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AHA > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Where should you place the stethoscope to hear bronchial sounds?

A

Above the manubrium, over the trachea

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2
Q

Expected findings for bronchial aucultation

A

Sounds should be high-pitched, harsh, and loud

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3
Q

Where are bronchiovesicular sounds heard?

A

Over the main bronchi

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4
Q

Describe bronchiovesicular sounds

A

Medium in loudness and pitch

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5
Q

Where are vesicular sound heard?

A

over the lower bronchi, the bronchioles, and the lobes

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6
Q

Describe the vesicular sounds

A

softest and lowest in pitch

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7
Q

Describe fine crackles

A

high pitched, discontinuous crackling sounds that occur when inhaled air meets deflated alveoli

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8
Q

Describe course crackles

A

loud, low-pitched bubbling sounds that are caused when air meets secretions in the airways

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9
Q

Describe rhonchi

A

continuous, low-pitched snoring sounds caused by airway obstruction from thick secretions, muscular constriction, or masses; coughing may clear sound

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10
Q

Describe wheezes

A

continuous, high-pitched musical sounds that are created by the narrowing of airways from swelling, secretions, or masses

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11
Q

Describe stridor

A

a loud, continuous high-pitched crowing sound caused by upper airway obstruction

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12
Q

Why are the superficial lymph nodes important?

A

They can be palpated and are a gateway to assessing the health of the entire lymphatic system; abnormalities can be some of the earliest clues for infection or malignancy

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13
Q

What would a coarse or gritty sensation when palpating the thyroid gland indicate?

A

An inflammatory process in the gland

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14
Q

How would a provider characterize nodules on the thyroid gland?

A

Number, smooth or irregular, soft or hard

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15
Q

What should the provider do if the thyroid is enlarged?

A

auscultate for vascular sounds with the bell of the stethoscope to assess for bruit (indicates a hypermetabolic state and increased blood flow)

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16
Q

What is the manubriosternal junction (angle of Louis)?

A

A visible and palpable angle of the sternum at which the second rib articulates with the sternum

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17
Q

Describe assessment findings for barrel chest

A

Ribs are more horizontal, the spine is somewhat kyphotic, and the sternal angle is more prominent

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18
Q

What are some causes of barrel chest?

A

chronic asthma, emphysema, or cystic fibrosis

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19
Q

What causes the sound heard on S1?

A

closing of the mitral and tricuspid valves

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20
Q

What causes the sound of S2?

A

Closing of the pulmonic and aortic valves

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21
Q

Where would the practitioner auscultate for the aortic area of the heart?

A

2nd intercostal space at the upper right sternal border

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22
Q

Where would the practitioner auscultate for the pulmonic area of the heart?

A

2nd intercostal space at the upper left sternal border

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23
Q

Where would the practitioner auscultate for Erb’s point?

A

the 3rd intercostal space at the medial left sternal border

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24
Q

Where would the practitioner auscultate the tricuspid area?

A

4th intercostal at the left sternal border

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25
Q

Where would the practitioner auscultate the apical/mitral area?

A

At the fifth left intercostal space, mid-clavicular line

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26
Q

Describe ventricular gallop

A

A third heart sound known as S3; occurs after S1/2 from the change in blood flow during diastole when rapid filling ends and slow filling begins

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27
Q

How would the practitioner identify the S3 sound?

A

The heart beat would sound like “KEN-TUCK-y” with Y being the S3; it is a low frequency and intensity sound and best heard with the bell of the stethoscope

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28
Q

Describe atrial gallop

A

A fourth heart sound, S4; occurs because of late diastolic filling due to atrial contraction right before S1; can indicate increased resistance in ventricles

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29
Q

How would the practitioner identify an atrial gallop?

A

Resembles the pronunciation of TEN-es-see; a low frequency sound

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30
Q

Describe a pericardial friction rub and what it can indicate

A

a sound generated from inflammation of the pericardial sac as it rubs against the linings surrounding the heart; is a sign of pericarditis

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31
Q

How will a practitioner identify a pericardial friction rub?

A

it is a scratching, grating, high frequency sound that is heard in both systole and diastole; best heard with diaphragm at the left lower sternal border

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32
Q

What is an innocent or functional murmur?

