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H & P > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Connective tissue of vessel

A

Tunica adventitia

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2
Q

Smooth muscle of vessel

A

Tunica media

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3
Q

Endothelium of vessel

A

Tunica intima

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4
Q

Put risk factors in…

A

HPI

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5
Q

Pregnant women’s blood pressure…..during pregnancy

A

Decreases

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6
Q

Unilateral edema is from…

A

Peripheral vascular disease

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7
Q

Bilateral edema is…

A

From the heart

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8
Q

Normal reperfusion for capillary refill is…

A

Less than 2 seconds

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9
Q

Carotid pulse point

A

60-70

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10
Q

Radial pulse point

A

> 80

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11
Q

Femoral pulse point

A

70-80

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12
Q

Pulses paradoxus

A

Decrease in SBP and pulse amplified with inspiration

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13
Q

Pulsus biferiens

A

Biphasic pulse, double peak

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14
Q

Pulsus parvus et tardus

A

Pulse is weaker and slower than expected

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15
Q

Pulsus alternans

A

Alternating strong and weak beats

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16
Q

Diaphragm

A

High frequency, deep pressure

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17
Q

Bell

A

Low frequency, light pressure

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18
Q

Allen test

A

Assess patency of the ulnar artery

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19
Q

What is one of the first symptoms with PAD?

A

Claudication

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20
Q

Arterial ulcers start out…

A

In the toes

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21
Q

Ulcers from veins are…

A

Usually in ankles

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22
Q

Arterial occlusion 3 p’s

A

Pain/paresthesias
Pallor
Pulselessness

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23
Q

Claudication

A 
Walking
Cramp/ache/pain
Unilateral
Constant
Atherosclerosis
Relief: stop activity/stand still
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24
Q

Pseudoclaudication

A 
Walking or standing
Parasthetic pain
Bilateral
Variable (not constant)
Spinal stenosis/herniated disc
Relief: sit down/lay down
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25
Q

Debakey 1

A

60%

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26
Q

Debakey 2

A

10-15%

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27
Q

Debakey 3

A

25-30%

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28
Q

Stanford A

A

Proximal

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29
Q

Stanford B

A

Distal

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30
Q

Quincke’s pulse

A

Blanching and flushing of the nail bed related to aortic insufficiency

Change in blanching and flushing is in conjunction with the cardiac cycle

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31
Q

Varicose veins

A

Dilation of vessel due to incompetent valves, collateral circulation developed, most easy to detect while patient is standing

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32
Q

Preeclampsia

A 
>40
Primagravida
Obese
Multigestational
Hx of HTN or gestational HTN
Renal disease/DM
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33
Q

Arterial insufficiency

A 
Pallor with elevation
Rumor
Intermitten claudication
Diminished/absent pulses
Thin, shiny, loss of hair
Ulceration on toes
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34
Q

Venous insufficiency

A 
No pain
Normal pulses
Edema
Normal color/cyanosis/brown
Ulceration medial ankles
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35
Q

Lipodermatosclerosis

A

Thick skin and fibrotic due to WBC trapped in capillaries from chronic venous insufficiency

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36
Q

Stage 1 mild venous insufficiency

A

18-22 pressure, mild discomfort, ankle swelling

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37
Q

Stage 2 moderate venous insufficiency

A

20-30 pressure, hyperpigmentation, edemas

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38
Q

Stage 3 severe chronic venous insufficiency

A

> 40 pressure, chronic pain, non healing ulceration

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39
Q

Virchow’s triad

A

Hypercoagulability
Abnormalities
Stasis

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40
Q

PE classic triad

A

Dyspnea
Chest pain
Hemoptysis

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41
Q

Thromboangiitis obliterans

A

Arterial obstruction in the upper extremity

20-40

Emboli

Diminished or absent pulses at the wrists

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42
Q

Temporal arteritis

A

50+ years

Temporal headache, visual disturbances, claudication

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43
Q

Kawasaki disease

A

Acute vasculitic illness
Males>females
Coronary artery aneurysms complication
Strawberry tongue

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44
Q

Coarctation of the aorta

A

Narrowing of the aorta distal to the L subclavian artery

Men>women

Disparity in pulses in upper and lower extremities

Severe HTN!

