CPD Written Midterm Flashcards
What are the signs of Respiratory Distress?
Cyanosis, tachypnea, tri-pod position, use of accessory breathing muscles
What are the signs of Cardiac Distress?
Chest pain (may radiate to arm or jaw), clutching, sweating, nausea
What are the signs of Toxic Distress?
anxious, sweating, flushed, febrile, tachypneic, tachycardic, behavioral changes, obtundation (delirium)
What are the Danger ranges of Blood Pressure?
above 180mmHg systolic & above 120mmHg diastolic is a hypertensive crisis.
What are the Danger ranges of Pulse Rate and Respiration Rate?
Bradycardia: below 60 bpm Tachycardia: above 80 bpm Tachypnea: above 20 rpm, Hyperpnea: deep rapid breaths Apnea: suspension of breathing
What are the Danger ranges of Temperature?
Hypothermia: less than 35°C (95°F)
Fever: 41°C (106°F) and above is a medical emergency
above 40°C (104°F) can be life threatening
above 39°C (102°F) can cause convulsions
What are the Danger ranges of Body Mass?
below 18.5 is underweight
above 25 is overweight
above 30 is obese
above 40 is morbidly obese
Why is it important to palpate the radial pulse while taking blood pressure?
So that the systolic BP is not underestimated and diastolic BP is not overestimated due to a region lacking pulse sounds.
What is the significance of skin discoloration, whether hypo, hyper, bluish, yellowish, etc.?
Hypopigmentation: vitiligo, anemia
Hyperpigmentation: Addison’s diesease
Erythema (red): infection, inflammation, fever
Cyanosis (blue, dusky):
- central-mouth, lips: COPD, Heart Disease
- peripheral-nail beds: Raynaud’s disease
Jaundice (yellow/orange):
- sclera, skin: hepatitis, carotenemia, uremic frost (KD Dz)
What are the 6 (+2) descriptors of skin lesions?
- Number
- Size
- Color
- Type
- Margination
- Shape
- Configuration
- Location/distribution
What are the 5 signs of a suspicious skin lesion?
Asymmetry Border irregularity Color variation Dimension larger than 6mm Evolving - change in size, shape, color, elevation, bleeding, itching, etc.
What kind of rashes are emergency conditions?
- Meningitis: purple or red spots on trunk or lower extremities with fever, headache, neck stiffness, altered mental status
- Pemphigus Vulgaris: large blisters or bullae caused by autoimmune dz against desmoglein in epidermis that can become infected
- Ulcers (skin):
- arterial insufficiency: painful, dependent rubor, where skin rubs
- venous insufficiency: not as painful, stasis dermatitis (brown)
- diabetic: numb (neuropathy), arterial, weight-bearing - Cellulitis: staph or strep infxn of skin or connective tissue, can lead to sepsis
- MRSA: Methicillin-resistant Staph - fever, red bumps, painful boils, can lead to sepsis or pneumonia
- Viral Exanthems: (reportable) Measles, Mumps, Rubella, Erythema infectiosum, Roseola infantum, Chickenpox, Viral hemorrhagic fever, Rocky Mountain spotted fever
- Stevens-Johnson Syndrome: immune rxn (drug or infxn) fever, skin & mucosal ulcers, can lead to epidermal necrosis
- Necrotizing fasciitis: at site of trauma, infxn spreading across fascial plane
What are normal and abnormal breath sounds?
Normal:
Bronchial: over large airways
Bronchovesicular: over transitional areas
Vesicular: over distal airways
Abnormal or Adventitious breath sounds:
Wheezing: whistling through narrowed airways
Crackles: alveoli popping open on inspiration
Rhonchi: low pitched bubbles or wheezes in upper airways
Pleural Friction Rub: leathery sounds in chest wall
Bronchial breathing: loud breath in vesicular regions
Absent sounds: no breath sounds
What is egophony and what does it test for?
Having a patient say E while auscultating over the lungs. If E changes to A, it is a positive sign for consolidation of tissue, usually due to pneumonia
What colors of sputum are a “red-flag” and why?
Hemoptysis: red or brown blood flecks are streaks
- smokers, pneumonia, lung cancer (late), tuberculosis
Clear: common cold, allergies, GERD, smoking, post-nasal drip
Yellow: (inflammatory) allergies, viral or bacterial infxn, asthma
Green: bacterial infxn, tuberculosis, post-nasal drip
What is pleuritic chest pain and why is it important?
Sharp localized pain on inhalation or coughing can be life-threatening if due to to: - Bacterial or viral infxn - Pneumothorax - Advanced Lung Cancer - Chest injury - blunt trauma, rib fracture - Pulmonary embolism - Herpes Zoster - vesicular rash
What are some common pulmonary conditions?
