NGR6002 Bate-s Physical Exam Final Study guide exam with 100- correct answers.

Explain Systole Ventricular Contraction; Aortic & Pulmonic valves open, Mitral & Tricuspid valves close. Blood flows from the ventricles through the aortic valve into the aorta to systemic circulation. Closure of the mitral valve during Systole is the first heart sound, S1, representing the beginning of systole. S1 loudest at apex of heart. Explain Diastole Ventricular relaxation; Blood flows from atrias into ventricles. The mitral and tricuspid valves are open and the aortic and pulmonic valves are closed. Aortic valve closure creates the second heart sound, S2, marking the end of systole. Loudest at base of heart. Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:00 / 0:15 Full screen Brainpower Read More S3 Ventricular filling. Ken-Tuck-Y or "lub-dub-dub", usually pathologic after 40 y/o: CHF or MI S4 Atrial contraction; Tenn-e-ssee or "dub-lub-dub", best heard in mitral and tricuspid areas. usually pathologic after 40 y/o: CHF, MI Murmurs: where to hear them best Longer duration than heart sounds. Mitral valve murmurs heard best at and around the apex. Best to position patient onto the left side in the left lateral decubitus position because it brings the left ventricle closer to the chest wall. USE BELL Aortic murmurs: USE DIAPHRAGM, have patient sit and lean forward, exhale completely and stop breathing in expiration. Press stethoscope at left sternal border and at apex. PMI: where do you find it Point of maximal impulse; Have patient exhale and hold breath; palpate 4-5th ICS, medial to the MCL. Five zones of cardiac auscultation A: aortic P: pulmonic E: Erb's point T: Tricuspid M: Mitral What does standing vs. squatting test for when auscultating cardiac sounds? Standing: venous return to the heart decreases, as does peripheral vascular resistance. Arterial blood pressure, stroke volume, and volume of blood in left ventricle all go down. Standing: Increases mitral valve prolapse Increases cardiomyopathy murmur Decreases aortic stenosis murmur Squatting: Increases venous return thus increasing left ventricular volume, increases vascular tone thus increasing arterial blood pressure and increased peripheral vascular resistance. Squatting: Decreases mitral valve prolapse Decreases cardiomyopathy murmur Increases aortic stenosis murmur Diastolic Murmurs Usually pathologic; usually indicates valvular heart disease. Includes Mitral Stenosis and Aortic regurgitation. M: mitral S: Stenosis A: Aortic R: Regurgitation D: Diastolic 1. Mitral stenosis: limited to apex. Little to no radiation. USE THE BELL. Decrescendo low pitched rumble. Turn patient to left lateral position. Better heard in exhalation. 2. Aortic Regurgitation: 2nd to 4th ICS. If loud, may radiate to the apex, possibly right sternal border. High pitch. USE DIAPHRAGM. Blowing decrescendo. Have patient sit forward and lean with breath held after exhalation. Systolic murmurs Mitral Regurgitation, Aortic Stenosis, Mitral Valve Prolapse What characteristics do you use to describe murmurs? Timing: Does it occur in diastole or systole? Pitch: High, med, or low? Intensity: G1 (very faint) to G6 (very loud with thrill & may be heard with stethoscope off of chest) Pattern: Crescendo or decrescendo? Quality: blowing, harsh, rumbling, musical Location: PMI? Where do you hear it best? Radiation? Midsystolic murmurs Innocent Murmurs: without any detectable physiologic or structural abnormality. Physiologic murmurs: from physiologic changes in body metabolism. Similar to innocent murmurs. Pathologic murmurs: arising from a structural abnormality in the heart or great vessels. Aortic stenosis: right 2nd ICS. Heart best when sitting and leaning forward. Often radiates to carotids, down the left sternal border, even to apex. Medium-harsh. Crescendo-decrescendo Hypertrophic cardiomyopathy: 3-4th Left ICS Radiates down left sternal border, possibly to base, but not to the neck. Medium pitch. Harsh quality. Decreases with squatting, increases with straining from Valsalva and standing. Pulmonic stenosis: 2nd-3rd left ICS. Radiates (if loud) towards the left shoulder and neck. Medium crescendo-decrescendo. Often harsh. If loud, associated with a thrill. Elevated JVP indicates what? Increased left ventricular end diastolic pressure and low left ventricular ejection fraction. Highly correlated with both acute and chronic right and left sided heart failure. Order of physical examination for the abdomen 1. Inspection 2. Auscultation 3. Percussion 4. Palpation Do you auscultate the abdomen with the diaphragm or bell? What is the normal finding? Auscultate all four quadrants with the diaphragm for bowel sounds. Normal sounds consist of clicks and gurgles approx 5-34 per minute. Borborygmi is stomach growling. Auscultate with the Bell to assess for bruits over aorta and renal and femoral arteries. Bruits suggest vascular occlusive disease. What is the normal tone found during abdominal percussion? Tympany due to the distribution of gas in the abdomen, possible dullness due to fluid and feces may be scattered, but tympanic is most common. What are the signs of peritonitis? Positive cough test (pain with coughing), guarding, rigidity, rebound tenderness, and percussion tenderness. Causes can include appendicitis, cholecystitis, and a perforated bowel. What are abdominal friction rubs? High pitched sounds that are heard in association with respiration. Use the Diaphragm of the stethoscope to hear. Rare in abdomen. Indicates inflammation of the peritoneal surface of the organ from tumor, infection or infarct. Liver and spleen. What do abdominal bruits sound like? Harsh or musical intermittent. May reflect blood flow turbulence. Best heard with BELL. Listen over epigastric, renal, iliac and femoral arteries. What is a venous hum? Soft, low-pitched, and continous sound heard best with the BELL. Occurs with increased collateral circulation between the portal and systemic venous systems. Epigastric region and around the umbilicus. What is the normal liver span? 6-12 cm (2 1/2 - 4 1/2 inches) Rovsing's sign Press deeply in the LLQ and then quickly withdraw your fingers; Referred pain in the RLQ is a positive sign. Psoas sign Place your hand just above the patients right knee and ask the patient to raise that thigh against your hand. Increased abd pain is a positive Psoas sign, suggesting irritation of the psoas muscle by an inflamed appendix. Obturator sign Flex the patient's right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. This manuever stretches the internal obturator muscle. Right hypogastric pain is a positive obturator sign from irritation of the obturator muscle by an inflamed appendix. Where is McBurney's point? 2 inches from the anterior superior spinous process of the right ilium on a line drawn from that process to the umbilicus. What is Murphy's sign? Hook your left thumb or the fingers of your right hand under the costal margin at the point where the lateral border of the rectus muscle intersects with the costal margin. A sharp increase in tenderness with a sudden stop in inspiratory effort constitutes a positive Murphy's sign of acute cholecystitis.