- loss of mm strength in thorax & diaphragm

- loss of lung resiliency

- skeletal changes of aging tend to emphasize the dorsal curve of the thoracic spine resulting in increasing the AP diameter

coughing

SOB

Chest Pain

TB

Cystic fibrosis

Emphysema

allergy, asthma, atopic dermatitis

malignancy

bronchiectasis

bronchitis

clotting disorders (PE risk)

pulmonary effusion: no breath sounds, absent tactile fremitis

lobar pneumonia: bronchial breath sounds, increased tactile fremitis

AP << transverse

at times by as much as half

compromised respiration

ie chronic asthma, emphysema or cystic fibrosis

the AP diameter is almost the same as the transverse

pigeon chest - prominent sternal protrusion

funnel chest - indentation of the lower sternum above the xiphoid process

persistent respiratory rate

approaching 25 respirations/minute

rapid, shallow breathing

hyperventilation

protective splinting from pain of a broken rib or pleurisy

massive liver enlargement

abdominal ascites

neurologic or electrolyte disturbance

infection

sensible response to protect against the pain of pleurisy

other irritative phenomena

exercise

anxiety

CNS and metabolic disease

always deep and most often rapid breathing

associated with metabolic acidosis

abnormally shallow respirations

(when pleuritic pain limits excursion)

a regular periodic pattern of breathing with intervals of apnea followed by crescendo/decrescendo sequence of respiration

in seriously ill

brain damage at the cerebral level

drug-caused respiratory compromise

severe and persistently increased ICP

drug poisoning

brain damage at the level of the medulla

increased respiratory effort

it reduces the effort of dyspnea

enlargement of the terminal phalanges of the fingers and/or toes

It is associated with chronic fibrotic changes of the lungs, CHD, CF

a crackly or crinkly sensation

a gentle bubbly feeling

always a sign requiring attention

a rupture somewhere in the respiratory system

infection with a gas-producing organism

inflammation of the pleural surfaces

 a palpable vibration of the chest wall that results from speech or other verbalizations

"99" or "Mickey Mouse"

atelectasis

thyroid enlargement

significant parenchymal and/or pleural effusion

tension pneumothorax

a tumor

nodal enlargements on the contralateral side

hyperinflation

may indicate emphysema, pneumothorax, or asthma

alelectasis

pleural effusion

pneumothorax

asthma

pulmonary lesions

abdominal lesions

or superficial pain

a large, relatively stiff-walled pulmonary cavity or

tension pneumothorax with bronchopleural fistula

crackles are discontinuous

rhonchi and wheezes are continuous

the passage of air through an airway obstructed by thick secretions,

muscular spasm,

new growth

or external pressure

bronchospasm of asthma

acute or chronic bronchitis

A friction rub heard over the heart suggest what?

Over the lungs?

pericarditis

pleurisy

great variety of noise

loud crackles and clicking and gurgling sounds

sychronous with the heart, not respiration

sounds are more pronounced during the end of expiration

commonly associated with tracheobronchial injury

If bronchophony is extreme even a whisper can be heard clearly and intelligibly through the stethoscope.

this is called:

vital capacity

indicator of the amount of air that is expelled after the pt takes a maximal inspiration and follows that with a maximal expiration

paroxysmal dyspnea

tachypnea

cough

wheezing on expiration and inspiration

chest pain and tightness

an inflammatory process involving the visceral and parietal pleura

the pleura becomes dry, edematous and fibrinous making breathing difficult

plerual effusion

breath sounds = absent or distant

percussion note = dull

 vocal fremitus = absent

pt is often febrile and tachypneic

appears ill

lung consolidation

resulting in tachypnea, dyspnea and crackles

crackles

rhonchi

tachypnea

generally nonproductive cough

substernal pain

cough, wheezing

a variety of patterns of emphysema and atelectasis

pneumonitis

hemoptysis

an acute or chronic condition involving right-sided heart failure

most often a direct result of PE

a syndrome that generally results from infection with a variety of viral agents, particularly the parainfluenza viruses

harsh, bark-like cough

labored breathing

retraction

hoarseness

inspiratory stridor

tachypnea

retractions

grunting

cyanosis

bc of the complications of shock,

asphyxia

and aspiration

hyperinflation of the lungs most often in infants

cause is viral

generalized retraction

cyanosis

abdomen appears distented from swallowed air

a nonspecific designation that includes a group of respiratory problems in which coughs, chronic and often excessive sputum production and dyspnea are prominent

ultimately expiratory airflow obstructions occur

most severe COPD

a condition in which air may take over and dominate a space in a way that disrupts function

dyspnea even at rest

thin, barrel chest

even cachectic

mitral and tricuspid

to prevent backflow

produces the heart sound S1, lubb

the aortic and pulmonic valves closing = S2

aortic closure (A2) happens slightly before pulmonic closure (P2)

typical angina

atypical angina

 prinzmetal variant angina

unstable angina

coronary insufficiency

MI

MVP

aortic dissection

pericarditis

pleurisy

pneumothorax

mediastinal emphysema

hiatus hernia

reflux esophagitis

esophageal spasm

cholecystitis

Peptic ulcer disease

pancreatitis

pulmonary HTN

pneumonia

PE

bronchial hyperreactivity

cervical radiculopathy

shoulder disorder or dysfunction

costochondral disorder

xiphodynia

chest pain

fatigue

cough

dyspnea, orthopnea

loss of conciousness

cardiac surgery, hospitalization

rhythm disorder

acute rheumatic fever, unexplained fever

swollen joints, inflam. rheumatism

St. Vitus dance

chronic illness: HTN, bleeding disorder, hyperlipidemia, DM, thyroid dysfunction, CAD, obesity, Congenital heart defect

