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NURP 530 Adv Health Assessment > Exam 2 > Flashcards

Exam 2 Flashcards

HEENT, CV, PV, Thorax and Lungs

1
Q

Erb’s point

A

3rd ICS on the left sternal border

best heard in the left lateral recumbent position

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2
Q

Mitral area

A

Also apex of the heart, best auscultated on the 5th ICS, at MCL

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3
Q

S3 - other name, best heard

common in? pathologic in?

causes?

A

Best heard with bell of stethoscope in the mitral/apical area, in early diastole, with person in left lateral decubitus position

  • When rapid filling ends and slow filling starts

A PHYSIOLOGIC S3 is common in young people (to age 35-40), last trimester of pregnancy, and athletes In older people, may be associated with volume overload

A PATHOLOGIC S3, or ventricular gallop, is abnormal in people over age 40 (high ventricular filling pressures and abrupt deceleration of inflow across the mitral valve at the end of rapid filling phase of diastole)

Causes include decreased myocardial contractility, HF and ventricular volume overload from aortic or mitral regurgitation, and left-to-right shunts.

KENTUCKY

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4
Q

S4 - other name, best heard

A

Atrial gallop

Occurs in late diastole, due to atrial contraction, right before S1, due to pressure overload

Heard in mitral/apical area, in left lateral recumbent position, with bell

May sometimes occur in people over 40 after exercise

However, almost always pathological including hypertension, aortic stenosis, and ischemic and hypertrophic cardiomyopathy.

TENNESSEE

“be lub dub” (s1 s4 s2)

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5
Q

S1 is louder than S2

A

At the apex (5th ICS at MCL)

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6
Q

S2 is louder than S1

A

At the base

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7
Q

Abnormal JVP # in cm’s

causes?

A

> 3 cm above the sternal angle or more than 8 cm in total distance above the right atrium

Elevated JPV 95% specific for: increased L ventiruclar end diastolic pressure and low L ventricular EF

May correlate with:

acute and chronic HF, tricuspid stenosis, chronic pulmonary HTN, SVC obstruction, cardiac tamponade and constrictive pericarditis.

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8
Q

Where JVP is best assessed

A

From pulsations in the RIJV, which is directly in line with the SVC and RA.

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9
Q

When to begin screening for cardiovascular risk factors

A

Age 20 for individual risk factors or “global” risk of CVD and for any family history of premature heart disease (age < 55 in first-degree male relatives and age < 65 in first-degree female relatives)

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10
Q

Atypical acute coronary syndrome symptoms in women

A

Particularly in age > 65, upper back, neck or jaw pain, SOB, PND, n/v, and fatigue

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11
Q

Carotid upstroke always occurs in…

A

systole immediately after S1 so sounds or murmurs coinciding with the upstroke are systolic, those after are diastolic

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12
Q

Grade 1 murmur

A

Very faint, heard only when listener is tuned in, may not be heard in all positions

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13
Q

Grade 2 murmur

A

Quiet, but heard immediately after placing the stethoscope on the chest

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14
Q

Grade 3 murmur

A

Moderately loud

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15
Q

Grade 4 murmur

A

Loud, with palpable thrill

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16
Q

Grade 5 murmur

A

Very loud, with thrill. May be heard when the stethoscope is partly off the chest

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17
Q

Grade 6 murmur

A

Very loud, with thrill. May be heard with stethoscope entirely off the chest

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18
Q

PMI best palpated…

A

when patient is in the left lateral decubitus position if not found in supine position, may help if s/he stops breathing while you check location, diameter, amplitude and duration

Lateral displacement toward the axillary line from ventricular dilatation is seen in HF, CMY and ischemic heart disease.

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19
Q

PMI diameter

A

< 3 cm or size of a quarter, occupies one interspace May feel larger in left decubitus position A diffuse PMI of > 3 cm may singal LV enlargement, > 4 cm LV overload 5 x more likely

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20
Q

PMI amplitude

A
  • Brisk, tapping, diffuse or sustained?
  • Normal: small in diameter and brisk and tapping
  • Abnormal: one example - hyperkinetic high-amplitude impulse occurs in hyperthyroid, severe anemia, pressure overload of LV from HTN or AS, or volume overload of the LV from AR
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21
Q

PMI duration

A
  • Normal: Lasts through 2/3 of systole or less
  • Abnormal: example, sustained high-amplitude impulse may indicate LVH
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22
Q

Stethoscope DIAPHRAGM

A

better for picking up high-pitched sounds of S1 and S2, murmurs of aortic and mitral regurgitations and pericardial friction rubs