Asthma: recurrent reversible airflow obstruction
COPD: chronic bronchitis or emphysema
Bronchitis: inflammation of mucus membranes in bronchi
Pneumonia: infection in alveoli
Tuberculosis: granulomatous bacterial lung infection
Pulmonary embolism: clot in pulmonary artery
Acute Respiratory Distress Syndrome: acute onset of lum parenchymal inflammation leading to hypoxia
Pneumothorax: air or gas in pleural space
Pleural Effusion: fluid (serous, blood, pus) in pleural space
Lung Cancer: chronic cough, hemoptysis, weight loss, dyspnea
What creates the normal cycles of heart sounds?
S1 (lub): closure of Mitral and Tricuspid valves
S2 (dub): closure of Aortic and Pulmonic valves
What are some possible abnormal heart sounds?
Splitting of S1 or S2: pathological if S2 split persists on expiration
S3: after S2 (Lub Dub da) - Congestive Heart Failure
S4: before S1 (ta Lub Dub) - CHF or MI (heart attack)
Murmurs:
- Regurgitation: valve not fully closing
- Stenosis: valve not fully opening
Pericardial friction rub: leathery murmur
Arrhythmias: irregularly irregular heart rhythm
Palpitations: sense of heart pounding, skipping, racing
Cardiogenic Heart Pain:
- Angina: Reversible
- Myocardial Infarction: heart attack (irreversible)
When is it important to perform special heart exams?
If you hear additional sounds, you can position the patient or do a hemodynamic maneuver
1) Have patient sit up, lean forward and hold breath to hear aortic or pulmonic (base or top of heart) sounds better.
2) Have patient roll onto left side to hear tricuspid or mitral sounds better
3) Have the patient “bear down” (Valsalva maneuver) to see how it changes a murmur.
Why is a change in PMI important?
Lateralized or wide PMI suggests heart enlargement (cardiomyopathy, CHF)
What are common cardiovascular conditions?
A. Coronary artery disease (CAD): build up of plaque in the coronary arteries, leading to cardiac ischemia. Reversible in case of Angina (recurrent chest pain on exertion, relieved with rest.) Leading cause of death worldwide.
B. Myocardial Infarction (MI): rupture of plaque, blockage of coronary artery or vasospasm leading to irreversible ischemia and thus damage to heart muscle Atypical symptoms: back pain, nausea, and vomiting, indigestion, weakness, dizziness
C. Sudden Cardiac Death (SCD): rapid and unexpected death from cardiac causes. Typically from coronary atheroma, ventricular hypertrophy, ventricular fibrillation
D. Peripheral vascular disease (PVD): obstruction or narrowing of peripheral arteries leading to poor tissue oxygenation. Common in diabetics, smokers, hypertension, high lipids
SSx: intermittent claudication (pain, cramping, numbness in muscles), poor hair growth, change on coloration (pale or blue), painful ulcers
E. Cardiomyopathy: disease of the heart muscle—typically thickening in response to changes in function, eg hypertension. Can lead to arrhythmias and sudden cardiac death.
F. Congestive Heart Failure (CHF): inability of heart to keep up with demands. Associated with ischemic heart disease, hypertension, smoking, diabetes, valve disease SSx: fatigue, SOB, orthopnea, peripheral edema, hepatomegaly, ascites, S3, S4, laterally displaced PMI
G. Pericarditis: inflammation in pericardium from infection, trauma
SSx: chest pain, dry cough, fever, fatigue, friction rub
H. Mitral Valve Prolapse (MVP): billowing of mitral leaflet into L atrium during systole, presenting as a click or murmur. Depending on severity, may be no complications or may progress to regurgitation, CHF or arrhythmias. On Valsalva, the sounds get louder
I. Atrial Fibrillation (AF): irregular conduction of electrical impulses to the ventricles. Can be asymptomatic, but typically: tachypnea, palpitations, light-headedness
J. Endocarditis: Often referred to as “subacute bacterial endocarditis.” Inflammation of the inner layer of the heart typically involving the valves, septum and chordae tendineae. If infective form the organism is often streptococcus viridans which populates the mouth and throat. This is why individuals with heart murmurs need antibiotics prior to dental work.
What are concerning findings on the gums?
Gingivitis: inflammation of gum tissue usually caused by plaque/bacterial biofilm
Dental abscess: Tooth infection leading to pus enclosed in the tooth root in jaw, tooth or jaw pain. Serious cases can lead to cavernous sinus thrombosis—emergency!
Leukoplakia: firmly attached white patches on the mucous membranes of the oral cavity. Leukoplakia is a premalignant lesion, often leading to oral cancer.
What are concerning findings on the tonsils?
Tonsillitis: swelling of tonsils from bacteria, viruses. Lymph nodes swollen. Common cause is streptococcus (GABHS=group A beta-hemolytic Strep), which if not treated well can lead to serious sequelae to heart or kidneys (rheumatic fever)
Centor criteria used as clinical guide: absence of cough, swollen/tender anterior chain lymphadenopathy, fever, tonsillar exudate (pus)
