things i dont know

S3 heart sound

• Ventricular gallop, overfilling of vbood in ventricles → ventricles vibrate 

• Normal in children, young adults

• Can signal heart failure, mitral regurgitation

• Kentucky

• Apex of heart

S4 heart sound

• Atrial gallop → stiff or thickened ventricles

• Can signal heart disease, hypertension, aortic stenosis

• Tennessee

• Left sternal border

S1 Split

Closure of av valves at different times

Normal costal angle

<90 degrees, greater that 90 means COPD or emphysema (overinflation of lungs)

Sibilant wheezes are heard when

Acute asthma or chronic emphysema 

Bronchoconstriction → high pitched, musical sounds (narrow flute) 

Usually expiration but could be inspiration 

Fine crackles are heard when

pulmonary fibrosis, congestive heart failure (fluid) 

Velcro, high pitched, gurgling, moist

Inspiration

Course crackles are heard when

Pneumonia, pulmonary edema

Inspiration

When are crackles heard in early inspiration

bronchitis, asthma, emphysema

Stridor is heard when

broncholaryngospasms or tracheal spasms

Upper airway obstruction = medical emergency

Inspirarition

Sonorous wheezes

• Chronic bronchitis (Airway obstruction from mucus, can be cleared from coughing)

• Snoring or moaning sounds

• Expiration 

Bronchophony

Heard through stethescope

• Normal: 99 is muddled and indistinct

• Abnormal: 99 is louder, clear voice sounds

Egophony

• Normal: ee heard as muffled e sounds

• Abnormal: ee is heard as “ay”

Whispered pectoriloquy 

Normal: whispered 99 or 123 is faint and indistinct

Abnormal: loud, clearer whispered sounds

What is Peau d’orange

Skin looks like orange peel, dimpling or pitted appearance of skin

• lymphatic obstruction (blocks lymphatic drainage)

• Breast cancer

Signs of breast cancer

• painless hard, immobile masses. poorly defined irregular margins

• Peau d’orange

• nipple retraction not baseline (puckering)

What is Murphy’s sign

examine for cholecystitis,

place hands below right costal margin (gallbladder)

ask patient to take a deep breath in 

Positive = pain 

What is cullen’s sign

bluish or purplish discoloration around umbilicus

• intraabdominal bleeding

• intraperitoneal bleeding 

• pancreatitis

What is gray turners sign

bluish or purple discoloration around abdominal flanks

• retroperitoneal bleeding

• acute pancreatitis 

What is rovsing’s sign

pain in RLQ during pressre in LLQ

• referred pain

What is Blumberg’s sign

Rebound tenderness @ McBurney’s point

Peritoneal irritation often from appendicitis

What are ascites

Free fluid in abdomen

• shifting dullness “thrill”

What is weber test

forehead

Conductive hearing loss = sound heard longer is affected ear

Sensorineural hearing loss = sound heard longer in nonaffected ear

Normal: sounds stops equally in both ears

What is rinne test

place tuning fork on mastoid bone, ask when they no longer hear the sound. move tuning fork to ear canal and ask again

• AC > BC = positive (normal)

  • patient hears sound longer and louder when next to ear canal compared to bone

• BC > AC, BC = AC

  • patient hears sound longer or just as long as ear canal on mastoid bone

Myopia 

Nearsightedness 

Presbyopia

Age related farsightedness

Hyperopia

Farsightedness 

Astigmatism

Uneven curvature of cornea/lens, blurred, distorted, stretched vision

Strabismus

Misalignment of eyes (do not look at same point simultaneously)