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23
Q

Stethoscope BELL

A

more sensitive to low-pitched sounds of S3 and S4 and the murmur of mitral stenosis

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24
Q

Auscultating for MITRAL STENOSIS

A

Pt in left lateral decubitus position, place bell of stethoscope lightly on the apical impulse (may also hear S3 and S4 and mitral murmurs)

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25
Q

Auscultating for AORTIC REGURGITATION

A

Pt sits up, leans forward, exhales completely and stop breathing after exhalation. Place diaphragm on the left sternal border and at the apex, pausing so that patient can breathe

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26
Q

Split S1

A

Delayed closure of the tricuspid valve, best heard in the lower left sternal border

Is not affected by respiratory cycle

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27
Q

Diastolic murmurs

A

usually represent valvular heart disease

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28
Q

Systolic murmurs

A

may correlate with valvular heart disease but can be physiologic flow murmurs arising from normal heart valves

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29
Q

Murmur of aortic stenosis radiates to

A

carotids, down left sternal border, even to apex (if severe = radiates to 2nd and 3rd interspaces)

carotid upstroke is delayed

intensity, soft but can be loud (4/6 or more)

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30
Q

Murmur in mitral regurgitation radiates to

A

left axilla

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31
Q

Murmur descriptors

A
  1. S - Site: location of maximal intensity
  2. C - Characteristic: Crescendo, descrecendo, crescendo-decresendo, plataeu
  3. R - radiates?
  4. I - intensity (grades) 1-6, 4-6 requires thrill
  5. P - pitch: high, medium, low
  6. T - Timing - systolic or diastolic
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32
Q

Fully described murmur

A

best heard in the 4th left interspace

blowing decrescendo

with radiation to the apex (aortic regurgitation)

grade 2/6

medium-pitched

diastolic murmur

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33
Q

Peripheral artery disease defined

A

as atherosclerotic disease distal to the aortic bifurcation, some guidelines also include the abdominal aorta

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34
Q

Key components of Peripheral Arterial Exam

A
  1. measure BP in both arms
  2. palpate carotid upstroke, auscultate for bruits
  3. auscultate for aortic, renal and femoral bruits, palpate the aorta and assess its maximal diameter
  4. Palpate the pulses of brachial, radial, ulnar, femoral, popliteal, DP, and PT arteries
  5. Inspect ankles and feet for color, temp, skin integrity
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35
Q

Signs of heart failure in infants

A

tachypnea, tachycardia and hepatomegaly

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36
Q

Noncardiac Signs of cardiac disease in infants

A
  • Poor feeding
  • FTT
  • Irritability
  • Tachypnea
  • Hepatomegaly
  • Clubbing
  • Poor overall appearance
  • Weakness
  • Fatigue
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37
Q

Split S2 in neonates

A

Detected in silence or when baby asleep

Its detection eliminates many, but not all, of the more serious congenital cardiac defects

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38
Q

S3 - Third heart sounds in children

A

Represent rapid ventricular filling

Normal in children

Should be differentiated from third heart sound gallop (pathologic)

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39
Q

Fourth heart sounds in children

A

NOT common

Suggest HF

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40
Q

Murmurs in infants

A

Benign if not other non-cardiac signs present, disappear by age 1 year

Pathological with other physical findings

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41
Q

Coarctation of the aorta

A

Blood pressure is lower in legs than arms (when normally, BP in legs should be higher in arm)

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42
Q

Still’s murmur

A
  • Grade 1-2/6
  • Benign murmur present in pre-school or school age children -
  • musical, vibratory, early and midsystolic murmur with multiple overtones located over mid or lower LSB; carotic artery compression will usually cause the precordial murmur to disappear.
  • Extremely variable; accentuated with exercise
  • May be heard with a carotid bruit which may be eradicated with carotid artery compression
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43
Q

Examples of pathological murmurs that appear in infancy and childhood

A

Aortic stenosis (systolic, crescendo-decrescendo, aortic area),

and Mitral Valve Disease e.g. MR, MVP, MS

MR - systolic, pansystolic, mitral area

MV prolapse - systolic, midsystolic click with late systolic murmur, mitral area

MS - diastolic, opening snap plus mid-diastolic rumble, mitral area

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44
Q

Benign murmur in adolescents

A

pulmonary flow murmur (chronic anemia or following exercise)

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45
Q

Pneumatic otoscope

A

tool that allows to assess mobility of the tympanic membrane

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46
Q

Rinne test

A

Compares bone conduction and air conduction and determines whether hearing loss is conductive vs. sensorineural

