301 Test 3 Jarvis Flashcards
a sudden increase in size of one breast signifies
trauma, inflammation, infection, or neoplasms
a fine blue vascular network normally is visible in light skinned women’s breasts during
pregnancy
unilateral dilated superficial veins in a nonpregnant woman is a ___ finding
abnormal
an abnormal finding in the breast, edema exaggerates the hair follicles is called
peau d’orange (orange peel look or pig skin look)
abnormal finding of the nipple
recent inversion
a finding of the breast that must always be explored, especially in the presence of a mass
discharge
retraction signs are due to fibrosis in the breast tissue, usually caused by growing
neoplasms
to screen for breast retraction, first ask the woman to
raise her arms over her head
When examining the axillae, usually the nodes are non palpable, although you may feel a small, soft nontender node in the __ group
central group
Axillae inspection- an abnormal finding is the nodes are enlarged because of local infection or the spread of
breast cancer
position for palpating the breast
supine with arm raised above the head
a normal finding is a firm transverse ridge of compressed tissue in the lower quadrants called the ___ ridge
inframammary ridge (especially noticeable in large breasts, not to be confused with an abnormal lump)
except during pregnancy and nursing, __ is abnormal
discharge
the best time for a BSE is right after the menstrual period or
the 4th to 7th day of the menstrual cycle
enlargement of the breast tissue in men
gynecomastia
in addition to happening normally during puberty, gynecomastia can also occur as an abnormal finding due to
medications and some disease states
a benign finding in the breast of infants
witch’s milk
occurs with thyroid dysfunction, stilbestrol ingestion, ovarian tumor, adrenal tumor
early breast development (age 7 to 8)
delayed development occurs with hormone failure, anorexia, severe malnutrition
delayed breast development
when palpating the breast of an adolescent, a mass is usually a benign fibroadenoma or
cyst
normal findings for breasts of pregnant women include
darker nipples and changes in Montgomery glands
colostrum changes to milk production around the
3rd postpartum day
Women over the age of __ have increased risk of breast cancer
50
benign breast disease is aka
fibrocystic breast disease
multiple tender masses in the breast that occur with numerous symptoms like like swelling, pain, discharge but is not cancerous
benign breast disease is aka fibrocystic breast disease
solitary, unilateral mass in the breast
cancer
solid, hard, dense mass in the breast
caner
breast cancer masses are often __less
painless
breast fibroadenoma is a __ tumor
benign tumor
breast fibroadenoma is commonly found in what age group
adolescent
lifestyle breast cancer risk factors include
nulliparity first child after 30 oral contraceptive use never breast fed long term estrogen and progestin use alcohol obesity inactivity
the ratio of AP diameter to transverse diameter is 1:2 or
0.7/1
In COPD, the neck muscles are found to
hypertrophied (from aiding in forced respirations)
Place your thumbs on T9 or T10 and medially pinch up a fold of skin between the thumbs. Ask the person to to inhale. This tests for
symmetric chest expansion
Unequal chest expansion occurs with marked atelectasis, pneumonia, rib fracture, or
pneumothorax
pain with deep breathing can mean that the pleurae are
inflammed
decreased fremitus occurs when
something obstructs the bronchus, pleural thickening, pneumothorax, or emphysema
increased fremitus occurs with
compression or consolidation of lung tissue
a normal finding of the tactile fremitus test
decreases as you move down the back
chest wall assessment- a coarse, crackling sensation palpalbe over the skin surface
crepitus
occurs when air escapes from the lung and enters the subcutaneous tissue
crepitus
normal finding of posterior chest percussion is the sound of
resonance
a test where you percuss to find the lower border of the lungs during inspiration and expiration
diaphragmatic excursion
normal value for diaphragmatic excursion
3 to 5 cm (though an athlete could have 7 to 8)
normal breath sound thats the loudest
bronchial (tracheal)
normal breath sound thats the softest
vesicular
bronchial sounds are abnormal over the
peripheral fields
adventitious sound that occurs with pneumonia and pulmonary edema
crackles (rales)
adventitious sound that occurs with asthma and emphysema
wheezes (rhonchi)
finding of abdominal muscles in someone with chronic emphysema
hypertrophy
Cerebral hypoxia can cause the mental status to be
drowsy, anxious, restless, irritable