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45
Q

Subclavian steal syndrome

A

Subclavian artery stenosis

BP differences in arms

Syncope/presyncope

Neuro

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46
Q

Vascular thoracic outlet syndrome

A

Compression of arteries at clavicle
Arterial or venous
Young active people

Numbness/tingling, arm/hand fatigue, edema, color changes, diminished pulse

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47
Q

Non modifiable risk factors

A

Age

Family history

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48
Q

Metabolic syndrome

A 
2 out of 5 of the following:
Abdominal obesity
Triglycerides >150
HDL men <40, women <50
HTN >130/88
Glucose >100
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49
Q

Pericarditis

A

Inflammation of the pericardium

2-4 days post MI

Worse with deep inspiration

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50
Q

Dressler syndrome

A

2-10 weeks postinfarct, chest pain, pleuropericarditis, fever

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51
Q

Viral pericarditis MCC

A

Coxsackie B virus in young adults

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52
Q

Cardiac tamponade

A 
Pulsus paradoxus 75%
Impending doom
Tachycardia
*muffled heart tones
Friction rub
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53
Q

Beck’s triad

A

JVD
Hypotension
Muffled heart sounds

Seen in cardiac tamponade

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54
Q

Cullen’s sign

A

Peri umbilical cyanosis

AAA

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55
Q

Grey-turner’s sign

A

Flank cyanosis

AAA

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56
Q

Janeway lesions

A

Palms of soles, crop up every few hours to daysa

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57
Q

Osler nodes

A

Painful blue or pink lesions on pads of fingers or toes

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58
Q

Valsalva maneuver

A

Forced expiration through closed airway, high intrathoracic pressure impeding venous return to the right atria

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59
Q

Aortic area

A

2nd right intercostal space, right sternal border

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60
Q

Pulmonic area

A

2nd left intercostal space, left sternal border

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61
Q

2nd pulmonic area

A

3rd left intercostal space, left sternal border

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62
Q

Tricuspid area

A

4th and 5th left intercostal space, left sternal border

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63
Q

Apex/mitral area

A

5th left intercostal space in medial clavicular line

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64
Q

A wave

A

Right atrial contraction

If absent, a fib

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65
Q

C wave

A

Closure of tricuspid valve

66
Q

v wave

A

Venous filling

Increasing volume and increasing pressure in right atrium

67
Q

X descent

A

Low atrial pressure just before passive atrial filling

68
Q

Y descent

A

Decrease in pressure after tricuspid valve opens and blood moves from right atria to right ventricle

Absent- tamponade

69
Q

Increased JVD

A

Severe right sided ADCHF

70
Q

Hepatojugular reflux

A

Tests for right sided heart failure

71
Q

Describing when auscultating

A

Timing
Location
Intensity
Pattern/configuration

72
Q

S1

A

Closure of AV valves
Ventricular systole
Loudest at apex

73
Q

S2

A

Closure of AV and PV valves
Ventricular diastole/relaxation
Loudest at base

74
Q

Paradoxical split

A

Appears with expiration
*pathology

Anything that delays closure of aortic valve

75
Q

Physiological split

A

Appears with inspiration
*normal

Heard best at base

76
Q

S3

A

Early diastole
Over 40, consider LV failure
Best at apex LLD

77
Q

S4

A

Presystole

Best at apex

78
Q

Special test for aortic regurgitation

A

Pt leans forward, exhales, stops breathing on exhalation

Auscultating along LSB and apex with the diaphragm

79
Q

Jugular venous distension

A

Measures estimated right atrial pressures

80
Q

Hepatojugular reflux

A

Aids in diagnosing peripheral congestion in CHF

81
Q

Standing/valsalva

A

Decrease LV volume

Decrease vascular tone

82
Q

Squatting

A

Increase LV volume

Increase vascular tone

83
Q

Normal central venous pressure in JVD

A

<9

84
Q

What is the best location to hear mitral murmurs?

A

Apex

85
Q

What is the best location to hear tricuspid murmurs?

A

LLSB

86
Q

What is the best location to hear aortic/pulmonic murmurs?

A

Base

87
Q

Where does mitral regurgitation radiate?

A

Axilla

88
Q

Where does aortic stenosis radiate?

A

Carotids and down sternal border

89
Q

High pitch murmurs

A

MR and AR

90
Q

Medium pitch murmurs

A

AS and PS

91
Q

Low pitch murmurs

A

MS and TS

92
Q

What murmurs are blowing?

A

MR/AR/TR

93
Q

What murmurs are coarse/harsh?

A

AS/VSD/ASD

94
Q

What murmurs are rumbling?

