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Advanced Health Assessment > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Other possible causes of chest pain

A

Pulmonary, GI, musculoskeletal, neurologic, psychogenic, idiopathic

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2
Q

Acute chest pain causes other than MI

A

GERD, peptic ulcer, gallstones, ischemic heart disease, pericarditis, pleuritis, pneumonia, pulmonary embolism, lung cancer, aortic aneurysm, aortic stenosis

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3
Q

Aggravating factors for angina

A

Eating, physical activity, smoking, cold weather, stress, anger, hunger, lying dow

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4
Q

Pericarditis

A

Substernal pain may radiate to neck and/or left arm
Sharp and may be accompanied by friction rub
Aggravated by deep breathing or supine postion
Alleviated by sitting up, leaning forward, anti-inflammatories

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5
Q

Dissecting aortic aneurysm

A

Retrosternal, upper abdominal, or epigastric pain

Excruciating and tearing pain

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6
Q

Costochondritis

A

Chest wall syndrome
Sharp, continuous or gradual pain; chest tender to touch
Aggravated by movement of palpation
Alleviated by time, analgesics, heat

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7
Q

Mitral regurgitation murmur

A

High pitched systolic murmur, heard best at the apex
Radiates to back or clavicle
Prone to CHF
S/S: SOB, pulmonary edema, orthopnea, decreased exercise intolerance, palpitations, A Fib

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8
Q

Mitral valve prolapse

A

Mild to late systolic click and late systolic murmur
Gets louder when patient stands up
Harmless in most cases

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9
Q

Mitral stenosis

A

Holodiastolic murmur
Low pitched
S/S: may begin with A fib, cough, difficuty breathig, fatigue, ankle edema

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10
Q

Aortic regurgitation

A

Diastolic murmur
High pitched
Best heard when sitting forward
S/S: SOB, CHF, palpitations,

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11
Q

Aortic stenosis

A

Systolic murmur
Louder with squatting
S/S: SOB with activity, angina, dizziness, palpitations

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12
Q

Pulmonic regurgitation

A

Diastolic murmur

S/S: right heart failure

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13
Q

Tricuspid regurgitation

A

High pitched systolic murmur

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14
Q

Tricuspid stenosis

A

Mid-diastolic murmur
Louder with exercise and inspiration
Softer with standing

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15
Q

Pulmonic stenosis

A

Systolic murmur
Sound radiates to neck or back
Deep inspiration will intensify the murmur

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16
Q

Inspiration augments which murmurs

A

Right sided sounds due to increased venous return

-Tricuspid and pulmonic stenosis

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17
Q

Vasalva maneuver augments which murmurs

A

Mitral stenosis, mitral valve prolapse

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18
Q

Squatting augments which murmurs

A

Aortic regurgitation, aortic stenosis, mitral regurgitation, mitral stenosis

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19
Q

MSARD

A

Mitral stenosis, aortic regurgitation

DIASTOLIC

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20
Q

MRASS

A

Mitral regurgitation, aortic stenosis

SYSTOLIC

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21
Q

Cardiac conduction

A

Starts in SA node to the AV node to bundle of His and then out to bundle branches and out to Purkinje fibers

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22
Q

Normal PR interval

A

0.12-0.2

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23
Q

Normal QRS

A

0.08-0.1

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24
Q

Normal QT

A

0.4-0.43

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25
Q

Premature Atrial Contraction

A

Rhythm regular
P wave premature or hidden
PR interval <0.2
QRS <0.12

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26
Q

Supraventricular tachycardia

A

Sudden start and stop

170-250 bpm

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27
Q

Atrial Flutter

A

Atrial HR 220-430
Rhythm regular
QRS <0.12

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28
Q

A Fib

A

Atrial HR 350-650
Irregular rhythm
No discernable P waves

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29
Q

V Tach

A

Symptomatic when sustained v tACH

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30
Q

1st degree AV block

A

Regular rhythm
One P wave to each QRS
OR prolonged
QRS normal

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31
Q

2nd degree AV block

Type 1

A

Rhythm regular

PR progressively lengthens until P wave occurs without QRS

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32
Q

2nd degree AV block

Type 2

A

PR interval constant but there is failure to conduct in the bundle of his and purkinje systems
QRS is dropped and wide
Pacemaker needed

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33
Q

3rd degree AV block

A

No impulses conducted from atria to ventricles
P waves marching through rhythm strip
Atrial rate 60-80, ventricle rate of 20-40
Pacemaker needed

