202 Exam 2 Flashcards
tension headache
(onset/duration?)
mild to moderate less disabling form of migraine
location: usually on both sides across frontal, temporal or occipital region
band-like tightness (nonthrobbing)
gradual onset
diffuse dull aching pain
migrane headache
(onset/duration?)
HA of genetically transmitted vascular and trigeminal nerve origin (2-3 times more common in women)
commonly one-sided, pain often behind eyes, temporal or frontal region
throbbing, pulsating
rapid onset (can last up to 72 hrs or more)
cluster headache
(onset/duration?)
intermittent , excruciating, unilateral with autonomic signs
location: on one side, often behind or around the eye
abrupt onset (45-90 mins)
can occur multiple times a day in “clusters”
cancerous lumps feel like
hard, fixed, not tender
parkinsons disease
a deficiency of the neurotransmitter dopamine, and degeneration of the substantia nigra of the basal ganglia in the brain
Cushing’s syndrome
excessive secretion of adrenocorticotropic hormone (ACTH), person develops round moon-like face
Bell’s palsy
a lower motor neuron lesion producing rapid onset of cranial nerve VII paralysis of facial muscles (unilateral)
brain attack or CVA
a upper motor neuron lesion (central). caused by a blood clot of a cerebral vessel as in atherosclerosis (ischemic stroke) or a rupture in a cerebral vessel (hemorrhagic stroke)
four functions of respiratory system
changing chest size during respiration
inspiration
expiration
control of respiration
Clear sputum
bronchitis, viral infection, cold
Yellow or green sputum
respiratory infection or bacterial infection
pulmonary edema sputum color
pink and frothy (very concerning)
anteroposterior-transverse diameter ratio
1:2
tactile fremitus pg 439
solid viscera organs/glands
liver
pancreas
spleen
adrenal glands
kidneys
ovaries
uterus
hollow viscera organs/glands
stomach
gallbladder
small intestine
colon
bladder
solid vs hollow viscera
solid: retains shape, solid in mass
hollow: shape depends on content (changes shape), organ is hollow
proper assessment order for abdomen
IAPP: inspect, auscultate, percussion, palpation
what is significant about kidney placement
the left kidney is slightly higher than the right. important for physical examination
dysphagia
difficulty swallowing
you may see abdominal pulsations in which people
newborns, children, skinny adults, HTN, a triple A, peristalsis
normal bowel sounds characteristics
high-pitched, gurgling, cascading (normally 5-30 times per min)
hyperactive bowel sounds
high-pitched, rushing, tinkling, signal increased motility
“borborygmi”
Colitis
hypoactive bowel sounds
most commonly follow abdominal surgery or with inflammation of the peritoneum, late bowel obstruction, NPO
two tests to confirm ascites
fluid wave
shifting dullness
arteries in the abdomen
aortic
renal
iliac
what is a bruit
A bruit is an audible vascular sound associated with turbulent blood flow
rebound tenderness (blumbergs sign)
hold hand at 90 degrees, palpate slowly and deeply, then lift up quickly
perform test at end of exam because it can cause pain and muscle rigidity
inspiratory arrest test (Murphy’s sign)
murphy’s sign is elicited in pts with acute cholecystitis by asking patient to take in a hold a deep breath while palpating the right subcostal (below the ribs)
if pain occurs when the inflamed gallbladder comes into contact with the examiners hand, murphy’s sign is positive
signifies acute cholecystis
3 types of hernias
umbilical hernia
epigastric hernia
incisional hernia
umbilical hernia
the protrusion of the momentum or intestine through a weakness or incomplete closure in the umbilical ring
epigastric hernia
protrusion of abdominal structures presents as a small fatty nodule at epigastrium in midline, through the Linea alba
incisional hernia
a bulge near an old operative scar that may not show when person is supine but is apparent when the person increases intra-abdominal pressure by a sit-up or standing
percussion of healthy lungs produces
resonance
which lung sound dominates
vesicular
decreased fremitus
asthma, collapsed lung, obstructed bronchus, pneumothorax, and emphysema
pleural effusion- fluid build up in the pleural cavity surrounding the lungs so it absorbs the vibrations from the visceral lung tissue (blocks the sound)
increased fremitus
increased density of lung tissue = increase vibrations example- pneumonia
enlarged thyroid gland is called a
Goiter
lymph node locations (10)
- preauricular
- posterior auricular
- occipital
- jugulodigastric
- superficial cervical
- posterior cervical
- supraclavicular
- deep cervical chain
- submandibular
- submental
lymph nodes characteristics and assessment
characteristics: <1cm, freely moveable, enlarged/inflamed = could indicate acute infection or illness
assessment: bimanual palpation, circular motion
anterior landmarks on thoracic cage
suprasternal notch
sternum
manubriosternal angle
costal angle
posterior landmarks on thoracic cage
vertebra prominens
spinous processes
inferior border of scapula
twelfth rib
number of lobes on each lung
2 lobes on the left
3 lobes on the right
listen to lower lobes (posteriorly or anteriorly?)