DM

Heart disease

CAD

hyperlipidemia

HTN

obesity

congenital heart defects, VSD

sudden death

confusion, dizziness, blackouts, syncope

palpitations

coughs and wheezes

hemoptysis

SOB

chest pains and tighness

impotence

fatigue

leg edema

inspection

palpation

percussion?

auscultation

aortic stenosis

pulmonic stenosis

VSD

mitral regurgitation

tricuspid regurg

mitral and tricuspid stenosis

aortic and pulmonic regurgitation

S2

because the closure of these valves is associated with the second heart sound, S2

S1

because the first heart sound is made by the closure of these two valves

the passive phase of ventricular filling relatively early in diastole

distends the ventricular walls and causes vibration

caused by the second phase of ventricular filling, often confused with an S1 split

vibration in the valves, papillae and ventricular walls

systolic (ejection) murmur, coarse

often followed by a click

diastolic rumble

early and late in diastole

aortic regurgitation

associated with Austin Flint

abdominal pain                urinary frequency

indigestion                      urinary incontinence

N/V/D                             hematuria

constipation                    chyluria (milky urine)

fecal incontinence

jaundice

dysuria

GI disorders

hepatitis or cirrhosis

ab or UT surgery or injury

UTI

major illness

blood transfusions

hep vaccines

colorectal cancer or related cancers

liver and gallbladder

pylorus

duodenum

head of pancreas

right adrenal gland

portion of right kidney

hepatic flexure

portions of ascending and transverse colon

lower pole of right kidney

cecum and appendix

portion of ascending colon

bladder (if distended)

overy and salpinx

uterus (if enlarged)

right spermatic cord

right ureter

lower pole of the left kidney

sigmoid colon

portion of the descending colon

bladder (if distended)

ovary and salpinx

uterus (if enlarged)

left spermatic cord

left ureter

fat                       fetus

fluid                     flatus

feces                    fibroid

full bladder           false pregnancy

fatal tumor

inspection

movement

auscultation

percussion

palpation

loud prolonged stomach gurgles

stomach growling

peritonitis and

paralytic ileus

tumor

infection

infarct

the epigastric region and around the umbilicus

(use the bell)

shifting dullness

fluid wave

auscultatory percussion

puddle sign

duodenal ulcer

hepatitis

hepatomegaly

pneumonia

cholecystitis

appendicitis                      salpingitis

ovarian cyst                      ruptured ectopic preg

renal/ureteral stone           strangulated hernia

meckel diverticulitis           regional ileitis

perforated cecum

intestinal obstruction

acute pancreatitis

early appendicitis

mesenteric thrombosis

aortic aneurysm

diverticulitis

ruptured spleen

gastric ulcer

aortic aneurysm

perforated colon

pneumonia

sigmoid diverticulitis             salpingitis

ovarian cyst                         ruptured ectopic preg

renal/ureteral stone              strangulated hernia

perforated colon                   regional ileitis

ulcerative colitis

if positive, they are experiencing LQ pain

pt lies supine and then place your hand over the lower thigh. Ask the pt to raise the leg, flexing at the hip as you push down against the leg

Why do would you do a obturator mm test?

How do you perform it?

for when you suspect a ruptured appendix or pelvic abscess

ask the pt to flex the right leg at the hip and knee and rotate their leg laterally

What does the markle heel jar test check for?

How do you do it?

tests for peritoneal irritation and appendicitis

ask the pt to do calf lifts

or tap on the bottom of the foot while they are laying down

C congenital

O obstruction

N neoplasms

S stricture of colon

T topical, painful hemorrhage

I impacted feces

P prolapse of the rectum

A anorexia and depression

T temperature high, dehydration

E endocrine; hypothyroidism

D diet, diverticulitis and drugs

Fat

Forty

Fertile

Flatulent

Female

color changes

scars

rashes

its curvature - scaphoid, flat, protuberant, distended

movement - peristalsis or aortic pulsation

pull arms across chest

it separates the shoulder blades

hypertrophy

CHF

enlarged heart

an impulse visible just prior to S1

or the upstroke of the carotid

peripheral edema

clubbing, cyanosis

bounding pulses/head nodding

hyperthyroidism-exopthalmos

slowed ventricular ejection rate/volume

mitral sufficiency

increased chest wall thickness

pericardial effusion

hypothyroidism

cardiomyopathy

LBBB

shock

aortic insufficiency

first degree AV block

increased CO

Increased AV valve flow velocity

RBBB

PVCs

VT

pulmonary HTN

CHF

HCM

HTN

pulm HTN

AS w/ severe LV disease

it increases afterload, systemic vascular resistance

increased volume

decreased HR

increases MR murmur

reduces the murmur of AS w/ HCM

decreases afterload

decreases venous return and SV

increased HR

increased SVR

accentuates murmur and S4 of MVP and HOCM

left lateral decubitus

or leaning forward in an upright position

pneumonia or

lung disease

good conditioning

heart block

digoxin intoxicity

CHF

excitement

fever

anemia

arrhythmia

What is alternans?

What is it a sign of?

every other beat is stronger

sign of HF

What is pulsus bisferiens?

It is often seen in those with...

beat hits you twice, biphasic pulse

often seen in those with aortic insufficiency and aortic stenosis

severe asthma

pericardial effusions

asthma

emphysema

chronic bronchitis

interstitial pneumonitis or fibrosis

asbestosis

pneumonia

lower pitched, longer sounds similar to snoring

may occur in pneumonia or COPD

Inspiratory wheezes are refered to as ____________.

stridor

indicates narrowing of the extrathoracic airway

croup

laryngitis

epiglottitis

vocal cord dysfunction

tumors

stenosis of the extrathoracic trachea

COPD

bronchiolitis

HF

When does an E to A sign occur?