acute care examination

Question 1

What are normal breath sounds?

Answer 1

vesicular, bronchial, bronchovesicular

Question 2

Describe vesicular breath sound.

Answer 2

normally heard in periphery.
soft, low pitch, gentle rustling
longer inhale than exhale

Question 3

Describe bronchial breath sound.

Answer 3

normally heard over sternum.
low, high pitch, hollow tube
longer exhale

Question 4

bronchovesicular

Answer 4

normally heard at 1st and 2nd intercostal space, between scapulae, medium pitch
even inhale and exhale

Question 5

List the adventitious breathe sounds.

Answer 5

crackles
wheezes
rhonci

Question 6

Describe the sound of crackles

Answer 6

Short, explosive, non-musical
Fine: high frequency, short duration=snapping open of previously closed airways
Coarse=lower pitch, longer duration=retain secretions, fluid accumulation.

Question 7

Describe the sound of wheezes

Answer 7

continuous, musical sounds w single or multiple notes

airway constriction due to occlusion, bronchoconstriction or collapse of airways

Question 8

Describe the sound of rhonci.

Answer 8

low pitched, gurgling, snoring, or moaning

retained secretions in larger airways

Question 9

What are the three categories of breath sound evaluation?

Answer 9

quality
volume
presence of adventitious sounds

Question 10

What is an egophony?

Answer 10

a sign of consolidation/increased density

patient says “e” sounds like “a”

Question 11

What is a branchophony?

Answer 11

a sign of consoidation/increased density

patient says “99” and “99” is heard clearly through stethoscope

Question 12

What does the heart sound “lub” indicate and where is it heard?

Answer 12

S1, beginning of systole
closure of the tricuspid and mitral valves
best heard of the mitral area(bottom left corner of heart, about rib 5)

Question 13

What does the heart sound “dub” indicate and where is it heard?

Answer 13

S2, beginning of diastole
pulmonic and aortic valve closure
best heard over aortic area (top right corner of heart, by rib 2

Question 14

What part of the stethoscope do you use for S1 and S2?

Answer 14

diaphragm

Question 15

What part of the stethoscope do you use for abnormal heart sounds?

Answer 15

Bell

Question 16

What is the type of abnormal heart sound described as vibrations caused by turbulent blood flow, often through incompetent valves?

Answer 16

Murmur

Question 17

How are heart murmurs graded?

Answer 17

I-VI, I being not a big deal

Question 18

What is an extra heart sound called?

Answer 18

Gallops

Question 19

What is a ventricular gallop?

Answer 19

S3 is right after S2

Can suggest onset of volume overload/heart failure

Question 20

What is an atrial gallop?

Answer 20

S4 right before S1
generated by atria ejecting blood into a stiff ventricle
Suggests diastolic dysfunction

Question 21

What can pitting edema indicate?

Answer 21

fluid overload due to organ failure, lymphedema

Question 22

What are symptoms suggesting CVP impairment?

Answer 22

chest pain (or neck, jaw, left arm)
dyspnea
dizziness or syncope
decreased activity tolerance
orthopnea or paroxysmal nocturnal dyspnea
palpitations, tachycardia
cough

Question 23

What is dyspnea?

Answer 23

shortness of breath

Question 24

What are causes of acute dyspnea? (minutes)

Answer 24

Pulmonary embolism, pneumothorax, asthma, pulmonary edema (CHF), upper airway obstruction, myocardial infarction

Question 25

What are causes of sub acute dyspnea? (hours-days)

Answer 25

Pulmonary edema, pneumonia, asthma, pleural effusions

Question 26

What are causes of chronic dyspnea? (weeks to years)

Answer 26

emphysema, restrictive lung dz, chronic heart failure

Question 27

What is the Borg Dyspnea Scale?

Answer 27

0-10 to evaluate dyspnea, 0=nothing at all

Question 28

What is the Visual Analog Scale used for?

Answer 28

Evaluate dyspnea

Question 29

What is the Breathlessness Scale used for?

Answer 29

Evaluate dyspnea. | 0-4, 0 being no dyspnea

Question 30

What are acute causes of coughing? (3 weeks or less)

Answer 30

Upper respiratory infections, acute bronchitis, pneumonia, asthma

Question 31

What are chronic causes of coughing? (longer than 8 weeks)

Answer 31

asthma, chronic bronchitis, bronchiectasis

Question 32

What are sub-acute causes of coughing?

Answer 32

post-infectious, bacterial sinusitis, asthma

Question 33

What colors can sputum be?

Answer 33

Color (from less sick to more sick) | clear, white, yellow, brown, green

Question 34

What consistency of sputum indicates illness?

Answer 34

thick

Question 35

What odor is present in sputum that would indicate a concern?

Answer 35

foul smell

Question 36

What factors do we evaluate in sputum?

Answer 36

color, consistency, odor, amount in a 24 hour period

Question 37

What is an indication of infection, inflammation, or cancer in sputum?

Answer 37

Hemoptysis, coughing up blood or blood colored mucus

Question 38

What are symptoms of angina?

Answer 38

squeezing, tightness, crushing Sub-sternal, mid-chest, left arm and shoulder worse with activity, relieved by nitroglycerin

Question 39

What are three complications of the pulmonary system after cardiothoracic surgery?