Normal: Air conduction > bone conduction

Conductive loss: Bone conduction >= to air conduction in bad ear

Sensorineural loss: AC > BC in both good and bad ears

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47
Q

hypertensive retinopathy

A

vascularity cross over into cup and disc

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48
Q

Recommendations of flu vaccine

A

Should be prioritized for pregnant and postpartum women, residents of nursing homes and LTC facilities, American Indians and Alaska natives, healthcare personnel, and household contacts less than/equal to 5 and greater than/equal to 50

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49
Q

left homonymous hemianopsia

A

can’t see on left side on both eyes

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50
Q

Recommendations of pneumonia vaccine

A

65 and older,

19-64 smoker or asthma,

2+ who are immunocompromised

residents of nursing homes or LTC facilities

adults 2-64 years with SCD, CV and pulmonary disease, DM, ETOH, cirrhosis, cochlear implants and leaks of CSF

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51
Q

paroxysmal nocturnal dyspnea

A

cardiac in nature, sob at night which is relieved by sitting up

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52
Q

pupillary responses

A

convergence, accomodation, the near reaction and the light reaction

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53
Q

LDCT annual for lung CA

USPSTF vs American Cancer society

A

Per USPSTF: 50-80 year old with 20 pack year smoking hx or currently smoking or have quit w/in 15 years

Per American Cancer Society: 55-74 year old with 30 pack year or have quit w/in 15 years

STOP screening once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability to or willingness to undergo invasive diagnostic procedures or to have curative treatment

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54
Q

pneumonia

A

pain with deep inspiration, purulent sputum, fever

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55
Q

weber test

A

Test assesses for lateralization in unilateral hearing loss

Conductive Loss: Lateralizes to bad ear

Sensorineural Loss: Lateralizes to good ear

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56
Q

aortic stenosis

A

midsystolic murmur, diminished S2, thrill transmitted to the carotid artery from the 2nd intercostal space

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57
Q

papilledema

A

bulging disc, related to high ICP

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58
Q

rib fracture

A

Upon examination, with one hand on the sternum and the other on the thoracic spine, the FNP squeezes the chest. This results in the patient’s local pain (distant from your hands)

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59
Q

heart failure: JVP measurement, carotid upstrokes and sound over carotid

A

JVP is 5 cm, carotid upstrokes are brisk, bruit is heard over carotid artery

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60
Q

Screening recommended for athletes

A

screening for risk factors and family history, history and physical

no imaging needed unless significant risk factors noted on exam

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61
Q

Heart failure with LVH

A

sustained PMI, elevated JVP, isolated systolic hypertension, widened pulse pressure

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62
Q

carotid upstroke/downstroke (or contour of the pulse wave)

A

Pressing inside the medial border of a relaxed SCM muscle, at the level of the cricoid cartilage while slowly increasing pressure until you feel a maximal pulsation; then slowly decrease pressure until you best sense the arterial pressure and contour will allow to assess this

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63
Q

croup

A

2 day history mild rhinorrhea, low grade fever, cough worse early in AM, inspiratory stridor, positive Hoover’s sign (indrawing of the chest wall)

Also known as laryngotracheal bronchitis usually due to viral cause

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64
Q

epiglottitis

A

child sitting stiffly in tripod position, difficulty swallowing saliva, sore throat, rarely seen thanks to the Hib vaccine

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65
Q

mitral valve prolapse

A

often preceded by midsystolic click with late systolic murmur, persistent til 2nd heart sound

best heard in mitral area

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66
Q

The setting sun sign

A

occurs with hydrocephalus when anterior fontanelles is bulging and eyes are deviated downward revealing upper scleras

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67
Q

substernal retractions

A

types of retractions

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68
Q

early systolic ejection sounds

A

Occur shortly after S1 Relatively high in pitch - best heard with diaphragm

Aortic ejection sound - heard at base and apex (louder), does not vary with respiration - indicative of dilated aortic, aortic valve disease or a bicuspid aortic valve

Pulmonic ejection sound - heard best in LEFT 2nd and 3rd ICS - intensity decreases with inspiration - indicative of dilatation of PA, pulm HTN, and pulmonic stenosis.

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69
Q

Systolic clicks

A

usually caused by MVP

Clicks are usually mid- to late-systolic

Heard medial to apex or at the left sternal border - heard best with diaphragm - may be followed by late systolic murmur from mitral regurg that crescendos up to S2

Squatting delays the click and murmur due to increased venous return.