Nystagmus

Involuntary, rapid, side to side eye movements when client’s eyes move laterally

Candidiasis 

Yeast infection

Bacterial vaginosis

grayish white vaginal discharge, fishy

Pale conjunctiva is caused by

iron deficiency

Rough skin, poor night vision is caused by

Vitamin A deficiency

Spoon shaped or brittle nails is caused by 

Iron deficiency 

What causes murmurs

• Stenosis

• Regurgitation

• Increased blood viscosity

• Decreased viscosity

• Septal defects

Swooshing or blowing sound

Where is S1 sound heard

Apex + lower left sternal border

• palpated on carotid pulse

• longer than S2

• beginning of ventricular systole

Where is S2 sound heard

Loudest at base of the heart

• end of ventricular systole

Crepitus

• Palpated

• SUBQ EMPHYSEMA

• Crackling sensation due to trapped air

What is tactile fremitus

vibration when patient says 99

What causes increased tactile fremitus 

Consolidation from fluid INSIDE THE LUNG

• pneumonia

• lung becomes more solid inside due to pus, exudate

• sound travels better through solid 

What causes decreased tactile fremitus

Increased fluid or air trapping in PLEURAL SPACES

• Effusion: increased fluid in pleural space

• COPD air trapping

• pneumothorax

• bronchial obstruction

What is a pneumothorax

increased air in pleural space, lung collapse

What are the effects of pectus excavatum

Murmurs, compression of heart + vessels

• also congenital

What are the effects of pectus carinatum

mostly cosmetic

What produces erythropoietin 

Kidneys 

What causes increase in platelets

polycythemia vera, iron deficieny anemia

What causes decrease in platelets

hemorrhage, pernicious, and hemolytic anemias

What is pernicious anemia

decreased production due to b12 deficiency

What is normal WBC

5000-1000mm3

What is normal hemoglobin (M/F)

Male: 14-18

Female: 12-16

Hematocrit normal values (M/F)

M: 42%-52%

F: 37%-47%

Platelets normal amount

150000-400000 mm3

What is pruritus 

itching

What is fistula

tunnel between anal canal and perianal skin

What causes fistula in rectal area

Abscess

Chron’s disease

What is hydrocele

fluid in tunica vaginalis

What is acute orchitis 

infection of testes 

What are s/s of benign prostatic hyperplasia

SMOOTH, firm enlarged prostate

• urinary hesitancy, weak stream, dribbling, nocturia, incomplete emptying

• painless

S/S of prostate cancer

• hard, nodular, peripheral

What is chlamydia and can it cause PID

• burning, unsual discharge

• can cause PID which can lead to infertiltiy and long-term pelvic pain

• same S/S as gonorrhea

What happens in pregnant women where the uterus is blocking drainage of iliac. veins and vena cava 

• dependent edema

• varicose veins 

• hemorroids

• blood flow reduced and venous pressure increase 

What are S/S of hepatitis 

dark urine/clay-colored stool, jaundice, flu-like symptoms 

HIV/AIDS s/s

CD4+ attack, flu-like symptoms

HPV s/s

cancer causing, warts → leads to aids

syphilis s/s primary, secondary, tertiary

primary: painless sore on genitals, mouth etc

secondary: rashes on palms, soles

tertiary: untreated → resp. failure, internal organ damage, cvd, neuro problems

trichonomiasis

yellow/green discharge

itching and burning itching and burning

stanky and fishy stanky and fishy

what are cheyne strokes

regular respiratoruypattern deep rapid breathing followed by periods of apnea

• seen in heart failure

• rhythmic

what are biot respirations

irregualr pattern of varied depth rate followed by apnea

• brain damage, meningitis

what is the difference between cheyne strokes and biot respirations

The main difference is not just that Biot is irregular—it’s that Cheyne-Stokes has a rhythmic waxing and waning pattern, whereas Biot is erratic with unpredictable pauses and tidal volumes.

what is kussmaul respirations 

deep, rapid, labored breathing

diabetic ketoacidosis 

what is kussmaul’s sign

jvp distension wih inspiration

what are some signs of underlying cardiovascular problems

edema, angina, orthopnea

what is pr interval

timing from sa node firing to beginning of ventricular depolariazaiton

what is aortic stenosis 

aorta is narrowing

crescendos after s1

right sternal border 2nd ics 

what is it when nurse hears both s3 and s4

summation gallop

what does varying s1 mean

heart block or arrhythmia

what causes diminished carotid artery pulse and systolic bruit

ahtlerosclerotic stenotic carottid arteries

what is a grade 2 murmur

quiet but heard immediately after placing stethescope on chest

what occurs at start of diastole

closure of aortic valve

what is lymphedema

unilateral non-pitting edema

• caused by blocked lymphatic circulation

• may be caused by breast surgery

are neuropathic ulcers sign of arterial or venous insufficiency 

venous 

when would you find capillary refill greater than 2 seconds

septic shock

what are interventions are associated with neuropathic ulcer

• location of common pressure points

• inquiring about history of diabetes 

• assessing absence of pain 

what does trendelenburg test

competence of saphenous vein valves 

what is homan’s sign

dorsifllext the foot for suspected dvt pain 

what is allen test

assess blood flow to fingers

• arterial patency

what is raynaud phenomenon

small vessel vasospasm

• some fingers pale

Lentigines are

age spots

senile purpura. is

bruising