A

Non-cardiac murmurs related to pregnancy, hyperthyroidism, or exersize; common in children

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33
Q

What is a pathological murmur?

A

A murmur due to congenital or valvular defects; specific defects can be identified by the timing of the murmur and the auscultation region where it is best heard

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34
Q

Name the organs of the lymphatic system

A

lymph nodes, spleen, thymus, tonsils, adenoids, and Peyer patches in the small intestine

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35
Q

What are the functions of the lymphatic system?

A

conservation of fluid and plasma that leak from capillaries, defending the body against disease as part of the immune system, and absorbing lipids from the intestinal tract

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36
Q

Where can lymph vessels be found in the body?

A

every tissue supplied by blood vessels except the placenta and the brain

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37
Q

How do lymphatic vessels work to fight disease?

A

maintains fluid balance, filters out substances that could be harmful to the body, initiates phagocytosis, produces lymphocytes, produces antibodies, absorbs fat and fat-soluble substances

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38
Q

Where is the thymus located?

A

in the superior mediastinum

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39
Q

What does the thymus do?

A

produces T lymphocytes and controls the immune responses generated by B lymphocytes- atrophies after puberty

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40
Q

Where is the spleen?

A

In LUQ between the stomach and diaphragm

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41
Q

What are the functions of the spleen?

A

destroying old RBCs, producing antibodies, storing RBCs, and filtering micro-organisms

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42
Q

What are Peyer patches?

A

small, raised areas of lymph tissue on the mucosa of the small intestine

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43
Q

Describe the development of the lymphatic system in infants and children

A

begins developing at 20 weeks gestation but is still immature at birth; large amount of lymphoid tissue in childhood and regression of tissue in adulthood

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44
Q

Describe changes to the lymphatic system in a pregnant patient

A

a pregnant patient has an altered immune system and is therefore more likely to get sick

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45
Q

Describe changes to the lymphatic system in the elderly

A

the number of lymph nodes will diminish in size and decrease; more likely to have fibrotic and fatty nodes

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46
Q

HPI for enlarged lymph nodes

A

Associated local symptoms: pain, edema, redness, warmth
Associated systemic symptoms: malaise, fever, weight loss
Predisposing factors: recent surgery, infection
Medications
Character: onset, location, duration

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47
Q

HPI for swelling of extremity

A

unilateral or bilateral, intermittent or constant, duration
Predisposing factors: trauma, surgery
Associated symptoms: warmth, redness, ulceration
Efforts to treat: TED hose, elevation

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48
Q

HPI for pregnant woman with lymphatic problems

A

Weeks gestation
Exposure to infections
Exposure to cat feces or litter
Immunization status

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49
Q

What are three physical signs of lymphatic problems?

A

enlarged lymph nodes (lymphadenopathy), red streaks (lymphangitis), and lymphedema

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50
Q

How to palpate the superficial lymph nodes

A

use pads of the second, third, and fourth fingers

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51
Q

Should the superficial nodes be palpable in a healthy individual?

A

No, they are normally not large or firm enough to be felt

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52
Q

Name some words to describe abnormal lymph nodes

A

Shotty (small and nontender), fluctuant (wavelike motion felt on palpation), and matted (group of nodules that feel connected)

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53
Q

How to characterize enlarged lymph nodes

A

location, size, shape, consistency (soft, hard), tenderness, mobility, or fixation to surrounding tissues

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54
Q

What would a hard, fixed, painless node suggest?

A

Malignancy

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55
Q

What would a very tender node indicate?

A

an inflammatory process

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56
Q

What would a palpable supraclavicular node indicate?

A

thoracic or abdominal malignancy

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57
Q

Differential diagnosis for lymph node enlargement

A

thyroid goiter, graves disease, parotid swelling, hemangioma, brachial cleft cyst

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58
Q

Where are the submandibular nodes located?

A

halfway between the angle and the tip of the mandible

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59
Q

Where are the parotid and retropharyngeal nodes?

A

angle of the mandible

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60
Q

Where are the postauricular nodes noted?

A

superficially over the mastoid process

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61
Q

Where are the posterior cervical nodes located?