Standing moves them closer to S1

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70
Q

Opening snap

A

MITRAL STENOSIS

Heard very early diastolic sound caused by abrupt deceleration during opening of a stenotic MV

Best heard medial to apex and along lower LSB

High pitch and snapping quality

Heard best with diaphragm

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71
Q

AHA CV Risk Categories for Women HIGH

A

>=1 of CHD, CVD, PAD, AAA, DM or ESRD or 10-year predicted risk of > 10%

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72
Q

AHA CV Risk Categories for Women AT RISK

A
  • >=1 major risk factor incl smoking, bp >=120/>=80 or treated HTN, total cholesterol >= 200, HDL < 50 or treated dyslipidemia obesity, poor diet, physical inactivity or family hx of premature CVD
  • evidence of advance subclinical atherosclerosis, metabolic syndrome or poor exercise capacity on a treadmill test
  • systemic autoimmune collagen vascular disease e.g. lupus or rheumatoid arthritis
  • history of preeclampsia, GD, pregnancy-induced HTN
73
Q

AHA CV Risk Categories for Women IDEAL

A
  • Total (untreated) cholesterol < 200
  • (untreated) BP < 120/80
  • (untreated) FBG < 100
  • BMI < 25
  • Non-smoking
  • Physical activity: 150 minutes per week moderate intensity or 75 minutes/week vigorous intensity or combo
  • Healthy diet
74
Q

Cyanotic heart diseases

A

DANGEROUS Pulmonary artery stenosis Pulmonary atresia Tetralogy of Fallot Tricuspid atresia Trunkus arteriosus Hypoplastic left heart syndrome Transposition of great arteries

75
Q

Acyanotic heart diseases

A

OK PDA Atrial septal defect Ventricular septal defect Coarctation of aorta Aortic stenosis Pulmonary artery stenosis (mild) PFO - may remain open after birth

76
Q

Identify this Eye Picture

A

Papilledema

Swelling of the optic disc and anterior bulging of the physiologic cup

a/s with IICP

77
Q

Name this Eye Picture

A

Glaucomatous cupping

Death of optic nerve fiblers leads to loss of the tiny disc vessels

Increased intraocular pressure within eye leads to increased cupping (backward depression of the disc) and atrophy.

The base of the enlarged cup is pale.

78
Q

Name this Eye Photo

A

Normal

Color yellowish orange to creamy pink

Disc vessels tiny

Disc margins sharp (except perhaps nasally)

Physiologic cup is located centrally or somewhat temporally. It may be conspicuous or absent. Its diambeter from side to side is usually less than half that of the disc.

79
Q

Name this Eye Photo

A

Hypertensive retinopathy

Marked arterial-venous crossing changes are seen, especially along the inferior vessels. Copper wiring of the arterioles is present.

Other possible characteristics are Concealment or AV nicking, banking, and tapering

80
Q

Name this Eye Photo

A

Diabetic retinopathy

deep retinal hemorrhages; microaneurysms and neovascularization (new blood vessels)

soft exudates: cotton wool spots (diabetes)

hard exudates

81
Q

Name this Eye Photo

A

Drusen

Yellowish round spots that vary from tiny to small.

Edges may be soft or hard.

They are haphazardly distributed.

Seen in normal aging and age-related macular degeneration.

82
Q

Name this Eye Photo

A

Esotropia (intermittent alternating convergent strabismus)

Developmental disorder

Usually appears in early childhood

[Note: exotropia is intermittent alternating DIVERGENT strabismus]

83
Q

Name this visual field defect

A

Left homonymous hemianopsia

A complete interruption of fibers in the optic radiation, produces a visual defect similar to that produced by a lesion of the optic tract

84
Q

Coarctation of aorta

A

Blood pressure of upper extremities is higher than blood pressure in lower extremities

85
Q

Conductive hearing is caused by

“conducting bad behavior”

A

Hearing disorders of external and middle ear such as:

Cerumen impaction, infection (otitis externa), trauma, SCC and benign bony growths such as exostoses or osteomas.

Middle ear disorders include otitis media, congenital conditions, cholesteatomas and otosclerosis, tumors and perforation of the TM.

Weber: Lateralizes to bad ear

Rinne: bone conduction is equal or longer than air conduction

86
Q

Sensorineural hearing loss is caused by

A

disorders of the inner ear from congenital and hereditary conditions such as

presbycusis, viral infections such as rubella and cytomegalovirus, Meniere disease, noise exposure, ototoxic drug exposure and acoustic neuroma.

Weber test: sound lateralizes to good ear

Rinne test: sound is heard longer through air (AC > BC)

87
Q

Anxiety with hyperventilation: symptoms and relieving factors

A

Sighing, lightheadedness, numbness or tingling of the hands and feet, palpitations, chest pain

Other possible manifestations: chest pain, diaphoresis, palpitations

Relieving factors: breathing in and out of a paper or plastic bag may help

88
Q

Intermittent claudication

A

Pain or cramping in legs during exertion that is relieved by rest within 10 minutes

Caused by narrowing or blockage in the main artery taking blood to your leg due to hardening of the arteries (atherosclerosis).