A

MS and austin flint murmur of AR

95
Q

What murmurs are machine like?

A

PDA

96
Q

What murmurs are intensified with inspiration?

A

Right sided murmurs (tricuspid stenosis/regurgitation)

97
Q

What murmurs are intensified with expiration?

A

Left sided murmurs (mitral stenosis/regurgitation)

98
Q

Common characteristics of still/innocent murmurs

A

Usually midsystolic, 1 or 2 grade, young patients, no radiation, brief and blowing, located in the second left intercostal space near left sternal borer

99
Q

Systolic murmurs

A

Aortic and pulmonic stenosis

Mitral and tricuspid regurgitation

Murmurs of ventricular and atrial septal defects

Hypertrophic cardiomyopathy

100
Q

Aortic stenosis murmur

A 
Midsystolic
Crescendo/decrescendo
Medium pitch
Coarse/harsh 
Ejection sound after S1
Radiates to carotids
101
Q

Mitral regurgitation murmur

A 
Best heard at apex, transmits to left axilla
Holosystolic
Plateau
Loud
High pitch
Blowing
102
Q

Mitral valve prolapse

A

Late systolic
Apex and left lower sternal border
*easily missed in supine position
Midsystolic click**

103
Q

Systolic clicks

A

Usually secondary to mitral valve prolapse

Mid to late systole, heard best at apex

Change position with physical maneuvers

104
Q

Ejection sounds

A

Usually AS/PS associated

Heard at base with expiration

Do not change with positional changes

105
Q

Pulmonic stenosis

A 
Crescendo decrescendo
Ejection sound
Coarse/harsh
Medium pitch
Fills systole 
Radiates to carotids
Palpable thrill
106
Q

Tricuspid regurgitation

A 
Holosystolic 
Lower left sternal border
Blowing
Increase on inspiration
Widely split S2 and distended jugular veins
107
Q

Hypertrophic cardiomyopathy

A 
Crescendo decrescendo systolic
Harsh
Lower left sternal border
Bifid carotid pulse
Does not radiate to carotids
108
Q

Ventral septal defect murmur

A 
Holosystolic
Very loud
High pitch
Harsh/coarse
Thrill or left on LSB

Most common pathologic murmur in children

109
Q

Atrial septal defect murmur

A 
Systolic
Loud, harsh, high pitched
Pulmonic area
Wide fixed s2 splitting
Rumbling, early diastolic murmur
110
Q

Diastolic murmurs

A

Mitral and tricuspid stenosis

Aortic and pulmonic regurgitation

ASD early diastolic rumbling

111
Q

Mitral stenosis

A

Heard best at apex LLD
Low pitch rumble
Does not radiate
Opening snap after s2

112
Q

Tricuspid stenosis

A 
LLSB
Mid-late low pitch rumble
Louder on inspiration
S1 split
Jugular venous pulse is prominent (right side of heart)
113
Q

Aortic insufficiency/regurgitation

A 
Best at LSB with patient sitting forward and exhaling
Early diastolic
Decrescendo
Soft
High pitch
Blowing
Water hammer/corrigan pulse
Austin flint M
Ejection sound at base
114
Q

Patent ductus arteriosis murmur

A

Loudest in late systole, has a loud and harsh machine like quality

115
Q

Pericardial friction rub

A

Scratchy, rubbing sound like a rocking chair “to and fro”

116
Q

Venous hum

A

Low pitch, low intensity, heard best in supraclavicular fossa

Intensified if patient sits or stands

117
Q

Pregnant women heart sound change

A

Audible s1 and s2 splitting

S3 at 20 weeks of gestation

Systolic ejection murmurs in pulmonic area in 90% of pregnant women

118
Q

Cyanotic congenital heart defects

A

5 T’s

Tetralogy of fallot
Transposition of great arteries
Truncus arteriosus
Total anomalous pulmonary venous return
Tricuspid atresia
119
Q