A

along the anterior border of the trapezius muscle

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62
Q

Where are the superficial cervical nodes located?

A

at the sternocleidomastoid muscle

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63
Q

Are lymph nodes more commonly enlarged in children or adults?

A

Children

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64
Q

When would lymphadenopathy call for further evaluation?

A

If localized & persistant (esp in young adults/children with supraclavicular) or without evidence of infection

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65
Q

How do you tell the difference between edema and lymphadema?

A

Edema- improved with diuretics or elevation of affected area

Lymphedema- not improved with diuretics or elevation; both can be pitting or nonpitting

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66
Q

What is lymphangioma?

A

a congenital malformation of dilated lymphatics; inadequate development and therefore obstruction of the lymphatic system mostly in the neck

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67
Q

S&S of lymphangioma

A

S- painless cystic masses during 1st year of life
O- soft, nontender, easily compressible mass without margins; present at birth and apparent early in life; diagnosed through physical exam and imaging

68
Q

What is lymphatic filariasis (elephantiasis)?

A

massive accumulation of lymphedema throughout the body; transmitted by mosquitos patient is more susceptible to infection, cellulitis, and fibrosis

69
Q

S&S of elephantiasis

A

swelling of limb or body area; travel to Asia, Africa, western pacific, India, or the Phillipines, fever, chronic pulmonary infection
O- lymphedema of entire arm or leg or genital regions

70
Q

What is non-hodgkin lymphoma?

A

Malignant neoplasm of the lymphatic system and the reticuloendothelial tissues; occur most often in chest, neck, abdomen, tonsils, and skin lymph nodes

71
Q

S&S of non-hodgkin

A

S- painless, enlarged lymph nodes, fever, weight loss, abdominal pain, family history
O- nodes may be localized in the posterior cervical triangle or become matted; nodes well-defined and solid

72
Q

Hodgkin lymphoma

A

Starts in a single node (most common in neck area) or chain and spreads to contiguous lymph nodes, spleen, liver, and bone marrow; often occurs in late adolescence and young adulthood; males twice as likely to get

73
Q

S&S of Hodgkin

A

S- painless enlarged lymph nodes, abdominal pain, history of mononucleosis
O- most common symptom is painless enlarged cervical lymph nodes, asymmetric and progressive, almost rubbery upon palpation

74
Q

What is epstein-barr virus mononucleosis?

A

an infection that targets oral epithelial cells and spreads to other structures such as salivary glands, liver, and spleen

75
Q

S&S of Epstein-barr virus mononucleosis

A

S- malaise, fatigue, acute or prolonged, fever, headache, sore throat, nausea, abdominal pain, myalgia
O- generalized lymphadenopathy most commonly in cervical nodes and especially epitrochlear nodes, hepatomegaly, splenomegaly, pharyngitis with tonsillar enlargement, petechiae in hard/soft palate

76
Q

What is toxoplasmosis?

A

caused by ingestion or inhalation of oocysts in soil, undercooked meat, or raw eggs, cat feces or litter; infection can persist for life without signs of disease or cause congenital infection if exposed during pregnancy especially in the first trimester

77
Q

What is roseola infantum?

A

an infection by human herpes virus 6; common in infancy; present in saliva of most adults and readily transmitted via oral secretions

78
Q

S&S of roseola infantum

A

S- fever, mild respiratory illness

O- lymphadenopathy, discrete and non tender, involves the occipital and postauricular chains

79
Q

What is HSV?

A

infection by human herpes virus 1 or 2; transmitted by oral secretions, genital secretions, and close contact

80
Q

S&S of HSV

A

S- burning, itching lesions, enlarged lymph nodes
O- discrete labial and gingival vesicles or ulcers, enlargement of lymph nodes that are firm, discrete, movable, and tender

81
Q

What is cat scratch disease?

A

a disease causing lymphadenitis in children caused by a bite, scratch or injury from a cat

82
Q

S&S of cat scratch disease

A

S- scratch or wound with painful enlarged lymph nodes

O- single lymph node, very large, lasting longer than 3 weeks

83
Q

Name some common life-threatening diseases associated with AIDS

A

Kaposi sarcoma, pneumonia, pulmonary tuberculosis, invasive cervical cancer, parotid enlargement simulating mumps, anemia, chronic diarrhea, recurrent infections

84
Q

What is serum sickness (Type III hypersensitivity reaction)?