Usually in age 50+, with higher incidence in smokers, those who have diabetes, heart diease or elevated cholesterol.

Tx: Modification of risk factors, exercise, e.g. structured walking program, medications, angioplasty, bypass surgery

89
Q

Neurogenic claudication

A

Pain with walking or prolonged standing

Radiating from the spinal area into the buttocks, thighs, lower legs or feet

Is a type of intermittent claudication

90
Q

Carotid upstroke is delayed in…

A

aortic stenosis

91
Q

Carotid pulse is bounding in…

A

aortic regurgitation

92
Q

Carotid pulse is small, thready or weak in…

A

cardiogenic shock

93
Q

Carotid bruit indicates…

A

aortic stenosis, mitral regurgitation, PDA or coarctation of the aorta

94
Q

Rhinosinusitis s/s

A

purulent nasal drainage, facial pain increases with valsalva maneuvers and leaning forward

95
Q

Pupillary light reactions

A

direct light reaction, consensual reaction to light

CN II, CN III

96
Q

Absence of red reflex indicates

A

opacity of the lens (cataract), vitreous, and less commonly, detached retina

or, in children, retinoblastoma

97
Q

Opthalmoscope settings

A

0: to view fundus

+10 or +12: to view anterior structures such as vitreous and lens

98
Q

Leukoplakia

A

A thickened white patch occurring anywhere in oral mucosa. This benigh reactive process of the squamous epithelium may lead to cancer and should be biopsied.

99
Q

Diffuse enlargement of the thyroid can be caused by…

A

Graves disease, Hashimoto thyroiditis, and endemic goiter

100
Q

Where is stridor the loudest?

A

over the neck

101
Q

S1 sound indicates…

A

indicates closure of the mitral valve

102
Q

S2 sound indicates…

A

closure of the aortic valve

103
Q

Sudden dyspnea occurs in…

A

PE, spontaneous PTX and anxiety

104
Q

Xiphoid process is most prominent in…

A

newborns and young infants

105
Q

Newborn or child with possible abnormal facies, carefully review…

A
  • family history
  • pregnancy
  • perinatal history
106
Q

Pneumonia in infants s/s

A

abnormal work of breathing (nasal flaring, grunting, retractions), fever, tachypnea, dyspnea, plus abnormal findings on auscultation such as crackles rule in PNA

Best symptom in ruling OUT pneumonia: absence of tachypnea

[Note: rhonchi indicate upper respiratory infections and wheezing occur normally in asthma or bronchiolitis]

107
Q

PDA or patent ductus arteriorosus s/s

A

continuous murmur begin in systole into diastole (s2), with silent interval late in diastole

due to hole

associated with hyperdynamic precordium and bounding distal pulses

108
Q

In infants/children,

a true gallop rhythm s/s

A

tachycardia plus a loud S3, S4 or both

Pathologic and indicate HF (poor ventricular function)

109
Q

Children: Adenoidal hypertrophy

A

Nasal voice plus snoring

110
Q

Children: hypernasal speech

A

submucosal cleft palate

111
Q

Children: hoarse voice plus cough

A

viral infection (croup)

112
Q

Childhood asthma s/s

A

Increased work of breathing, expiratory wheezing and a prolonged expiratory phase.

Wheezes are often accompanied by inspiratory rhonchi.

Asthma flares often occur with viral infections.

113
Q

In pediatric population

A

4th heart sounds represent decreased ventricular compliance, suggesting heart failure

114
Q
A
115
Q

chest pain: angina pectoris

location?

quality?

problem r/t to?

timing?

aggravate?

factors that relieve?

symptoms?

A
  • retrosternal, anterior chest, radiates to shoulders, armss, neck, lower jaw, upper abdomen
  • quality: pressing, squeezing, heavy, burning
  • problem: cardiovascular
  • severity: mild - moderate ; discomfort rather than pain
  • timing: 1-3 mins but up to 10 mins; can be up to 20 mins
  • aggravate: exertion, colds, meals, emotional stress, at rest
  • relieve: rest, nitroglycerin
  • sx’s: dyspnea, nausea, sweating

fist over sternum

116
Q

chest pain: mycardial infarction

problem r/t to?

location?

quality?

timing?

aggravate?

factors that relieve?

symptoms?

