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Advanced Assessment > Cardio/Resp > Flashcards

Cardio/Resp Flashcards

1
Q

Vertical Axis

A

Counting down ribs and intercostal spaces

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2
Q

Circumference of the Chest Measurment

A

series of vertical lines as landmarks

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3
Q

Anterior Circumference of Chest Measurements

A
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4
Q

Posterior Circumference of Chest Lines

A
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5
Q

Lateral Circumference of Chest Lines

A
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6
Q

Supraclavicular

A

Above the Clavicles

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7
Q

Infraclavicular

A

Below the Clavicle

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8
Q

Interscapular

A

Between the scapulae

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9
Q

Infrascapular

A

Below the scapulae

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10
Q

Which lung has 3 lobes

A

Right Lung

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11
Q

Anterior lung fields

A
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12
Q

Anterior Respiratory Ausculation Points

A
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13
Q

Right Lateral Lung Fields

A
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14
Q

Left Lateral Lung Fields

A
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15
Q

Posterior Lung Fields

A
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16
Q

Posterior Respiratory Auscultation Points

A
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17
Q

Accessory Muscles of the Neck

A

Sternomastoid Muscle

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18
Q

Accessory Muscles of the Chest

A

Intercostal Muscles

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19
Q

Gestures:

Clenched fist over sternum

A

suggests angina pectoris

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20
Q

Gestures:

Finger pointing to tender area

A

Suggests muscoloskeletal pain

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21
Q

Gestures:

hand moving from neck to epigastric area

A

Suggests heartburn

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22
Q

7 attributes of symptom complaint

A

Location

Quality

Severity

Timing

Setting in which it occurs

Alleviating/Aggrevating factors

Accompanying symptoms

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23
Q

Most frequent cause of chest pain in children

A

Anxiety

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24
Q

How should you rate shortness of breath

A

In relation to daily activities

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25
Q

Breathing difficulty in Anxiety Patients

A

“can’t get enough air”

tingling aroung lips/extremities (paresthesia)

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26
Q

Cardiac related cough

A

sign of left sided heart failure

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27
Q

Acute cough duration

A

Less than 3 weeks

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28
Q

Subacute cough duration

A

3-8 weeks

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29
Q

Chronic cough duration

A

More than 8 weeks

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30
Q

Most common cause of acute cough

A

Viral Upper Respiratory Infections

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31
Q

Mucoid Sputum

A

Translucent, white, or gray

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32
Q

Purulent Sputum

A

Yellow or Green

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33
Q

Foul smelling sputum

A

Present in anaerobc lung abcess

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34
Q

Patient position for examining posterior thorax

A

Sitting with arms crossed over chest and hands resting on opposite shoulders

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35
Q

Patient position for examining anterior thorax

A

Supine

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36
Q

Thorax assessment techniques

A

Inspect

Palpate

Percuss

Auscultate

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37
Q

Normal repiratory rate for healthy adult

A

14-20

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38
Q

Stridor

A

High-pitched wheeze

Sign of upper airway obstruction

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39
Q

Lateral displacement of trachea

A

Occurs in pneumothorax, plueral effusions, or atelectasis

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40
Q

AP diameter

A

Shape of chest from front to back

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41
Q

Observed assymetric chest expansion

A

Pleural effusion

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42
Q

Observed retraction

A

Severe asthma

COPD

Upper airway obstruction

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43
Q

Posterior Palpation for chest expansion

A

Raise a small skin fold between your fingers, ask patient to take deep breath, and watch for equal expansion of hands

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44
Q

Fremitus

A

Vibrations felt in thorax when patient is speaking

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45
Q

Technique for detecting tactile fremitus

A

Use the ball of your palm

Have patient repeat “99”

Feel for symmetry of both sides

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46
Q

Anterior palpation points for tactile fremitus

A
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47
Q

Posterior palpation points for tactile fremitus

A
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48
Q

Typical findings:

Tactile Fremitus

A

More prominent interscapularly than in lower lung fields

disapears below diaphragm

Often more prominent on right than left

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49
Q

Findings:

Asymetric decreased fremitus

A

Unilateral pleural effusion

pneumothorax

Neoplasm

Decreased transmission of low frequency sounds

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50
Q

Findings:

