Lines
The anterior/posterior and lateral thorax can be divided by imaginary lines which are landmarks used to help describe location. Name the 3 on the anterior chest.
Midsternal, Midclavicular, anterior axillary
Lateral: Anterior- Mid- Posterior axillary
Posterior: Scapular(Midscapular)Vertebral and posterior axillary
When evaluating edema, if the provider is able to press down ~ 8 mm and have the depression last more than 2 minutes, where would this fall on the scale for pitting edema?
4+ ( most severe)
A murmur that spans from S1-S2 entirely is referred to as this.
What is holosystolic.
What are the 3 layers of arteries?
INtima- INner layer with INtrinsic properties
Media- Middle smooth Muscle, cells dilate and constrict to accomidate blood pressure and fluid.
ADVENTitia- OUTer connective tissue
(in the OUTdoors you go on ADVENTures)
S1 is best heard at the _________ of the heart, which is located at the __________.
apex, left 5th ICS at the MCL
the left 4th and 5th intercostal space is where your palpate for the apical pulse(PMI)
When identifying the descent of the diaphragm during respiration lines are drawn on the back and measured. What is this called and what is a normal range?
diaphragmatic excursion- normal values are 3-5 cm from when have patient take a large breath and hold it as well as complete exhalation, but can be higher in well conditioned, healthy people.
When testing collateral circulation, both the ulnar and radial arteries are compressed and the palm turns pale. The ulnar artery is then released and in a normal test, the hand's color returns in 3-5 seconds. What is this test called?
Allen test
This is used for ABGs. A positive result is when the hand remains pale. It should be repeated by releasing the radial artery.
A false positive can occur if the hand or fingers are fully extended.
A holosystolic crescendo decrescendo looks like this shape.
What is an isosceles triangle.
If a COPD patient can't cough to bring up sputum where would it likely settle?
In the right lungs via the right bronchus which is shorter, wider and in terms of gravity- the path of least resistance because it is more midline than it's left counterpart.
This heart sound is described as sounding like a state's name which contributes to how the term got it's name. It is a physiological sound in children and young adults produced by rapid ventricular filling and is low in pitch.
Gallop
A ventricular gallop is heard in auscultation as S3
This breathing pattern is deep breaths alternated with periods of apnea. It might be normal in children and for adults in sleep but could also be indicative of heart failure, uremia, could be drug induced or due to an insult to the brain.
Cheyne-Stokes
I just ran at the gym for the first time in 2 years. On a 0-3 scale my pulse grade would be?
3+ bounding
Arms Rest is a mnemonic for these murmurs
Aortic Regurgitation
Mitral Stenosis
Rest- Diastolic
When auscultating breath sounds, at this location expiration is greater than inspiration, the intensity of expiration is loud, pitch is relatively high, and it is best heard over the manubrium. It is not continuous
Bronchus
What are the 5 places on the precordium that we auscultate?
Apple Pie Tastes Mmm + Erb's point
Apex
Pulmonic
Tricuspid
Mitral
A patient with a metabolic demand; the body wants more O2 and to blow off more CO2. What breathing pattern would this patient likely have?
large, fast, deep respirations.
This test evaluates right ventricular function by applying pressure to the right upper abdomen for ~10 seconds and noting blood flow and increased pressure.
hepatojugular reflux
What grade would a murmur be if if was noted to be quiet, but heard immediately after placing the stethoscope on the chest?
Grade 2
When percussing for lung sounds, you would expect someone with COPD to sound
a.flat
b. dull.
c. resonant.
d. hyperresonant.
e. tympanic
This is characterized as having a very loud intensity, lower pitch and longer duration
d. Hyperresonant
I remember this as Frank Drank Rum Hot Toddies
This heart sound is also known as atrial gallop.
S4
It occurs in late diastole just prior to the first heart sound
The S1 corresponds with which letter of the PQRST wave form of an EKG?
R
P- atrial depolarization
Q Septal depolarization
R ventricular depolarization
S deflection following R wave
T ventricular depolarizing and recovering
This test involves the patient saying a 2-3 syllable sound as you listen to the posterior positions of the thorax with a stethoscope. Normal is when the voice remains soft. What is the name of the test and what would an abnormal test show.
Bronchophony. An abnormal test would have the sound transmitted louder.
These are similar to egophony and whispered pectoriloquy
This murmur is heard best at the LLSB and sometimes the apex described as blowing systolic, medium pitch, variable intensity, radiating from the right of the sternum to the xiphoid process.
What is a tricuspid regurgitation.
How many different places we will take a pulse on exam?
13 but I will accept 15
carotid x2
apical
brachial x2
radial x2
popliteal x2
dorsalis pedis x2
posterior tibial x2
we will not be evaluating the femoral pulse x2 but should also know that would typically be considered
This abnormal pulse is characterized by a regular rhythm, but amplitude/force alternates. This is due to alternation of strong and weak ventricular contractions. It is almost always indicates severe left ventricular dysfunction.
Pulsus Alternans
The other noted abnormal pulse is the Paradoxical Pulse: Large drop in systolic blood pressure during inspiration- Qualitatively present if the radial pulse disappears on inspiration-Quantitatively present if: