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50 Cards in this Set
- Front
- Back
What is this an XR of?
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pneumothorax
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Describe where you would find the apex of the lung anteriorly.
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about 2-4cm above the inner 1/3 of the clavicle.
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At what level is the lower border of the scapula?
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rib 7/7th intercostal
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What is this an XR of?
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Plueral effusion
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Normal respiratory rate for adults
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14-20 breaths per minute
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Normal respiratory rate for children?
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<2 mos = <60
2-12 months= <50 1-5yrs= <30 5-12yrs= <25 |
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AP diameter changes with..? Also what is it called in pathologic states?
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-age
-COPD, emphysema called "barrel chest" |
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"pink buffers" and "blow bloaters"?
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Pink buffers refers to pts with emphysema
Blue bloaters refers to pts with chronic bronchitis |
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Hoover's sign
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paradoxiclal movement during breathing (chest inward on inspiration, anbdomen outward) because of inward instead of downward movement of the diaphragm; a/w COPD, nl in newborns
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Pectus excavatum
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caved in (funnel) chest
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Pectus carniatum
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Pidgeon chest
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kyphosis; can be in combination with scoliosis and = thoracic kyphoscoliosis
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Causes of asymmetric chest wall expansion?
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-paralyzed hemidiaphram
-endobronchial mass obstructing air flow -pleural effusion -pneumothorectomy often best appreciated when standing at foot of bed |
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Superior Vena Cava Syndrome
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- direct obstruction the SVC by malignancies such as compression of it by R upper lobe tumores or mediastinal lypmphadenopathy; most common cause = bronchogenic carcinoma; sxs= SOB, swelling in face/arm
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Cyanosis
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blueish coloring, sign of hypoxemia
Central cyanosis (see in lips) vs acrocyanosis (extremities) |
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Clubbing indicative of
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chronic pulmonart, cardiac, liver diseases
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Sign of Leser-Trelat
appearance of seborrheic keratosis in xmas tree pattern on the back, highly indicative of cancer |
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6% of pts in ER with chest pain who had costochondritis (inflammation of the costal cartilage) had what?
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an acute MI
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Percussion..what fingers
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3rd plexor strikes the DIP of the other 3rd pleximeter
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5 sounds on percussion
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Flat- thigh
Dull- liver Resonant- healthy lungs tympanitic- puffed of cheek Hyperrresonant- kronigs |
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Kronigs sign
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Absence of one of the 2 hyperresonant strips between the neck and shoulders (over the shoulders); suggest disease in the apical lung to pleura on that side
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Diaphragmatic excursion usually...
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should be symmetric and 5-6cm
abnormally high diaphragm can suggest plueral effusion, atelectasis, diaphragm paralysis |
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How would a pleural effusion sound on percussion? What about fremitus?
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dullness over aran of fluid collection, hyperresonant area just above it- "Skodaic resonance". No fremitus over area
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Auscultation--what in general produces high or low frequencies?
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high frequencies are air moving through narrowed spaces (ex wheezes, stridor)
low frequencies is air moving through water (ex: rhonchi |
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Breath sounds are usually louder where?
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lower posterior lung fields
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pectoriloquy
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when whispered sounds sound louder than normal on auscultation; indicative of consolidation
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egophany
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eee to ay change on ausculation; consolidation
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Pneumonia
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-increased fremitus
-egophany, pectoriloquy -bronchial or bronchiovesicular sounds (broncial=pause between insp and exp, predominantly ex) |
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rales
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aka crackles
sounds like hair between fingers early inspiratory- coarse rales: chronic brochitis, asthma late inspiratory- fine rales: pneumonia, CHF pulmonary fibrosis |
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rhonchi
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low frequencies sounds, secretions
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Still's murmur
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most common midsystolic murmur heard in children, ceased by carotid compression
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differences in thorax of an infant
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rounder, thinner musculature, xiphoid protrudes
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Normal RR for infants
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30-40 breaths per min alternating with periodic breathing
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split S2 best heard on
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inspiration
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Persistent S2?
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ASD, indicate R ventricular volume overload
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Smoking and "5 A's"
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23% of US adults smoke
ask, advise, assess, assist, arrange f/u |
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Heart rate
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-Adults normal 55-90
Children 1-2: 110 2-6: 100 6-10: 95 |
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5 korotkoff sounds
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1) 1st tapping noise (systolic)
2) soft lung sounds 3) louder sounds 4) muffled sounds 5) disappeared sound (diastolic) |
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BP cuff
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-should be 40% of arm width, 80% arm length
-2.5 cm over cubital space -too loose? will give low reading on small arm, high reading on large arm -too small: give high reading |
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LOEx pulse much lower than upper extremity?
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coarctation of the aorta
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JVP
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Reflects R atrial pressure which in turn reflects ventral venous pressure and R ventricular end diastolic pressure; use R internal jugular, bed at 30; biphasic (can see a and v waves), disynchonrous with arterial. Should be no more than 4cm above sternal angle
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a,c,v waves
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a- atrial contraction
c- AV valve closure v- ventricular contraction |
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bruits
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normal sounds of turbulence in kids, arterial obstruction in adults
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PMI
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5th intercostal space, MCL, 4-5cm from sternum
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LSSB is what part of heart?
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R ventricle
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Erb's point
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3rd intercostal space, can hear both aortic and pulmonary valves here
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S1
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-represents AV valves closing (end diastole early systole)
-Split can be heard best LLSB (M1 then T1) -high pitch -louder at apex than base |
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S2
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-closure of aortic and pulmonary valves
-split S2 can be heard on inspiration -louder at base than apex |
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S1 path?
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softer S1? mitral insufficiency, long PR, L ventric dysfunction
louder S1? mitral stenosis, short PR, high CO wide split S1- RBBB |
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ejection click
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opening of aortic or pulmonary valve, abnormally heard
Pulmonary- softer with ins LUSB Aorta- doest not alter with resp, RUSB and apex |