A

a hypersensitivity reaction in response to antigens in the blood stream

85
Q

S&S of Serum sickness

A

S- enlarged lymph nodes, organ transplant, rashes, pain, pruritus, and erythematous swelling at the injection site, recent administration of antibiotics
O- symptoms present 7-10 days after administration of provoking substance, facial and neck edema, urticaria, purpuric lesions

86
Q

Latex allergy type IV dermatitis

A

T-cell mediated hypersensitivity reaction caused by chemicals used in latex products; skin reaction occurs within 48-72 hours after infection

87
Q

Latex allergy type I reaction

A

true allergic reaction caused by immunoglobulin E antibodies causes release of histamine, leukotrienes, prostaglandins, and kinins; causes generalized urticaria with angioedema, asthma, GI symptoms, anaphylaxis

88
Q

Why are an infant’s cranial bones separated?

A

Because the spaces between the bones permit the expansion of the skull to accomodate brain growth

89
Q

When does ossification of sutures begin?

A

At 6 years of age

90
Q

Why does a pregnant woman need increased iodine intake?

A

Because the mother is the source of the infant’s thyroid hormone until the second trimester; if pregnant woman’s thyroid is enlarged = iodine deficiency

91
Q

What are some changes to the thyroid in older adults?

A

T4 production decreases and thyroid gland becomes more fibrotic

92
Q

S&S of Cushing’s syndrome

A

face is moon-shaped with thin, erythematous skin; upper thoracic fat pad present

93
Q

S&S of myxedema

A

course, sparse hair, temporal loss of eyebrows, periorbital edema, prominent tongue

94
Q

S&S of hyperthyroid

A

Fine, moist skin with fine hair, prominent eyes with lid retraction

95
Q

S&S of Bell palsy

A

(CNVII); asymmetry of one side of the face

96
Q

Facial assessment findings for children with downysndrome

A

depressed nasal bridge, epicanthal folds, mongoloid slant of eyes, low-set ears

97
Q

Facial assessment findings for children with Hurler syndrome

A

enlarged skull with low forehead, corneal clouding, and short neck

98
Q

Facial assessment findings for children with hydrocephalus

A

enlarged head, thinning of the scalp with dilated scalp veins, sclera visible above the iris

99
Q

Facial assessment findings for children with fetal alcohol syndrome

A

poorly formed philtrum, widespread eyes, with inner epicanthal folds and mild ptosis; short nose, thin upper lip

100
Q

Neck anatomical landmarks

A

hyoid bone, thyroid, and cricoid cartilages: should be smooth and nontender and should move when patient swallows

101
Q

Explain what happens to an infant’s respiratory system when it is born

A

Infant initially gasps and cries, filling the lungs up with air for the first time; increased blood flow to lungs causes closure of the heart’s foramen ovale and ductus arteriosiswithin minutes

102
Q

What is patent ductus arteriosis (PDA)?

A

failure to close of the heart’s foramen ovale and ductus arteriosus; more common in infants under 30 weeks of gestation; if large enough can lead to left ventricular overload and heart failure

103
Q

Describe anatomical changes to chest during pregnancy

A

lower ribs flare increasing the lateral diameter; the diaphragm at rest rises as much as 4 cm above its usual resting positioning; minute ventilation increases and increased tidal volume

104
Q

Changes of chest in older adults

A

barrel chest is common, increased AP chest diameter, stiffening of chest wall, alveoli become more fibrous , dry mucous membranes

105
Q

HPI for patient with cough

A 
Onset: sudden or gradual
Nature: dry, moist, wet, hacking
Sputum production/characteristics
Pattern
Severity: tired patient, disrupts sleep
106
Q

HPI for shortness of breath

A 
Onset: sudden or gradual, duration
Position most comfortable
Related to activities?
Harder to inhale or exhale
Efforts to treat? oxygen?
107
Q

What would a Kussmaul breathing pattern indicate?