Answer 39

atelectasis retained secretions pneumonia

Question 40

What are two complications after cardiothoracic surgery on the cardiac system?

Answer 40

atrial fibrillation | heart block

Question 41

Is blood glucose typically elevated or decreased after cardiothoracic surgery?

Answer 41

elevated

Question 42

What are reasons for a CABG?

Answer 42

coronary artery disease leads to angina leads to ischemia =need for CABG

Question 43

Why would someone have a valve repair/replacement?

Answer 43

stenotic or incompetent valves

Question 44

What are two types of surgery used for end stage heart failure?

Answer 44

Transplant or ventricular assistive device

Question 45

What is claudication?

Answer 45

burning feeling in leg that limits LE movement

Question 46

Why would someone need a LE bypass?

Answer 46

stenotic or clogged LE arteries that have caused claudication

Question 47

What does CABG stand for?

Answer 47

coronary artery bypass graft

Question 48

What is the term for where new artery is attached during a CABG?

Answer 48

anastamosis

Question 49

On-pump during CABG, what happens?

Answer 49

heart is stopped chemically during procedure, pump takes blood in and puts back as surgery progresses

Question 50

What is a side-effect of an on-pump CABG?

Answer 50

longer surgery time=short/long-term neurocognitive deficits

Question 51

Off-pump during CABG, what happens?

Answer 51

heart still beating during procedure

Question 52

What is a benefit of an off-pump CABG?

Answer 52

less early neurocognitive deficits

Question 53

What are the two benefits of using arteries for a CABG?

Answer 53

longer lasting | durable under high pressure

Question 54

What is the benefit of using veins for a CABG?

Answer 54

risk of plaque build-up is less

Question 55

What is the major contraindication to using biological tissue in a valve replacement?

Answer 55

patient's use of blood thinners, concerns over previous stroke or brain bleed

Question 56

What kind of medication will a patient have to take with a mechanical valve replacement?

Answer 56

anti-coagulants

Question 57

What are two major questions a PT needs to ask in relationship to mobilization/fall risk post CABG?

Answer 57

Low blood pressure | neurocognitive deficits caused by on-pump CABG

Question 58

What is a ballooning/weakening of the vessel wall in the aorta called?

Answer 58

Aortic aneurysm

Question 59

What is a tear in the intimal layer of the aorta called?

Answer 59

aortic dissection

Question 60

What is mechanism by which an aortic aneurysm is dangerous?

Answer 60

rupture of the vessel

Question 61

What is the mechanism by which an aortic dissection is dangerous?

Answer 61

Each time there is a pulse

Question 62

Acute, intimal tear in the aorta that originates in the ascending aorta and can extend into the descending aorta?

Answer 62

Type A

Question 63

Acute or chronic intimal tear in the aorta that originates in the descending aorta and can extend into the iliac arteries? What can this cause due to perfusion?

Answer 63

Type B | paralysis due to the path of the descending arteries

Question 64

What is the difference between control of blood pressure non- and post- operatively when thinking about CABG or aneurysm related issues?

Answer 64

Blood pressure should be kept low initially when aortic root is replaced due to coronary artery anastamosis but there is a risk of ischemia and LE infarct=paraplegia during surgery.

Question 65

What is a major concern as a sternotomy heals?

Answer 65

malunion of sternum

Question 66

What four surgeries warrant sternal precautions?

Answer 66

CABG valve thoracic aorta transplant

Question 67

What are 7 examples of sternal precautions?

Answer 67

protect incision prevent sternal bone malunion 1-3 months of limitations no weight lifting over 5-20 lbs avoid pushing and pulling during bed mobility no driving due to twisting and/or use of narcotics

Question 68

What are two procedures that would warrant a thoractomy?

Answer 68

approach to lung or aorta

Question 69

What is the name of a classic procedure used for a double lung transplant?

Answer 69

clamshell thoractomy

Question 70

What is the goal of a LE bypass?

Answer 70

Correct pain from lack of perfusion from peripheral artery disease

Question 71

LVRS? Why?

Answer 71

lung volume reduction surgery small section of lung removed cancer or emphysema in isolated area

Question 72

What is the term for the removal of an entire lobe of lung?

Answer 72

lobectomy

Question 73

If the entire lung is removed, what is that called?

Answer 73

pneumonectomy

Question 74

What are some procedures potentially associated with a thoracotomy?

Answer 74

lobectomy lung transplant aortic aneurysm repairs

Question 75

What are post-operative precautions associated with a thoractomy?

Answer 75

2-4 weeks or as directed by physician no "heavy lifting" ROM encouraged avoid boney involvement (the ribs were spread!)

Question 76

What is the equation to determine FEV1% post lobectomy?

Answer 76

ppoFEV%=preopFEV1%* (1-%Functional lung tissue removed/100)

Question 77

How many total lung subsegments are in the body?

Answer 77

42

Question 78

How many subsegments are in the right superior lobe?

Answer 78

6

Question 79

How many subsegments are in the right middle lobe?

Answer 79

4

Question 80

How many subsegments are in the right inferior lobe?

Answer 80

12

Question 81

How many subsegments are in the left superior lobe?

Answer 81

10

Question 82

How many subsegments are in the left inferior lobe?

Answer 82

10

Question 83

LVAD? Is this a permanent solution?

Answer 83

Left ventricular assistive device | Can be thought of a "bridge to a decision"