Cardiac/Lymph/Abdominal/Thyroid Flashcards
To diagnose hypertension, how many readings over how many visits are required?
2 or more readings on at least 2 visits
List the systolic and diastolic levels of pre-hypertension
120-139 over 80-89
List 3 examinee factors that may affect BP
white coat effect, recent tobacco or caffeine, full bladder, talking, legs crossed
Sinus Bradycardia
Less than 60
Sinus Tachycardia
Greater than 100
When comparing BP in the upper extremity bilaterally, what is the allowable difference in mmHg from side to side?
10-12 mmHg from side to side (diastolic doesn’t change much)
Of the following conditions that can decrease systolic BP in an extremity which is more common?
Peripheral arterial disease
List the sequence of evaluation when assessing the arterial system:
Inspect, Auscultate, Palpate
List the arteries auscultated in an arterial exam
Carotid, Subclavian, Abdominal Aorta, Renal, Femoral (controversy as to the usefulness of this)
List the arteries palpated in an arterial exam
Carotid, Temporal, Abdominal Aorta, Iliac, Femoral, Popliteal, Posterior Tibial, Dorsal Pedal
Name the three qualities you assess when taking a Radial pulse
a) Rate or beats/minute; b) Amplitude or “strong”; c) Rhythm or “regular”
What is the “classic” but unreliable measurement of the abdominal aorta upon supra-umbilical palpation?
2.5-4 CM
When auscultating the carotid artery, we ask the patient to briefly hold their breath?
True
We use the ? or the Diaphragm to auscultate the carotid artery?
Bell
What is a bruit?
A Bruit is the term for the unusual sound that blood makes when it rushes past an obstruction called turbulent flow in an artery when the sound is auscultated with the bell portion of a stethoscope.
Which is better for detecting an aneurysm of the abdominal aorta, palpation or auscultation?
Palpation
What 2 possible findings might we get from palpating the anterior chest wall?
a) Thrills or Heaves; b) MFTPs
How might you position a patient to better hear the heart sounds?
Either lean them forward and/or off to the left side
See diagram to the right: a) Label auscultatory points
a) Label the auscultatory points
See diagram to the right: b) What point is missing from this diagram?
ERBs
In a US primary care setting, what is the most likely cause of chest pain?
Musculoskeletal conditions (36%)
Define Arrhythmia
Heartbeats that are too slow, too rapid, irregular, or too early
Atrial Fibrillation is
considered the most common form of arrhythmia, is associated with high rates of morbidity and mortality and is thought to be responsible for 15% to 20% of all strokes. It is most often seen in patients over 60, especially those with coronary heart disease, high blood pressure, COPD, etc.
S1 marks the beginning of
Ventricular Systole
S1 marks the beginning of Ventricular Systole. What valves are closing?
AV Valves
S1 marks the beginning of Ventricular Systole. Where do you listen to hear S1 best?
Apex of heart Mitral and Tricuspid points
S2 marks the end of
Ventricular Systole
S2 marks the end of Ventricular Systole. What valves are closing?
Aortic and Pulmonic
S2 marks the end of Ventricular Systole. Where do you listen to hear S2 best?
Aortic and Pulmonic points
Name all of the lymph node groups covered in lab in the head and neck region:
Posterior auricular, pre-acuricular, submandibular, submental, anterior cervical chain, posterior cervical chain and supraclavicular
Which lymph nodes have the highest risk of malignancy estimated at 90% in patients over 40 and 25% in those under 40?
Supraclavicular
Virchow’s node, also known as the Sentinel Node, is located where?
Left supraclavicular fossa
T or F: The vertical inguinal lymph nodes drain the abdomen?
False, they drain the lower extremity, the horizontal nodes drain the abdomen
Most patients with an enlarged thyroid or goiter have which of these?
Euthyroidism (80% and accompany NO signs or symptoms of thyroid disease)
Describe the physical findings of a HYPERPLASTIC “REACTIVE” lymph node:
Firm, moveable, non-tender, discrete margins, less than 1 cm
Barrel chest is a finding that may indicate what?
Late Stage COPD (Board Q)
Normal thoracic excursion should be symmetric with thumbs moving ? CM apart during deep inspiration.
3-5 CM
Digital clubbing has been classically associated with what?
Advanced chronic bronchitis
What is the normal tone heard when percussing the lung?
Resonant
Where would we percuss to hear a “flat” or “dull” tone in a normal patient?
Directly over bone, over large skeletal muscle, or over a normal liver
List the sequence of evaluation when assessing the abdomen system:
i) inspection/observation, ii) auscultation, iii) percussion, iv) light palpation, v) deep palpation
Name the test used to differentiate between pain in the superficial wall of the abdomen and deeper structures.
Carnett’s