A
  • cardiovascular
  • retrosternal or chest radiating shoulders, arms, neck, lower jaw, upper abdomen
  • pressing, squeexing, tight, heavy, burning
  • severity: not always a severe pains
  • 20 mins to few hrs
  • not always triggered by exertion
  • not relieved by rest
  • sx’s: dyspnea, nausea, vomiting, sweating, weakness
117
Q

chest pain: pericarditis

problem r/t to?

location?

quality?

timing?

aggravate?

factors that relieve?

symptoms?

A
  • cardiovascular
  • retrosternal or left precordial, radiate to tip of left shoulder
  • sharp, knife like
  • severe
  • persistent
  • aggravate: breathing, changing positions, coughing, lying down , swallowing
  • seen in autoimmune, post MI, viral infection, chest irradiation
118
Q

chest pain: aortic dissection

problem r/t to?

location?

quality?

timing?

aggravate?

factors that relieve?

symptoms?

A
  • cardiovascular
  • anterior or posterior chest, radiating to neck, back or abdm
  • ripping, tearing
  • very severe
  • abrupt onset, early peak, hrs +
  • aggravate: HTN
  • no relief
  • sx’s: if thoracic, Hoarseness dysphagia, also syncope, hemiplegia, paraplegia
119
Q

chest pain: pleuritic pain (inflamm of parietal pleura)

problem r/t to?

location?

quality?

timing?

aggravate?

factors that relieve?

symptoms?

A
  • pulmonary
  • chest wall
  • sharp, knife like
  • severe
  • timing: persistent
  • aggravate: deep inspiration, coughing, movements of trunk
  • no relief
  • sx’s: underlying illness
120
Q

What etiology? Dyspnea:

  • dyspnea progresses slowly
  • aggravate: lying down, exertion
  • relief: rest, sitting up, dypnea may be persistent
  • sx’s: cough, orthopnea, paroxysmal nocturnal dyspnea; wheezing
  • setting: hx of heart disease or predisposing factors
A

Left sided heart failure (L ventricular failure or mitral stenosis)

  • elevated pressure in pulmonary capillary bed w/ transduction of fluid into interstitial spaces and alveoli, decreased compliance (increased stiffness) of lungs, increased work of breathing
121
Q

What etiology? Dyspnea:

  • chronic productive cough then slow progressive dyspnea
  • aggrevate: exertion, inhaled irritants, respiratory infections
  • relief: expectoration; rest, though dyspnea persistent
  • sx’s: chronic productive cough, recurrent respiratory infection, wheezing
  • setting: hx of smoking, air pollutants, COPD
A

chronic bronchitis

  • excessive mucus production in bronchi, after chronic obstruction of airways
122
Q

What etiology? Dyspnea:

  • slowly, progressive dyspnea, mild cough later
  • aggravate: exertion
  • relief: rest, dyspnea peristent
  • sx’s: cough with scant mucoid sputum
  • setting: hx smoking, air pollutants
A

COPD

  • overdistention of air spaces distal to terminal bronchioles, with destruction of alveolar septa, alveolar and limitation of expiratory air flow
123
Q

What etiology? Dyspnea:

  • acute episodes, then sx’ free periods; nocturnal episodes
  • aggravate: allergens, irritants, respiratory infxns, exercise, cold, emotions
  • relieve: remove irritants
  • sx’s: wheezing, cough, chest tightness
  • setting: environmental
A

asthma

  • reverisble bronchial hyperresponsiveness; release of inflammatory medaitors, increased airway secretions, bronchoconstriction
124
Q

What etiology? Dyspnea:

  • progessive dyspnea; varies on the cause
  • aggravate: exertion
  • relief: rest; dyspnea persistent
  • sx’s: weakness, fatigue, (less common: cough)
  • setting: varied
A

diffuse interstitial lung diseaes

(sarcoidosis, widespread neoplasms, idiopathic pulmonary fibrosis, asbestosis)

  • abnormal & widespread infiltration of cells, fluid, collegen into interstitial spaces b/t alveoli; many causes
125
Q

What etiology? Dyspnea:

  • acute illness, timing depends on cause
  • aggravate: exertion, smoking
  • relief: rest, persistent dyspnea
  • sx’s: pleuritic pain, cough, sputum, fever (may not be present)
A

pneumonia

  • infection of lung parenchyma from respiratory bronchioles to the alveoli
126
Q

What etiology? Dyspnea:

