HAPE Exam 2 Flashcards

Vesicular breath sounds

Soft, low-pitched sounds over peripheral lungs; inspiration longer than expiration.

Bronchovesicular breath sounds

Medium-pitched sounds near major bronchi; inspiration and expiration roughly equal.

Bronchial breath sounds

Loud, high-pitched sounds normally over trachea; expiration longer than inspiration.

Crackles

Discontinuous popping sounds associated with fluid or opening of small airways.

Wheezes

Continuous musical sounds from narrowed airways.

Rhonchi

Low-pitched snoring sounds often associated with airway secretions.

Stridor

Harsh high-pitched upper-airway sound, often inspiratory.

Pleural friction rub

Grating sound caused by inflamed pleural surfaces rubbing.

Tactile fremitus

Palpable chest vibration when a patient speaks.

Increased tactile fremitus

Increased vibration transmission, often seen with lung consolidation.

Decreased tactile fremitus

Reduced vibration transmission, as with pleural effusion or pneumothorax.

Lung consolidation

Airspaces filled with material; often dull to percussion with increased fremitus.

Pleural effusion

Fluid in pleural space; typically dull with reduced breath sounds and fremitus.

Pneumothorax

Air in pleural space; often hyperresonant with reduced breath sounds and fremitus.

Egophony

Spoken E sounds like A during auscultation; may suggest consolidation.

Bronchophony

Spoken words are unusually clear through the stethoscope.

Whispered pectoriloquy

Whispered words are heard unusually clearly through the stethoscope.

S1

Mitral and tricuspid valve closure; marks onset of systole.

S2

Aortic and pulmonic valve closure; marks onset of diastole.

S3

Extra sound during early rapid ventricular filling; may suggest overload in older adults.

S4

Extra sound just before S1 from atrial contraction into a stiff ventricle.

Physiologic splitting of S2

Inspiration delays pulmonic closure, separating A2 and P2.

Aortic auscultation area

Right second intercostal space at sternal border.

Pulmonic auscultation area

Left second intercostal space at sternal border.

Tricuspid auscultation area

Left lower sternal border.

Mitral auscultation area

Left fifth intercostal space near midclavicular line.

Aortic stenosis murmur

Systolic crescendo-decrescendo murmur at right upper sternal border; may radiate to neck.

Mitral regurgitation murmur

Holosystolic murmur at apex; often radiates to axilla.

Aortic regurgitation murmur

Early diastolic decrescendo murmur, often along left sternal border.

Mitral stenosis murmur

Diastolic rumble at apex, often with opening snap.

Thrill

Palpable vibration caused by turbulent blood flow.

Heave or lift

Sustained chest-wall impulse associated with ventricular activity.

Jugular venous pressure (JVP)

Visible jugular venous pulsation used to estimate right atrial pressure.

JVP examination position

Patient reclined with head elevated about 30-45 degrees.

Carotid palpation safety

Palpate one carotid artery at a time.

Orthostatic hypotension

Standing BP drop of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes.

Intermittent claudication

Exertional limb pain relieved by rest.

Elevation pallor

Limb becomes pale when raised; suggests impaired arterial perfusion.

Dependent rubor

Dusky-red limb color when lowered; associated with arterial insufficiency.

Peripheral arterial disease (PAD)

Reduced arterial blood flow to extremities.

Chronic venous insufficiency

Impaired venous return causing edema and skin pigmentation changes.

Arterial ulcer

Often painful, punched-out distal wound associated with reduced perfusion.

Venous ulcer

Often shallow irregular ulcer near medial ankle with edema and brown discoloration.

Neuropathic ulcer

Pressure-point wound often surrounded by callus with diminished sensation.

Deep vein thrombosis (DVT)

Blood clot within a deep vein.

Bruit

Whooshing sound caused by turbulent arterial blood flow.

Allen test

Assessment of collateral radial and ulnar arterial flow to the hand.

Ankle-brachial index (ABI)

Ankle systolic pressure divided by brachial systolic pressure.