posteriorly
During a health history interview with patient what question should you ask? (thorax and lungs)
do you have to sleep with a lot of pillows at night? (orthopnea)
bronchial (trachea) breath sound characteristics
pitch: high
amplitude: loud
duration: inspiration < expiration
quality: harsh, hollow, tubular
location: trachea, larynx
Bronchiovesicular breath sound characteristics
pitch: moderate
amplitude: moderate
duration: inspiration = expiration
quality: mixed
location: over major bronchi where fewer alveoli are located
Vesicular breath sound characteristics
pitch: low
amplitude: soft
duration: inspiration > expiration
quality: rustling
location: over peripheral lung fields where air flows through smaller bronchioles and alveoli
adventitious lung sounds: Crackles
discontinuous popping sounds heard over inspiration
mechanisms: inhaled air collides with previously deflated airways, airways suddenly pop open
example- (late)- pneumonia, heart failure, interstitial fibrosis. (early)- chronic bronchitis, asthma, emphysema
adventitious lung sounds: wheezes
continuous musical sounds heard mainly over expiration
mechanisms: air compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors
example- acute asthma, or chronic emphysema, COPD
percussion sound that predominates over abdomen
tympany
measurement of pulmonary function status
forced expiratory time
pulse oximeter
6-minute walk
Barrel chest
AP-T 1:1
chronic emphysema and asthma as a result of hyperinflation of lungs
scoliosis
a lateral s-shaped curvature ofd the thoracic and lumbar spine usually involved in vertebrae rotation
most common in adolescent aged girls
kyphosis
exaggerated posterior curvature of the thoracic spine that cause significant back pain and limited mobility (humpback)
pectus excavatum
sunken sternum and adjacent cartilages (also called funnel breast). depression at 2nd ICS
pectus carinatum
a forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions long costpchondral junctions (pigeon breast)
cheyne-stokes respiration
a cycle in which respirations gradually wax and wane in a regular pattern, increasing rate and depth then decreasing.
most common in heart failure, in some cases renal failure, meningitis, drug overdose, increase intracranial pressure
biot respirations
similar to cheyne stokes however pattern is irregular. series of normal respirations (3-4 breaths) followed by period of apnea
chronic obstructive breathing
normal inspiration and prolonged expiration to overcome airway resistance
rhonchal fremitus
vibrations felt when inhaled air passes through thick secretions in the larger bronchi (may decrease by coughing)
pleural friction fremitus (palpable friction rub)
produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid
the opposing surface makes a coarse grating sound when rubbed together during breathing
discontinuous lung sounds
crackles- fine
crackles - coarse
atelectatic crackles
pleural friction rub
continuous lung sounds
wheeze- sibilant
wheeze- sonorous rhonchi
stridor (r/t anaphylaxis)
Stridor lung sound
originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissue, or lodged foreign body
croup and acute epiglottis, ANAPHYLAXIS
percussion (of the lungs) is helpful in identifying ___
surface alterations of lung tissue
layers of the heart (outer to inner)
pericardium
myocardium
endocardium
precordium
the area on the anterior chest directly overlying the heart and great vessels
S1 sound occurs with __
closure of the Atrioventricular (AV) valves (tricuspid and mitral)
beginning of systole
S2 sound occurs with __
closure of the semilunar valves (pulmonic and aortic) and signals the end of systole
effect of respiration on amount of blood in heart
moRe to the Right heart
Less to the Left
extra heart sounds
S3 - occurs immediately after S2 (may hear in pts with CHF, Acute MI, coronary artery disease, late pregnancy)
S4- occurs immediately before S1 (athletes, elderly pt, chronic hypertension, aortic stenosis, cardio myopathy)
S1 is louder at ___ and coincides with ____ pulse
the apex, carotid artery pulse
S2 is louder at
the base
jugular veins give information about the __ side of the heart
right
(JVD shows more in right jugular vein)
jugular vein distention can indicate
Right side heart failure
Right heart pressure
venous congestion
cultural consideration- prevalence of heart disease and stroke is higher among ___
black adults