  • sudden onset of tachypnea, dyspnea
  • aggravate: exertion
  • relief: rest, persistent dyspnea
  • sx’s: none, retrosternal oppressive pain if massive occlusion, pleuritic pain, cough, syncope, hemoptysis, and/or unilateral leg swelling and pain from instgating DVT, anxiety
  • setting: PP or post op; prolonged bed rest, HF, chronic lung disease, fractures of hip or leg, DVT, hypercoagulability, heredity or acquired (hormone therapy)
A

acute pulmonary embolism

  • sudden occlusion of part of pulmonary arterial tree by blood clot that usually originates in deep veins of legs or pelvis
127
Q

What etiology? Dyspnea:

  • episodic
  • aggravate: rest
  • relief: breathing in & out of paper bag
  • sx’s: sighing, lightheadedness, numbness or tingling of hands and feet, palpitations, chest pain
  • other manfestations of anxiety: chest pain, diaphoresis, palpitations
A

anxiety with hyperventilation

  • overbreahing, with resultant respiratory alkalosis and fall in aterial partial pressure of carbon dioxide (pCO2)
128
Q
A

exotosis: non malignant overgrowth blocking tympanic membrane

129
Q
A

tophi: deposit of uric acid crystals form chronic tophaceous gout
- hard nodules in helix or antihelix

chalky white

can be on joints, hands

130
Q
A

cutaneous cyst aka sebaceous cyst

dome shape lump in dermis forms a benign closed firm sac to epidermis

131
Q
A

basal cell carcinoma (teletangectious (tiny blood vessels)

in fair skin, overexposed to sunlight

132
Q
A

rheumatoid nodule

  • chronic RA, look for small lumps on helix or antihelix and nodules on hands and ulnar to elbow, knees, heels

ulceration from repeated injuries

133
Q
A
134
Q
A

preauricular skin tags/cysts

common

a/s with hearing deficits and/or renal problems

135
Q
A
136
Q
A

preauricular sinus/pit

a/s hearing loss, renal deveelopment issues (SCREEN & repeat screening!)

assess kidney

137
Q
A

normal TM

pinkish gray; malleus behind upper drum

138
Q
A

perforation of tympanic membrane

  • from infxn of middle ear

TM becomes scarred ; discharge may drain out; pain relief once perforates

139
Q
A

tympanosclerosis

scarring process of middle ear form otitis media from hyaline, Ca, phosphate crystal deposits in TM and middle ear

140
Q
A

serous effusion

  • viral upper respiratory infection (otitis media w/ serous effusion) or sudden changes in atmospheric pressure from flying or diving (otitic barotrauma) = eustachian tube can’t equalize air pressure in middle to outer ear
  • amber fluid; air bubbles
141
Q
A

acute otitis media with purulent effusion

  • S. pneumoniae or H influenzae
    sx: earach, fever, hearing loss

TM reddens, loses landmarks, bulges laterally towards eye

142
Q
A

bullous myringitis

  • painful hemorrhagic vesicles appear on TM, ear canal or both

sx’s: earach, blood tinged discharge from ear and conductive hearing loss

bulla on TM

  • caused by mycoplasma, viral and bacterial otitis media
143
Q
A

acute otitis externa

  • red bulging TM; amber serous effusion

swimmers ear, common in diabetics, tug test +

144
Q

esotropia

A

inward deviation

145
Q

exotropia

A

outward deviation

146
Q

exophthalmus

A

bulging out, permanent

hyperthyroidism

147
Q

Examining the optic disc and retina

A
  1. locate optic disc (yellow/orange)
  2. sharp focus: adjust lens, if no refractive error for both, should be 0 diopters (if nearsighted = minus diopers, if far sighted = plus diopters)
  3. inspect optic disc for sharpness, color, size of central cup, comparative symmetry
148
Q

how to use opthalmoscope

A
  • dark room
  • turn focusing wheel to 0 diopter (which neither converge or diverge lights)
  • hold scope in RIGHT hand with MY RIGHT eye to see pt’s RIGHT eye (vise versa to L eye)
  • hold scope against medial aspect of my bony orbit with handle 20 degrees slant form vertical
  • tell pt look up and over my shoulder and point on the wall
  • i’m 15 inches away and 15 degrees lateral to pt’s line of vision
149
Q
A

geographic tongue

  • benign condition
  • scattered smooth red areas denuded of papillae, with normal rough and coated areas

map like pattern that changes over time

150
Q
A

fissured tongue

  • appear with increasing age

“furrowed tongue”

food gets stuck and irritates

benign

151
Q
A

candidiasis

  • thick white coat from candida infection
  • raw red surface was scraped off

infxn can occur w/o white coating

seen in immunosuppression from chemotherapy or prednisone therapy

152
Q
A

black harry tongue

  • associated with candida and bacterial overgrowth, antibiotic therapy, poor dental hygiene

can occur spontaneously

153
Q
A

smooth tongue (atrophic glossitis)