finding of the finger nails with chronic respiratory disease
clubbing
some of the accessory muscles used for forced expiration
rectus abdominus and internal intercostals
Most lung tissue responds with resonance, but dullness over the cardiac area is a
normal finding
emphysema causes what percussion sound
hyperresonance
The highest portion of lung fields (front and back) give what normal sound
vesicular
the best time to check an infants respiratory rate is when they are
sleeping
brief periods of apnea less than 10 or 15 seconds is normal in
infants
abnormal respiratory rate in an infant that could be an early sign of heart failure
50 to 100 breaths per minute
From infancy to 6 years old, __ sounds are normally heard in the peripheral lungs fields
bronchovesicular can be heard because they have thin chest walls
A normal (normal for immediate newborn only) adventitious sound heard in newborns caused by opening of airways and fluid clearing
fine crackles
adventitious sound: discontinuous, high-pitched, short, popping heard during inspiration and can’t be cleared by coughing
fine crackles (rales)
adventitious sound: loud, low-pitched bubbling and gurgling. Starts in early inspiration and early expiration
course crackles (rales)
adventitious sound: sound like fine crackles but don’t last and aren’t pathologic
atelectatic crackles (rales)
adventitious sound: a very superficial sound that is coarse and low pitched
pleural friction rub
adventitious sound: high-pitched, musical, squeaking
wheeze, high pitched
adventitious sound: low pitched, musical snoring/moaning sound
wheeze, low pitched (rhonchi)
adventitious sound: high pitched inspiratory crowing sound
stridor
breathing pattern that may occur with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons
tachypnea
breathing pattern that may occur with diabetic ketoacidosis, hepatic coma, salicylate overdose, lesions of the midbrain, metabolic acidosis
hyperventilation
breathing pattern that may occur with drug-induced respiratory depression, increased intracranial pressure, diabetic coma
bradypnea
breathing pattern that may occur with bedrest or conscious splinting of the chest to avoid pain
hypoventilation
breathing pattern where breaths gradually increase and then decrease down to period of apnea
Cheyne-Stokes respiration
breathing pattern that can be caused by HF, renal failure, meningitis, drug overdose, and increased intracranial pressure
Cheyne-Stokes respiration
Cheyne-Stokes respiration can be normal in
infants and elderly people during sleep
breathing pattern similar to Cheyne-Stokes respiration except that the pattern is irregular
Biot’s respiration
breathing pattern seen with head trauma, brain abscess, heatstroke, spinal meningitis, and encephalitis
Biot’s
a carotid bruit is audible when the lumen is occluded by
1/2 to 2/3
besides a bruit, another sound that can be heard when auscultating the neck is a
murmur sound that radiates up from the heart
position the patient supine with the head at 30 to 45 degrees and shine a flash light on the neck to inspect
jugular venous pulse
unilateral distention of external jugular vein is from a local cause such as
aneurysm
fully distended external jugular veins above 45 degrees show increased
central venous pressure
You may or may not see the apical impulse. When it is visible its in the
4th or 5th intercostal space
a sustained forceful thrusting of the ventricle during systole
heave or lift
heave or lift occurs with ventricular
hypertrophy
A normal sized __ should only occupy one intercostal space
heart
a palpable vibration in the chest
thrill
type of arrhythmia that occurs normally in young adults and children
sinus arrhythmia
the S1 is louder than the S2 at the
apex
the S2 is louder than the S1 at the
base
S1 coincides with the carotid artery
pulsation
S1 coincides with the __ wave
R wave
S1 and S2 are both diminished with increased air or tissue between the heart and your stethoscope such as
emphysema, obesity, and pericardial fluid
S1 signals the beginning of
systole
A split of S2 toward the end of inspiration is a __ finding
normal
T-DUP sound
split S2
A __ split is unaffected by respiration
fixed split
S3 and S4 occur in diastole; either may be normal or
abnormal
1st condition that can result in a murmur: high rate of flow through a normal valve such as with
exercise
2nd condition that can result in a murmur: restricted forward blood flow through a ___ valve
stenotic valve
3rd condition that can result in a murmur: backward flow through a __ valve
regurgitant valve
4th condition that can result in a murmur: blood flow through
abnormal openings in chambers