Acyanotic congenital heart defects

A 
ASD
VSD
PDA
Coarctation
Aortic stenosis
Pulmonic stenosis
120
Q

Transposition of great vessels

A

Significant cyanosis, not compatible with life without immediate intervention

121
Q

Tetralogy of fallot

A

Pulmonary stenosis

Thickened right ventricle wall

Ventricular septal defect

Aorta overrides septal defect

122
Q

Cor pulmonale

A

Enlargement of right ventricle secondary to pulmonary malfunction

Crackles, left parasternal systolic heave

123
Q

Acute rheumatic fever

A

Connective tissue disease from strep pharyngitis or skin infection

Jones criteria

Stenotic and regurgitant, mitral or aortic regurgitant

Friction rub

124
Q

Kawasaki disease

A

Inflammation of walls in medium sized arteries

Common issue is coronary artery aneurysm

125
Q

Pectins excavatum

A

Depression in sternum

126
Q

Pectus carinatum

A

Outward pointing of the chest wall

127
Q

Flail chest

A

Paradoxical breathing

128
Q

Tachypnea

A

Fast and shallow breathing

129
Q

Hyperventilation

A

Fast and deep breathing

130
Q

Tactile fremitus

A

“99”

Decreased- increased air

Increased- consolidation or fluid

131
Q

Tracheal position toward affected side

A

Atelectasis, fibrosis, pneumo

132
Q

Tracheal position away from affected side

A

Tension pneumo, enlarged thyroid

133
Q

Crepitus

A

Crackly or crinkling sensation, air in subcutaneous tissue

134
Q

Vesicular sounds

A

Low pitched, low intensity over healthy lung tissue

135
Q

Bronchovesicular sounds

A

Over major bronchi, moderate in pitch and intensity

136
Q

Bronchial sounds

A

Highest in pitch and intensity, only over the trachea

137
Q

Amphoric breath sounds

A

Blowing over the mouth of a bottle

Stiff walled pulmonary cavity

138
Q

Cavernous breath sound

A

Hollow, rigid pulmonary wall

139
Q

Crackles aka rales

A

Discontinuous sounds
Fine- high pitched, short
Medium- lower, mid stage of inspiration
Coarse- low pitched, long in duration

140
Q

Rhonchi

A

Deeper, rumbling

Pronounced during inspiration

Due to passage of air through obstructed airway

141
Q

Wheezes

A

Continuous, high pitched musical sounds

Narrowed or obstructed airway (asthma)

142
Q

Friction rub breath sound

A

Outside respiratory tree

Dry, crackly, grating, low pitched sound

Inflamed, roughened surfaces rubbing together, pleurisy

143
Q

Mediastinal crunch (ham man sign)

A

Mediastinal emphysema

Loud crackles, clicking and gurgling

Synchronous with heartbeat

144
Q

Bronchophony

A

Greater clarity and increased loudness of spoken sounds

145
Q

Whispered pectoriloquy

A

Extreme bronchophony where even a whisper is clearly heard

Specific for consolidation

146
Q

Egophony

A

E’s become a’s

147
Q

Infants in respiratory exam

A

Do not percuss

Listen to crying babies when taking a deep breath in

148
Q

Stridor

A

High pitched, piercing sound most often during inspiration due to obstruction high in respiratory tree

149
Q

Respiratory grunting

A

Expel trapped air/fetal lung fluid

150
Q

Peripartum cardiomyopathy

A

9/10th month pregnancy within 5 months post partum, start having heart failure symptoms

SOB, edema, abnormal weight gain

151
Q

Asthma

A

Small airways obstruction due to inflammation and hyperreative airways

Worse at night and in the cold

Wheezing, chest tightness, cough

152
Q

Pleurisy

A

Very painful, wont take a deep breath in, inflammatory process with visceral and parietal pleura

153
Q

Pneumonia

A

Most common cause of consolidation

Cough, fever, dyspnea, chest pain, rigors, sputum, tachypnea, tachycardia, rales/ronchi

Egophony, whispered pect.

154
Q

Tuberculosis

A

Upper lobe, coug with blood streaked sputum

155
Q

Bronchiolitis

A

Bronciolar inflammating leading to hyperinflation of the lungs, most infants younger than 6 months

156
Q

Croup

A

Viral, 1.5 to 3 years

Stridor, barking cough, wheeze

157
Q

Cystic fibrosis

A

Cough and sputum less than 5 years old

158
Q

Emphysema

A

Alveoli enlarge, barrel chested, non productive cough, smoking hx, overinflated and hyperresonate

159
Q

Chronic bronchitis

A

Large airway inflammation, chronic irritant exposure

Cough and sputum, recurrent bacterial infection

Patients older than 40

160
Q

Bronchiectasis

A

Chronic dilation of bronchi or bronchioles caused by repeated pulmonary infections and bronchial obstruction

H & P (4 decks)

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