  • lost its papillae, sometimes in patches
  • deficiency in riboflavin, niacin, folic acid, vitamin B12, pyridoxine, iron, or treatment to chemotherapy
154
Q
A

oral hairy leukoplakia

  • whitish raised asymptomatic plaques with feathery or corrugated pattern, on sides of tongue

CAN’T be scraped off

caused by Epstein barr virus, HIV, AIDS

155
Q
A

varicose veins

  • small purplish or blue/black round swellings under tongue with age

dilatations of lingual veins

no clinical significance

156
Q
A

mucous patch of syphyilis

  • painless lesion secondary to syphilis

highly infectious

slightly raised, oval, covered by grayish membrane

multiple or elsewhere in mouth

157
Q
A

tori mandibularis

  • rounded bony growths on inner surfaces of mandible

bilateral, asx, harmless

158
Q
A

aphthous ulcer (canker sore)

  • painful, shallow whiteish gray oval ulceration with halo of reddened mucosa

single or multiple

heals in 7-10 days but can recur in behcet disease

159
Q
A

leukoplakia

  • peristent painless white patches in oral mucosa, undersurface of tongue white

patches any size raise sus of SCC! NEED BX

160
Q
A

carcinoma, floor of mouth

  • ulcerated lesion common in carcinoma

red area medially (erythoplakia) = malignancy (biopsy!!)

161
Q

nasal abnormalities

A

ulcers or nasal polyps (pale, sac like growths of inflamed tissue that obstruc tthe air passage or sinuses; seen in allergic rhinitis, aspirin sensitivity, asthma, chronic sinus infections, CF)

162
Q

pale boggy nasal mucous membranes are found in children with

A

allergic rhinitis

163
Q

purulent rhinitis is common in what type of infections?

A

viral infections

164
Q

in young preschool children, foul smelling, purulent, unilateral discharge from nose may be due to

A

foreign body

more likely to stick objects into body orifices

165
Q

signs of sinusitis in children

A
  1. purulent rhinorrhea > 10 days
  2. worsening course
  3. severe sx’s, high fever, purulent rhinorrhea > 3 days

headache, sore throat, tenderness over sinuses on percussion or palpation

166
Q

Describing retractions

A

supraclavicular, intercostal, substernal, subcostal

167
Q
A

chondrodermatitis: chronic inflammatory lesion

need bx to rule out carcinoma

common in bed bound pt’s

starts out as painful tender papule on helix or antihelix

168
Q

in newborns and young infants, nasal flaring can mean

A

upper respiratory infection

pneumonia

serious respiratory infection

169
Q

nasal flaring + grunting + tachypnea =

A

LOWER respiratory infection (anything lower than vocal cords)

pneumonia, bronchiolitis

170
Q

in infants, best findings to ruling IN pnemonia? ruling out?

A

ruling in pneumonia: increase breathing + crackles

ruling out: NO tachypnea

171
Q

acute cough (< 3 weeks) causes

A

most common: viral upper respiratory infections (sputum translucsent, white, gray)

acute bronchitis, pneumonia, L sided HF , asthma, foreign body, smoking, ace inhibitor

172
Q

subacute (3-8 weeks) cough causes

A

post infectious (lingering), pertussis, acid reflux, bacterial sinusitis, asthma

173
Q

chronic (> 8 weeks) cough causes

A

smoking, post nasal drip, asthma, GERD, chronic bronchitis, bronchiectasis

174
Q

attributes of a symptom

A

location, quality, quantity/severity, timing, onset (when did it start), duration, frequency, modifying factors, associated manifestations

175
Q
A
176
Q

influenza shots can be given ____ or older and should especially be given to those with:

nasal spray is only approved for what ages

A

_>_6 months

chronic pulmonary conditions, nursing home residents, > 50 years old, american indians and alaska natives, household contacts, health care, pregnant people

nasal spray: healthy 2-49 years old and not recc every year

177
Q
A

chronic venous insufficiency

medial or lateral malleolus

ulcers that are small, brown painful granulation tissue and fibrin, necrosis

irregular borders, flat, slightly steep

178
Q
A

arterial insufficiency

toes, feet, areas of trauma (ie: shins)

severe pain unless masked by neuropathy

decreased pulses, trophic changes, pallor on elevation

179
Q
A

neuropathic ulcer

develops in pressure points with diminished sensation

diabetic neuropathy, neurologic disorders, hansen disease

no pain; unnoticed

decreased sensation and absent ankle jerks

NURP 530 Adv Health Assessment (7 decks)

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