a pattern of a murmur where it is growing louder
crescendo
a pattern of a murmur where it is getting quieter
decrescendo
pattern of a murmur where it is increasing to a peak and then decreasing
diamond-shaped
some murmurs are common in healthy children or adolescents and are called __ or __
innocent or functional
murmurs in the first 2 or 3 days of life a a __ finding
normal
A thrill in the right interspaces occurs with ___ stenosis
aortic stenosis
A thrill in the left interspaces occurs with ___ stenosis
pulmonic stenosis
abnormal pulsation that occurs with right ventricular hypertrophy, as in pulmonic valve disease or chronic lung disease
lift (heave)
conditions that can skew that results of a capillary refill test
smoking, peripheral edema, anemia
refill lasting more than 1 or 2 seconds signals decreased cardiac output and vaso___
constriction
rating of an absent pulse
0
rating of a normal pulse
+2
what kind of pulse would you find in someone with shock or PAD
weak/thready (+1)
what kind of pulse would you find in someone with anemia or hyperthyroidism
full/bounding (+3)
appearance of the legs when there’s arterial insufficient
pallor and coolness
what is the best position for checking varicosities
standing
normal lymph nodes are
movable and nontender
abnormal lymph nodes are
fixed and tender
the 4 pulses you should check in the legs
femoral, popliteal, dorsal, posterior tibial
varicosities occur in the __ veins
saphenous
device used to detect a weak peripheral pulse, monitor BP in children, and measure a low BP in a lower extremeity
Doppler Ultrasonic Probe
For this test, the patient should lay flat with heels supported. Shouldn’t smoke for 2 hours, and should rest for 5 to 10 min
Ankle-Brachial Index
ABI formula
Highest ankle BP over highest arm BP
transient acrocyanosis (symmetric cyanosis) is a __ finding at birth
normal
signs of arterial insufficiency (thin, shiny skin, hairless) in the legs is a normal finding for
elderly
pulse found in someone with aortic stenosis
weak/thready (+1)
pulse found in someone with aortic regurgitation
Water-Hammer (Corrigan) (+3)
pulse that stronger than normal, but suddenly collapses
Water-Hammer (Corrigan) (+3)
pulse found in someone with a conduction disturbance
Pulsus Bigeminus
pulse where every other beat comes early or a normal beat is followed by a premature beat
Pulsus Bigeminus
pulse that can occur when heart rate is normal, but there’s a severe left ventricle failure
pulsus alternans
pulse commonly found with cardiac tamponade
pulsus paradoxus
pulse found when there’s aortic stenosis AND regurgitation
pulsus bisferiens
___ abdomen occurs with malnourishment
scaphoid
enlarged and everted umbilicus could signal
umbilical hernia (not of course it’s totally normal during pregnancy)
the accumulation of fluid in the peritoneal cavity, causing abdominal swelling
ascites
with ascites the skin of the abdomin appears
taut and shiny
cutaneous angiomas (spider nevi) can occur in the abdomin caused by
portal hypertension or liver disease
marked visible peristalsis together with a distended abdomen indicates intestinal
obstruction
abdomen: restlessness and constant turning to find comfort occur with
colicky pain of gastroenteritis or bowel obstruction
abdomen: absolute stillness, resisting any movement is demonstrated with the pain of
peritonitis
Begin auscultating the abdomen in which area
RLQ (where the ileocecal valve is)
rate of normal bowel sounds
5 to 30 per minute
hyperactive bowel sounds can occur from
gastroenteritis and subsiding paralytic ileus
hypoactive bowel sounds can occur from
inflammation of the peritoneum
the normal liver span is
6 to 12 cm
normal spleen size
less than 7 cm
a constant, board-like hardness of the abdominal muscles. It’s a protective mechanism against acute inflammation of the peritoneum
involuntary rigidity
abdominal tenderness is a normal finding over which organ
sigmoid colon
you can feel the liver when a person
takes a deep breath (the diaphragm pushes it down)
If the liver can be felt even when it’s not being pushed by the diaphragm, it’s probably
enlarged
lung condition that makes the liver palpable
COPD (because the lungs are distended)
a palpable spleen is a __ finding
abnormal
an enlarged spleen is easy to
rupture
rebound tenderness and cough tenderness are signs of
peritoneal inflammation
___ shaped abdomen appears in infants and children that are malnourished
scaphoid
pyloric stenosis causes
marked peristalsis
possible difference between an older person and younger person with an acute abdomen
older person may complain of less pain
What is last in the abdominal assessment
palpation