Asymetric increased fremitus

A

Unilateral pneumonia

increased transmission through consolidated tissue

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51
Q

What does percussion determine

A

If tissues are air-filled, fluid-filled, or solid

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52
Q

Percussion technique

A

Place top joint of middle finger on surface and tap it quickly with the tip of your other middle finger. Movement comes from wrist, not fingers

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53
Q

Percussion sounds:

Flat

A

Intensity: Soft

Pitch: High

Duration: short

Location example: thigh

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54
Q

Percussion sounds:

Dull

A

Intensity: Medium

Pitch: Medium

Duration: Medium

Location Example: Liver

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55
Q

Percussion Sounds:

Resonant

A

Intensity: Loud

Pitch: Low

Duration: Long

Location examply: Healthy lung

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56
Q

Percussion Sound:

Hyperresonant

A

Intensity: Very loud

Pitch: Lower

Durantion: Longer

Location example: Shouldn’t be one

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57
Q

Percusiion sound:

Tympanitic

A

Intesity: Loud

Pitch: High

Duration: Longer

Location example: Gastric air bubble or puffed out cheek

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58
Q

Percussion points of posterior thorax

A
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59
Q

Percussion with consolidation or fluid

A

Dullness rather than resonance

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60
Q

Lobar pneumonia

A

Alveoli are filled with fluid and blood

Dull percussion

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61
Q

Pleural effusion

A

Pleural accumulations of serous fluid

Dull percussion sounds

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62
Q

Hemothorax

A

Pleural accumulation of blood

Dull percussion

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63
Q

Empyema

A

Pleural accumulation of pus

Dull percussion

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64
Q

Percussion in presence of fibrous tissue or tumor

A

Dull percussion

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65
Q

Oserved generalized hyperresonance

A

Hyperinflated lungs of COPD or asthma

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66
Q

Observed unilateral hyperresonance

A

Suggests large pneumothorax or air filled bulla

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67
Q

Technique to identify diaphragmatic location

A

Percuss the area you expect to be dull then move upward until sound changes from dull to resonant. This is level of diaphragm

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68
Q

Noted abnormally high diaphragm level

A

Suggests pleural effusion, atelectasis, or phrenic nerve paralysis

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69
Q

Estimate diaphragmatic excursion

A

DIstance between level of dullness on full expiration and level of dullness on full inspiration (normal is about 3-5.5 cm)

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70
Q

Vesicular breath sounds

A

Soft, low pitched sound heard over most lung fields. Lasts through entire inhalation and fades about 1/3 of the way into exhilation

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71
Q

Broncho-vesicular sounds

A

Inspiratory ad expiratory sounds are about equal in length, pitch, and intensity

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72
Q

Bronchial sounds

A

Expiratory sounds last longer than inspiratory sounds, louder, harsher, and higher pitched

73
Q

Tracheal sounds

A

Inspiratory and expiratory sounds are equal, loud, and relatively high

74
Q

Anterior ausculatory areas for normal breath sounds

75
Q

Posterior ausculatory areas for normal breath sounds

76
Q

Bronchovesicular or bronchial sounds noted in abnormal areas

A

Suspect fluid or consolidation

77
Q

Which side of stethoscope is used to auscultate breath sounds

78
Q

Crackles

A

Abnormalities of the lung or airways

Possible pneumonia, fibrosis, early heart failure, bronchitis

79
Q

Wheezes

A

Narrowed airways

Asthma, COPD, bronchitis

80
Q

Rhonchi

A

Secretions in large airways

Sounds like snoring

81
Q

Anterior palpation for chest expansion

A

Push fold of skin up between thumbs and ask patient to take a deep breath. Watch for symmetrical movement of thumbs

82
Q

Pectus Excavatum

(Funnell Chest)

83
Q

Barrell Chest

84
Q

Costovertebral Angle

A

Palpate for Kidney Tenderness

85
Q

Point of Maximum Impulse (PMI)

A

Produces The apical pulse and is located in the 5th intercostal space at the midclavicular line

86
Q

Cario Review of Symptoms:

History?