Abnormal ABI

ABI of 0.90 or lower, supporting peripheral arterial disease.

Noncompressible ABI

ABI above 1.40; suggests noncompressible arteries.

Chief complaint

Patient's primary reason for seeking care.

History of present illness (HPI)

Chronological detail of the current problem and symptoms.

Review of systems (ROS)

Organized symptom review across body systems.

Past medical history (PMH)

Prior and ongoing illnesses and hospitalizations.

Past surgical history (PSH)

Previous operations and significant procedures.

Medication reconciliation

Comparing documented medications with what the patient actually takes.

Medication adherence

How consistently a patient follows a prescribed regimen.

Family history

Relevant health conditions among relatives.

First-degree relatives

Parents, siblings, and children.

Social history

Lifestyle, exposures, living circumstances, and support systems.

Social determinants of health

Life conditions affecting health and access to care.

Collateral history

Relevant history obtained from another source when appropriate.

Health maintenance

Preventive care including vaccinations and screenings.

Pack-years

Packs smoked per day multiplied by years smoked.

OLDCARTS

Onset, Location, Duration, Character, Aggravating, Relieving, Timing, Severity.

Abdominal exam sequence

Inspection, auscultation, percussion, palpation.

Tympany

Drumlike percussion sound usually heard over gas-filled bowel.

Dullness

Thudlike percussion sound over solid organs or fluid.

Borborygmi

Loud, prolonged intestinal gurgling.

Guarding

Abdominal muscle tightening during palpation.

Involuntary guarding

Reflex abdominal muscle tightening that can suggest peritoneal irritation.

Rebound tenderness

Pain that increases when abdominal pressure is released.

Murphy sign

Inspiratory arrest due to pain during right upper quadrant palpation.

Rovsing sign

Right lower quadrant pain elicited by left lower quadrant palpation.

Psoas sign

Abdominal pain with resisted right hip flexion or passive extension.

Obturator sign

Pain with internal rotation of the flexed right hip.

McBurney point tenderness

Localized tenderness at a right lower quadrant appendiceal landmark.

Ascites

Free fluid in the peritoneal cavity.

Shifting dullness

Abdominal percussion dullness moves with patient position; suggests ascites.

Fluid wave

Transmitted fluid impulse across abdomen, assessed when ascites is suspected.

CVA tenderness

Pain elicited by tapping over the costovertebral angle.

Normal spleen palpation

A normal-sized spleen is usually not palpable in a healthy adult.

Cullen sign

Bruising around the umbilicus; may indicate internal bleeding.

Abdominal aortic aneurysm (AAA)

Abdominal aorta dilated to at least 3 cm.

Respiratory inspection

Observe rate, rhythm, depth, effort, symmetry, and accessory muscle use.

Normal chest expansion

Both sides of the chest move symmetrically with inspiration.

Reduced unilateral chest expansion

May occur with pleural effusion, pneumothorax, or atelectasis.

Resonance

Expected percussion note over normal air-filled lung.

Hyperresonance

Excessively hollow percussion note, as with pneumothorax or emphysema.

Fine crackles

Brief, high-pitched discontinuous popping sounds, often at end inspiration.

Coarse crackles

Lower-pitched, longer popping sounds associated with airway fluid or secretions.

Tachypnea

Abnormally rapid breathing.

Bradypnea

Abnormally slow breathing.

Apnea

Temporary cessation of breathing.

Orthopnea

Shortness of breath when lying flat, improved by sitting upright.

Accessory muscle use

Recruitment of neck or chest muscles due to increased work of breathing.

Diaphragm of stethoscope

Best for high-pitched sounds such as S1, S2, and many murmurs.

Bell of stethoscope

Best for low-pitched sounds such as S3, S4, and mitral stenosis rumble.

Systolic murmur

Murmur occurring between S1 and S2.

Diastolic murmur

Murmur occurring between S2 and the next S1; generally pathologic.