cyanosis is r/t ____
decrease cardiac output
edema
starts in lower extremities and works its way up
nocturia
frequent urination during the night
how to palpate carotid arteries
one at a time
grade 1+ 2+ or 3+
how to check carotid artery for bruit
ask pt to take a breath in, then out and hold breath and then listen
apical pulse location (palpate)
midclavicular line 5th ICS
how to calculate pulse deficit
difference between apical pulse rate and radial pulse rate
apical minus radial
most common irregular heart rhythm
atrial fibrillation
how to listen for extra heart sounds (S3 and S4)
roll pt to their left side and listen with the bell at the apex for presence of diastolic filling sounds (S3 and S4)
point of max impulse = apical pulse location
auscultatory areas on heart
aortic area (2nd ICS, right sternal border)
pulmonic area (2nd ICS, left sternal border)
Erb’s point (3rd ICS, left sternal border)
tricuspid area (5th ICS, left sternal border)
mitral area (5th ICS, left midclavicular line)
sound of a murmur
swishing
pericardial friction rub
inflammation of the pericardium
sound is high pitched and scratchy
examples: cardio myopathy, pericarditis
abnormal pulsations on the precordium
a thrill is heard at the base of the heart in the 2nd and 3rd ICS on the right (indicates severe aortic stenosis, and systemic hypertension) and on the left (indicates pulmonic stenosis and pulmonic hypertension)
a lift (heave) occurs with ____
right ventricular hypertrophies
seen in pts with pulmonic valve disease, pulmonic hypertension, and chronic lung disease
peripheral vascular system lymph nodes
cervical
axillary
epitrochlear
inguinal
intermittent claudication
r/t arterial disease, numbness, tingling or cramps*
use doppler for pulse
amplitude
only gets your systolic
lack of hair on one foot vs the other indicates
less blood flow and less nutrients
water-hammer (corrigan’s) pulse
3+ , collapses suddenly
peripheral vascular disease in arms
raynauds syndrome
lymphedema- accumulation of protein-rich fluid in the interstitial spaces of the arm following breast surgery or treatment
peripheral vascular disease in legs
arteriosclerosis-ischemic ulcer
venous (stasis) ulcer
superficial varicose veins
DVT
deep vein thrombosis
requires immediate attention, high risk for PE
ascites
free fluid in the peritoneal cavity
blood flow through the heart
Superior/inferior vena cava
right atrium
tricuspid valve
right ventricle
pulmonic valve
pulmonary artery –> lungs to exchange CO2 for Oxygen
pulmonary veins
left atrium
mitral valve (bicuspid)
left ventricle
aortic valve
aorta—> oxygenated blood to the rest of the body
tests for suspected appendicitis
lliopsoas muscle test
obturator muscle test
Chronic arterial symptoms
Deep muscle pain usually in calf
Intermittent claudication- feels like a cramp
Aggravating factors: walking, claudication distance (distance it takes to produce pain), elevation
Relieving factors: rest, dangling
Acute arterial symptoms
Distal to occlusion, may involve entire leg
Throbbing
Sudden onset
Six Ps: pain, pallor, pulselessness, Paresthesia, poikilothermia, paralysis
Chronic venous symptoms
Calf, lower leg
Aching, tenderness, feeling of fullness
Aggravating factors: Prolonged sitting or standing
Relieving factors: elevation, lying, walking
Associated symptoms: edema, varicosities
At risk: jobs with long time sitting or standing, obesity, prolonged bed rest, varicosities, trauma
Acute venous symptoms
Calf
Moderate to intense, sharp, deep, tender
Pain increases with palpating
Helped by pain medication
Symptoms: red, swollen, warm
Modified allen test
Used to evaluate the adequacy of collateral circulation before cannulating the radial artery
Occlude both radial and ulnar pulse and then release the ulnar
Cervical lymph nodes drain
The head and neck
Ancillary lymph nodes drain
The breast and upper arm
Epitrochlear lymph nodes drain
The AC fossa and the hand and lower arm
Inguinal nodes drain
Most of the lymph of the lower extremity, external genitalia and anterior abdominal wall
Artery that supplies the hand
Ulnar
+ Blumbergs test indicates
Appendicitis
Murphys test indicates
Inflamed gallbladder
Hemoptysis
Coughing up blood
Manual compression test
Varicose veins
palpate the dilated vein with the fingertips of one hand. With the other hand, firmly compress the vein at a point at least 8″(20.3 cm) higher. Feel for an impulse transmitted to your lower hand