A

MI

HTN

Thrombophlebitis

rheumatic fever

murmurs

(Personal and family)

87
Q

Cardio Review of Symptoms:

Labs

A

Last lipid screening, EKG, stress tests, cardiac cath, echo

88
Q

Cardio review of symptoms:

current complaints

A

Assess for DOE, nocturnal dyspnea, orthopnea, palpitations, edema, light-headedness

89
Q

Cardiovascular risk factors

A

Smoking, DM, HTN, cholesterol, sedentary lifestyle, obesity, family history

90
Q

Basic anatomy of coronary circulation

91
Q

Which side of the stethoscope is used to auscultate heart sounds while supine

A

Diaphragm and Bell

92
Q

Auscultation points for heart sounds

93
Q

Which side of stethoscope is used fro auscultation of left lateral heart sounds

94
Q

Which side of stethoscope is used for auscultation of heart sounds while patient sits

95
Q

Heart sounds auscultated when supine

A

Aortic, pulmonic, erb’s point, tricuspid, mitral

96
Q

Heart sounds auscultated left lateral side

A

Tricuspid, mitral

97
Q

Heart sounds auscultated while patient is sitting and leaning forward

A

Aortic, pulmonic

98
Q

Review of Heart sounds

99
Q

Stroke volume

A

Amount of blood ejected with each heartbeat

100
Q

Preload

A

Volume of blood in the right ventricle at the end of diastole

(volume overload)

101
Q

Myocardial Contractility

A

Ventricles contract during systole

102
Q

Afterload

A

the degree of vascular resistance to ventricular contraction

(pressure overload)

103
Q

What does JVP reflect

A

Right atrial pressure

104
Q

How do you figure cardiac output

A

Stroke volume x Heart rate

105
Q

Which valves are open during systole

A

Pulmonic

(Blood pumped into pulmonary arteries)

Aortic

(Blood pumped into aorta)

106
Q

What closes during systole

A

Mitral and tricuspid valves

107
Q

What valves are open during diastole

A

Mitral

(Blood flow from left atrium to left ventricle)

Tricuspid

(Blood flow from right atrium to right ventricle)

108
Q

What closes during diastole

A

Aortic and pumonic valves

109
Q

Murmur Type:

Aortic Stenosis

A

Systolic murmur

110
Q

MurmurType:

Pulmonic stenosis

111
Q

Murmur Type:

Mitral Regurg

112
Q

Murmur Type:

Tricuspid Regurg

113
Q

Murmur Type:

Aortic Regurg

114
Q

Murmur Type:

Pulmonic Regurg

115
Q

Murmur Type:

Mitral Stenosis

116
Q

Murmur Type:

Tricuspid Stenosis

117
Q

Septal Defects

118
Q

Examination Technique:

JVP

A
  • Raise HOB 30 degrees
  • Turn patient’s head gently to the left
  • Find the top point of pulsation
  • Place centimeter ruler on sternal angle
  • place tongue blade from the top of JVP to ruler (right angle)
  • Read distance above sternal angle (3-4cm is normal)
119
Q

Palpation of brisk carotid upflow

120
Q

Palpation of delayed carotid upstroke

A

Suggests aortic stenosis

121
Q

Palpation of bounding carotid upstroke

A

Suggests aortic insufficiency

122
Q

Why should you auscultate carotid arteries

A

Check for bruits

123
Q

Thrills

A

Turbulence produced by damaged valve that can be palpated on chect wall as a vibration

124
Q

Where should you palpate for thrills

A

Aortic, pulmonic, left parasternal, and apical areas

125
Q

How do you assess PMI

A

Palpate with finger pads at the apex of the heart

(best felt in left pateral position)

126
Q

Normal PMI amplitude

A

Brisk or tapping

127
Q

Sustained PMI

A

Suggests LV hypertrophy from aortic stenosis or HTN

128
Q

Diffuse PMI

A

Suggests dialated ventricle from, CHF or cardiomyopathy

(diameter greater 3cm)

129
Q

When assessing PMI what should be noted

A

Location

Amplitude

Duration

Diameter

130
Q

Patient complains of paroxysmal nocturnal dyspnea

A

Suggests LV heart failure, mitral stenosis, nocturnal asthma attacks

131
Q

Typical causes of dependent edema

A

CHF, hypoalbuminemia

132
Q

Edema in nephrotic syndrome

A

Periorbital, tight rings

133
Q

Edema in liver failure

A

Abdominal (ascites)

134
Q

Stroke risk factors unique to women

A

pregnancy, hormone therapy, early menopause

135
Q

Global risk factors to assess for CVD risk

A
  • Family history of premature CVD
  • Smoking
  • Poor DIet
  • Physical Inactivity
  • Obesity
  • HTN
  • Dyslipidemias
  • Diabetes
  • Pulse
136
Q