A

metabolic acidosis

108
Q

Describe Cheyne-Stokes respirations

A

regular periodic pattern of breathing with intervals of apnea followed by crescendo/decrescendo sequences

109
Q

What would Cheyne-stokes respiratory pattern indicate?

A

brain damage at the cerebral level or drug associated respiratory compromise

110
Q

How do chest retractions appear?

A

the chest wall seems to cave in at or around the bones

111
Q

What would the prescence of retractions indicate?

A

an obstruction in the airways

112
Q

S&S of an obstructed airway

A

inspiratory stridor, hoarse or barking cough or cry, retractions, difficulty swallowing

113
Q

Describe crepitus

A

a crackly or crinkly sensation felt upon palpation of chest; indicates an underlying pathological process

114
Q

How does one evaluate thoracic expansion?

A

stand behind the patient and bplace thumbs along the spinal processes at the level of the 10th rib with palms lightly in contact with the posterolateral surfaces

115
Q

What would decreased or absent fremitus indicate?

A

excess air in the lungs or emphysema, pleural thickening or effusion, or bronchial obstruction

116
Q

What would increased fremitus indicate?

A

fluids or a solid mass within the lungs, heavy bronchial secretions, or a compressed lungs

117
Q

What can indicate tension pneumothorax?

A

Displaced trachea to either side depending on where the tension pneumo is; pneumo on the right= trachea displaced to the left and vice versa

118
Q

Patient positioning for percussion of the chest

A

1st. examin back- patient sitting with head bent forward and arms folded infront
2nd. Have patient raise the arms overhead while you percuss the lateral and anterior chest

119
Q

Correct order of percussion of chest

A

Start with back and then front’ always move from superior to inferior and medial to lateral

120
Q

What sound is expected on percussion of the chest?

A

resonance

121
Q

What would hyperresonance on percussion of chest indicate?

A

hyperinflation: emphysema, pneumothorax, or asthma

122
Q

What would dullness or flatness on percussion of the chest indicate?

A

pneumonia, atelectasis, pleural effusion, or asthma

123
Q

How to measure the diaphragmatic excursion

A

Have patient hold breath on inhale, percuss along scapular line until you locate the lower scapular border, mark the point, ask the patient to take several breaths and exhale and hold, percuss from marked point and make another mark at position of the lower scapular border; measure and record distance between marks

124
Q

What is the normal diaphragmatic excursion distance

A

3-5 cm

125
Q

Describe a hyperresonant sound over percussion of the chest

A

Very loud, low pitch, long duration, booming quality

126
Q

What can bad breath indicate?

A

An infection in the nasal or oral cavity or deep in the lung

127
Q

What can a sweet, fruity breath indicate?

A

Diabetic ketoacidosis

128
Q

Describe a pleural friction rub

A

Dry, rubbing, or grating sound usually caused by inflammation of pleural surfaces; loudest over lower lateral anterior surface

129
Q

What is Hamman sign?

A

Also known as mediastinal crunch; found with mediastinal emphysema

130
Q

Would men or women have greater vocal resonance? Why?

A

Men; because their voices are lower-pitched

131
Q

Define bronchophony

A

Vocal resonance with greater clarity and increased loudness of spoken sounds

132
Q

Describe whispered pectoriloquy

A

when a whisper can be heard clearly and intelligibly through the stethoscope on the chest; a sign of consolidation of the lungs

133
Q

What is a newborns expected respiratory rate?

A

40-60 respirations per minute

134
Q

What does stridor indicate?

A

an obstruction high in the respiratory tree

135
Q

What is respiratory grunting?

A

a mechanism by which the infant tries to expel trapped air or fetal lung fluid while trying to retain air and increase oxygen; cause for concern only if persistant

136
Q

Changes to respiratory system in children

A

Chest is thinner and more resonant; intrathoracic sounds easier to hear; increased respiratory rate

137
Q

Trick to have a child complete big expiration

A

Have them “blow out” the candle/flashlight

138
Q

Changes to respiratory system during pregnancy

A

SOB is common, more deep breaths

139
Q

Changes to respiratory system in older adults

A

chest expansion decreased, loss of subcutaneous tissue, kyphosis, flattening of lumbar curve

140
Q

Sample subjective information for respiratory workup

A

Nonproductive cough for past several days. Persistent, worse when lies down. Feels ill. Chest feels “heavy”. SOB when walking up stairs. Fever up to 101 degrees. Taking cough syrup without relief

141
Q

Sample objective information for respiratory assessment

A

Chest without kyphosis or other distortion. Thoracic expansion symmetric. Respirations rapid and somewhat labored, no retractions or stridor. No friction rubs or tenderness over ribs. Tactile fremitus increased over the left base posteriorly. Crackles heard on inspiration and expiration on left base.

