Fundamentals of Physical Examination and Clinical Laboratory Studies

Vocabulary study flashcards covering physical examination signs, heart sounds, lab values, and diagnostic tests.

Rapid and shallow breathing

A sign on physical inspection indicating restrictive lung disease or possible respiratory failure.

Prolonged expiratory time

A sign on physical inspection indicating intrathoracic airway obstruction.

Prolonged inspiratory time

A sign on physical inspection indicating acute upper airway obstruction.

Use of accessory muscles

A sign on physical inspection indicating increased work of breathing.

Abdominal paradox

A sign on physical inspection indicating diaphragmatic fatigue.

Respiratory alternans

A sign on physical inspection indicating diaphragmatic fatigue.

Central cyanosis

A physical sign indicating inadequate oxygenation.

Clubbing

A physical sign indicating chronic cardiopulmonary disease or hypoxemia.

Increased tactile fremitus

A palpation finding caused by more solid lung tissue, associated with pneumonia, masses, or atelectasis.

Decreased tactile fremitus

A palpation finding associated with pleural effusion, emphysema, or pneumothorax.

Unilateral decreased chest expansion

A palpation finding associated with atelectasis, pneumonia, or lung tumor.

Bilateral decreased chest expansion

A palpation finding associated with emphysema or neuromuscular disease.

Subcutaneous emphysema

Air located under the skin identified during palpation.

Increased resonance / hyperresonance

A percussion finding caused by increased air in the chest, indicating emphysema or pneumothorax.

Decreased resonance / dullness

A percussion finding caused by increased tissue density, indicating pneumonia, atelectasis, or pleural effusion.

Crackles

An auscultation sound caused by sudden opening of collapsed airways (fine) or excessive airway secretions (coarse).

Wheezing

An auscultation sound caused by narrowed airways.

Stridor

An auscultation sound caused by a narrowed upper airway.

Diminished or absent breath sounds

Auscultation findings indicating pneumothorax, pleural effusion, or severe airway obstruction.

PERRLA

An acronym assessing brain status where P stands for pupils normal, E for equal, R for round, R for reactive, L for light, and A for accommodation.

S1 Heart Sound

The 'LUB' sound produced by the closure of the tricuspid and mitral AV valves.

S2 Heart Sound

The 'DUB' sound produced by the closure of the pulmonic and aortic semilunar valves.

P2 Heart Sound Abnormality

An abnormal pulmonary valve sound indicating pulmonary hypertension due to higher pressure coming from the lungs.

A2 Heart Sound Abnormality

An abnormal aortic valve sound indicating systemic arterial hypertension.

Stenotic valve

A narrow or stuck valve through which blood has trouble flowing forward.

Incompetent valve

A leaking valve that does not close properly, causing blood to flow backwards.

Gallop rhythm

An extra heart sound (S3 or S4) in adults caused by ventricular abnormalities or overdistension of a ventricle.

Murmur

A heart sound caused by forward flow through a stenotic valve, back flow (regurgitation) through an incompetent valve, or rapid flow through a normal valve.

White Blood Cells (WBC)

Normal range is $5,000 - 10,000/\text{mm}^3$; high counts indicate infection or inflammation, while low counts indicate bone marrow disease, medications, radiation, B12 deficiency, or overwhelming infection.

Red Blood Cells (RBC)

Normal range is $4-6\text{ million}/\text{mm}^3$; low counts indicate anemia, while high counts indicate polycythemia in response to chronic hypoxia or low $PaO_2$.

Hemoglobin (Hb)

Normal value is $12-16\text{ gm}/100\text{ ml}$; low levels indicate anemia or decreased oxygen-carrying ability.

Hematocrit

Normal range is $40 - 50\text{\%}$; low levels indicate anemia, and high levels indicate polycythemia.

Platelets

Normal range is $150,000 - 400,000/\text{uL}$; high counts cause thrombocytosis (thrombosis risk), while low counts cause thrombocytopenia (bleeding risk).

Sodium (Na+)

Normal range is $135 - 145\text{ mEq/L}$; high levels (hypernatremia) indicate excessive water loss or insufficient intake, while low levels (hyponatremia) indicate excessive water intake or Na loss.

Potassium (K+)

Normal range is $3.5 - 5.0\text{ mEq/L}$; high (hyperkalemia) or low (hypokalemia) levels can cause cardiac dysfunction, and low levels may affect ventilator weaning.

Chloride (Cl-)

Normal range is $98 - 107\text{ mEq/L}$; high levels (hyperchloremia) indicate kidney disease or prolonged diarrhea, while low levels (hypochloremia) stem from loss of HCl like severe vomiting.

Bicarbonate (HCO3-)

Normal range is $22 - 30\text{ mEq/L}$; elevated levels indicate metabolic alkalosis or chronic CO2 retention compensation, while low levels indicate metabolic acidosis or chronic CO2 loss compensation.

Anion Gap

The balance between cations and anions calculated as $\text{Na}^+ - (\text{Cl}^- + \text{HCO}_3^-)$; normal range is $8 - 16\text{ mmol/L}$, where a high value indicates metabolic acidosis.

APTT

Activated partial thromboplastin time with a normal value of $25 - 35\text{ secs}$, used specifically to monitor heparin.

INR

International normalization ratio with a normal value of $0.8 - 1.2$ off medication and $2.0 - 3.5$ on medication, used to monitor warfarin.

Prothrombin Time (PT)

A blood coagulation test with a normal range of $12 - 15\text{ secs}$.

D-Dimer

A measure of fibrin clot breakdown with a normal level of $< 240\text{ ng/mL}$; values $> 240\text{ ng/mL}$ indicate a clot and risk for pulmonary embolism.

Troponin

Normal value is $< 0.01\text{ ng/mL}$; values $> 0.04\text{ ng/mL}$ indicate a cardiac event or acute coronary syndrome.

Bronchoalveolar lavage (BAL)

A procedure performed during bronchoscopy by placing sterile fluid into the lungs and collecting it to analyze microorganisms, diagnose interstitial lung disease, or identify persistent infection causes.

Transudate

Fluid accumulation resulting from a pressure or fluid problem, such as in congestive heart failure (CHF).

Exudate

Fluid accumulation resulting from disease, inflammation, or infection, such as in tuberculosis (TB), pulmonary embolism, or malignancy.