Conditions which cause elevated JVP

A
  • Acute and chronic right and left sided heart failure
  • tricuspid stenosis
  • chronic pulmonary hypertension
  • superior vena cava obstruction
  • pericardial disease such as tamponade or constrictive pericarditis
137
Q

Venous pressure appears elevated on expiration only

A

Obstructive lung disease, not an indicator of heart failure

138
Q

What does an elevated JVP indicate

A

Increased risk of death from heart failure

139
Q

Pulse in cardiogenic shock

A

Small, thready, or weak

140
Q

Intensity of heart sounds at the apex

A

S1 is louder than S2

141
Q

Intensity of heart sounds at the base

A

S2 is louder than S1

142
Q

Systole

A

Period between S1 and S2

143
Q

Diastole

A

Period between S2 and S1

144
Q

If S3 is present, when is it heard

A

Just after S2

145
Q

If S4 is present, when is it heard

A

Just before S1

146
Q

When would you expect S1 to be diminished

A

1st degree heart block

147
Q

When would you expect S2 to be diminished

A

Aortic stenosis

148
Q

What is a useful tool for timing the sound of a murmur?

A

Palpation of carotid artery while auscultating

(sounds/murmurs coinciding with the upstroke are systolic. Sounds/murmurs heard after upstroke are diastolic)

149
Q

How do you palpate for thrills

A

Press the ball of your hand firmly on the chest to check for buzzing or vibration

150
Q

Why place patient in left lateral position

A

Brings left venricle closer to chest wall

Accentuates mitral murmurs

151
Q

What to assess while patient is in left lateral position

A

palpate PMI

auscultate tricuspid and mitral heart sounds

152
Q

Technique for auscultation while in left lateral position

A

Lightly place bell on the apical pulse

153
Q

How can you accentuate aortic murmurs

A

Have patient lean forward, exhale completely, and hold breath

Listen at the right and left sternal borders with the diaphragm

154
Q

Timing of murmur refers to

A

whether it is diastolic or systolic

155
Q

Duration of murmur refers to

A

Whether it is early mid or late in either systolic or diastolic cycles

156
Q

Grade 1 murmur

A

only detected after very careful auscultation

157
Q

Grade 2 murmur

A

Soft murmur that is readily evident

158
Q

Grade 3 murmur

A

Moderately intense

159
Q

Grade 4 murmur

A

Loud murmur with no palpable thrill

160
Q

Grade 5 murmur

A

Loud murmur with palpable thrill. Cannot be heard without auscultation

161
Q

Grade 6 murmur

A

Loud with palpable thrill. Does not require auscultation to be heard

162
Q

What characteristics should be used to describe heart murmurs

A

Quality

(Harsh, musical, soft, bowing, etc)

Pitch

(high, medium, low)

Location

(anatomical location where it is best heard)

163
Q

Murmur heard over pulmonic region between S1 and S2

A

Systolic pulmonic stenosis

164
Q

Murmur heard over pulmonic region between S2 and S1

A

Diastolic pulmonic regurg

165
Q

Murmur heard over tricuspid area between S1 and S2

A

Systolic tricuspid regurg

166
Q

Murmur heard over tricuspid area between S2 and S1

A

Diastolic tricuspid stenosis

167
Q

Murmur heard over mitral are between S1 ans S2

A

Systolic mitral regurg

168
Q

Murmur heard over mtral area between S2 and S1

A

Diastolic mitral stenosis

169
Q

Murmur heard over aortic region between S1 and S2

A

Systolic aortic stenosis

170
Q

Murmur heard over aortic region between S2 and S1

A

Diastolic aortic regurg

171
Q

peripheral signs of venous insufficiency

A
  • Hyperpigmentation
  • edema
  • cyanosis
  • venous stasis ulcers
172
Q

Peripheral signs of arterial insufficiency

A
  • intermittent claudication
  • peripheral extremity hair loss
  • coldness
  • numbness
173
Q

1+ pulse

A

Diminished, weaker than expected

174
Q

2+ pulse

A

Brisk, expected

175
Q

3+ pulse

176
Q

4+ pulse

177
Q

Pulse sites

A
  • Radial
  • Brachial
  • Femoral
  • carotid
  • popliteal
  • dorsalis pedis
  • posterior tibial

Advanced Assessment (8 decks)

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