142
Q

Physical findings associated with asthma

A

Tachypnea, tachycardia, decreased fremitus, wheezing, prolonged expiration, decreased lung sounds, diaphragm level lower with decreased descent

143
Q

Physical assessment findings with atelactasis

A

Delayed or diminished chest wall movement, tachypnea, diminished fremitus, apical cardiac impulse and trachea deviated, dullness over affected lung, adventitious lung sounds

144
Q

Physical findings with bronchiectasis

A

Respiratory distress, hyperinflation, clubbing, crackles, rhonchi

145
Q

Physical findings with bronchitis

A

tachypnea, shallow breathing, diminished fremitus, adventitious lung sounds, prolonged lung sounds

146
Q

Physical assessment findings of COPD

A

respiratory distress, cyanosis, distended neck veins, limited mobility of diaphragm, hyperresonance, decreased breath sounds with inspirational crackles

147
Q

Physical findings with emphysema

A

pursed lips, barrel chest, underweight, apical impulse decreased, diminished fremitus, hyperresonance

148
Q

Physical assessment findings with a pleural effusion

A

diminished and delayed chest movement, PMI & trachea shifted contralaterally, diminished fremitus, bronchophony, whispered pectoriloquy, dull/flat percussion

149
Q

Assessment findings with pneumonia consolidation

A

limited chest rise, increased fremitis (unless emphysema or pleural effusion), dullness, bronchial breath sounds, egophony, whispered pectoriloquy

150
Q

Assessment findings for pneumothorax

A

Tachycardia, bulging intercostal spaces, contralateral tracheal deviation (if tension), diminished or absent breath sounds, hyperresonance, diminished or absent fremitus

151
Q

Difference in symptoms between acute and chronic bronchitis

A

Acute- fever & chest pain; chronic- productive cough

152
Q

What is pleurisy?

A

inflammatory process involving the visceral and parietal pleura

153
Q

Assessment findings for pleurisy

A

chest pain when taking a breath (sometimes radiating to shoulder), rapid and shallow respirations, pleural friction rub, possible fever

154
Q

What is a pleural effusion?

A

excessive nonpurulent fluid in the pleural space

155
Q

What is an empyema?

A

purulent exudative fluid collected in the pleural space

156
Q

S&S of empyema

A

febrile, tachypneic, cough and chest pain, progressive dyspnea, cough with blood and sputum, absent or distant breath sounds, percussion is dull and absent fremitus

157
Q

What can be an indication of a small pneumothorax?

A

unexplained but persistent tachycardia

158
Q

What is a major clue to a pulmonary embolism?

A

pleuritic chest pain with or without dyspnea

159
Q

Objective findings for pulmonary embolism

A

low-grad fever, isolated tachycardia, hypoxia, possible pleural friction rub

160
Q

S&S of epiglottitis

A

begins suddenly and progresses rapidly without cough, panful sore throat, high fever, beefy red epiglottis

161
Q

Common respiratory problems in infants/children

A

diaphragmatic hernia, cystic fibrosis, croup, tracheomalacia, bronchiolitis

162
Q

S&S of cystic fibrosis

A

cough with sputum, malabsorption, bronchiectasis, barrel chest, pulmonary hypertension, cor pulmonale

163
Q

What is cystic fibrosis?

A

autosomal recessive disorder of exocrine glands involving the lungs, pancreas, and sweat glands

164
Q

S&S of croup

A

barking cough, labored breathing, retractions, restlessness

165
Q

What is tracheomalacia?

A

lack of rigidity or floppiness of the trachea or airway

166
Q

S&S of tracheomalacia

A

noisy breathing, wheezing, stridor, respiratory distress

AHA (2 decks)

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