people, increases risk of colon CA ulcerative colitis
inflammation of bowel wall in skip pattern, small, soft, watery stools, little to no blood, diarrhea may wake pt at night, crampy periumbilical or RLQ pain, anorexia, low fever, wight loss, rectal abcesses, may lead to bowel obstructions, colon CA risk crohn's
bulky soft, light yellow/grey stools, possibly mushy, oily, greasy, or frothy, floats in toilet, anorexia wight loss fatigue abd distention, crampy lower abd pain, nutritional deficiency sx malalbsorption syndrome
black, tarry, shiny stools, occult pos. blood from esophagus, stomach, or duodenum (transit time 7-10 days)possibly r/t GERD, peptic ulcers, Mallory-Weiss tear, esophageal varices melena
red blood in stools, originates in colon, rectum, or anus. hematochezia
prolonged gurgles of hyper-peristalsis borborygmi
these nodes drain the ulnar surface of the forearm and hand, little and ring fingers, and adjacent surfaces of hte middle finger epitrochlear nodes
ankle brachial index of 0.60-0.89 mild PAD
ankle-brachial index of <0.39 severe PAD
Edema: soft, bilateral, pitting after 1-2 seconds of pressure. w/o skin thickening, ulcerations, or pigmentation. r/t dependent legs, prolonged sitting or standing, heart failure, nephrotic syndrome, cirrhosis pitting edema
edema: soft, pitting on pressure, occasionally bilateral. brawny skin thickening, ulcerations, brownish pigment, r/t incompetent valves chronic venous insufficiency
edema: soft then indurated hard and non-pitting. thickened skin w/o ulcerations or pigment changes lymphedema
insufficiency: intermittent claudication, r/t tissue ischemia, decrease pulses, pale skin on elevation, dusky red when dependent, cool, mild edema, thin shiny atrophic skin with loss of hair/nails, may develop gangrene arterial insufficency
insufficiency: painful, r/t venous htn, normal pulses but difficult to palpate, brown pigmentation in chronic state, normal temp, edema, thickened skin venous insufficiency
kidney or spleen? notch is palpated on medial border, edge extends beyond midline dull percussion, finger can probe deep bwetween the medial and lateral borders, but not between the mass and costal margin SPLENOMEGALY
preservation of normal tympany in LUQ, fingers can probe between the mass and costal margin but not deep in to its medial and lover borders ENLARGED KIDNEY
Created by: kaFoster