Erythema marginatum
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Pink rings on the trunk and inner surfaces of the limbs
•Pale centers and rounded or serpiginous margins
•Acute rheumatic fever
,PALPATION - LYMPH NODES
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Upper Extremity
•Epitrochlear - area surrounding medial elbow
•Axillary - central, lateral, pectoral, subscapular
•Make sure arm is relaxed
Lower Extremity
•Inguinal
•Looking for Lymphadenopathy:
•Swelling
•Induration (Hardness)
•Mobility
•Pain
Know what a friction rub, how to differentiate it from a pleural rub and the most
common cause
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Friction Rub
○ Rubbing of 2 inflamed tissues (pericardium)
○ Most commonly due to acute pericarditis
○ Pericardial rubs heard better when patient leans forward while holding
breath during inspiration
○ A rub that disappears while patient is holding their breath is a pleural rub
Abnormal PMI
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If PMI is felt as a right parasternal pulsation - associated with a dilated
pulmonary artery and aortic aneurysm
•i.e. this location may be felt more forcefully than the left ventricular
impulse (normal PMI)
•Absent left ventricular apical impulse - may be due to right ventricle
dilation, due to posterior displacement of the left ventricle
•Laterally displaced or diffuse left ventricular apical impulse - most
commonly due to enlarged heart
Inspect LE: Edema, Ulcers, Temperature, Moisture, Varicosities pertinent negative
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Lower extremities are warm and dry without evidence of ulcers, edema,
varicosities bilaterally.
what is happening during the murmurs that you need to know for the practical
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Pulmonic Stenosis
○ Systolic murmur, blood thru pulmonic valve abnormally narrowed
○ Midsystolic, crescendo-decrescendo murmur
● Aortic Regurgitation
○ Defective aortic valve closure, blood flows back to LV during diastole
○ Early diastolic murmur, high-pitched, faint, blowing quality
● Mitral Stenosis
○ Turbulent blood flow through narrowed valve
○ Mid diastolic murmur, low-pitched, rumbling
● S3
○ Ventricular, low-frequency diastolic sound
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Pink rings on the trunk and inner surfaces of the limbs
•Pale centers and rounded or serpiginous margins
•Acute rheumatic fever
,PALPATION - LYMPH NODES
Give this one a try later!
Upper Extremity
•Epitrochlear - area surrounding medial elbow
•Axillary - central, lateral, pectoral, subscapular
•Make sure arm is relaxed
Lower Extremity
•Inguinal
•Looking for Lymphadenopathy:
•Swelling
•Induration (Hardness)
•Mobility
•Pain
Know what a friction rub, how to differentiate it from a pleural rub and the most
common cause
Give this one a try later!
Friction Rub
○ Rubbing of 2 inflamed tissues (pericardium)
○ Most commonly due to acute pericarditis
○ Pericardial rubs heard better when patient leans forward while holding
breath during inspiration
○ A rub that disappears while patient is holding their breath is a pleural rub
Abnormal PMI
, Give this one a try later!
If PMI is felt as a right parasternal pulsation - associated with a dilated
pulmonary artery and aortic aneurysm
•i.e. this location may be felt more forcefully than the left ventricular
impulse (normal PMI)
•Absent left ventricular apical impulse - may be due to right ventricle
dilation, due to posterior displacement of the left ventricle
•Laterally displaced or diffuse left ventricular apical impulse - most
commonly due to enlarged heart
Inspect LE: Edema, Ulcers, Temperature, Moisture, Varicosities pertinent negative
Give this one a try later!
Lower extremities are warm and dry without evidence of ulcers, edema,
varicosities bilaterally.
what is happening during the murmurs that you need to know for the practical
Give this one a try later!
Pulmonic Stenosis
○ Systolic murmur, blood thru pulmonic valve abnormally narrowed
○ Midsystolic, crescendo-decrescendo murmur
● Aortic Regurgitation
○ Defective aortic valve closure, blood flows back to LV during diastole
○ Early diastolic murmur, high-pitched, faint, blowing quality
● Mitral Stenosis
○ Turbulent blood flow through narrowed valve
○ Mid diastolic murmur, low-pitched, rumbling
● S3
○ Ventricular, low-frequency diastolic sound