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34
Q

Cor pulmonale

A

Enlargement of right ventricle secondary to pulmonary malfunction

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35
Q

Tetralogy of fallot

A

Ventricular septal defect
Pulmonic stenosis
Dextroposition of the aorta
R. Ventricular hypertrophy

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36
Q

Acute rheumatic fever

A

Systemic connective tissue disease occurring after streptococcal pharyngitis or skin infection

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37
Q

Kawasaki disease

A

Condition causing inflammation in walls of small and medium arteries throughout the body

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38
Q

S/S A fib

A

Palpitations, lightheadedness, fatigue, poor exercise capacity, angina, dypnea, syncope

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39
Q

Labs for MI

A

Troponin 1 and T increased 3-6 hours after onset and peaks at 12-24 hours, remaining elevated for 2-3 days
Myoglobin is early marker for myocardial necrosis which peaks at 1-4 hours

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40
Q

Levine’s sign

A

Clenched fist over center of chest

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41
Q

Dx labs for familial hypercholesterolemia

A

Severely high LDL >330, mildly elevated triglycerides, HDL normal or low

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42
Q

Giant cell arteritis/temporal arteritis

A

Headache, painless blindness without any visual changes to the eye, jaw claudication, scalp tenderness

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43
Q

Endocarditis

A

Fever, chills, cough, dyspea, night sweats, weight loss

May have signs of HF, splinter hemorrhages in nail beds, conjunctival petechiae, splenomegaly, retinal hemorrhage

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44
Q

Pericarditis

A

Pleuritic pain which is reduced by leaning forward and worsened by laying supine; SOB
Pericardial friction rub, S3, cardiac tamponande

45
Q

Wolff-Parkinson White syndrome

A

Mild chest pain or palpitations, syncope, fatigue, SOB
May have SVT, A fib, A flutter
Check electrolytres
Seen in young patients with episodes of paroxysmal tachycardia; congenital usually

46
Q

Arterial ulcer

A

Irregular margin, punched out edges, cold and dry, pain present, dimijnished pulses, variable sensation, shiny and taught with no edema

47
Q

Venous ulcer

A

Irregular margin, pink base, usually exudative, warm, mild to moderate pain, present pulses, sensation present, erythema and edema

48
Q

Diabetic ulcer

A

Red, often deep and infected; warm and dry; pulse may be present or not; loss of sensation, reflexes and vibration sense, shiny and taut

49
Q

Thrombophlebitis/DVT

A

Swelling, tenderness, inflammatio nand pain with ambulation

Dx: doppler ultrasound, D-dimer compression US, contrast venography

50
Q

Aneurysm s/s

A

Ripping/tearing sensation in chest, pressure on trachea or esophagus, dyspnea, cough, hoarseness, dysphagia

51
Q

Coarctation of aorta

A

Headaches, lower limb claudication, syncope, chest pain, dyspnea, irritability, poor feeding

52
Q

S/S kawasaki syndrome

A

Fever, rash, extremely irritabiity, conjunctival injection, red lips, strawberry tongue, rash wirthin 5 days of fever, reddened palms and soles, edema of extremities, tachycardia

53
Q

Intermittent asthma

A

<2 days per week
FEB >80
SABA as needed

54
Q

Mild asthma

A

> 2 days per week

FEV >80, Low dose ICS

55
Q

Moderate asthma

A

Daily
Fev 60-80
Medium dose ICS

56
Q

Severe asthma

A

Throughout day
FEV <60
Medium dose ICS + LABA

57
Q

When to use oral steroids for asthma

A

> 2 exacerbations in 6 months or >4 wheezing per year

58
Q

Normal respiratory

A

resonant percussion, trachea midline, breath sounds vesicular, no adventitious sounds, normal tactile fremitus

59
Q

Sounds of chronic bronchitis

A

Resonant percussion, trachea midline, vesicular breath sounds, scattered coarse crackles or some wheezes, normal tactile fremitus

60
Q

Sounds of LHF

A

Resonant percussion, midline trachea, vesicular breath sounds, late inspiratory crackles in dependent area of lungs, ormal tactile fremitus

61
Q

Sounds of consolidation

A

Dull percussion, midline trachea, bronchial breath sounds, late inspiratory cfrackles, increased tactile fremitus

62
Q

Sounds of atelactasis

A

Dull percussion, trachea shifted toward affected side, breath sounds absent, tactile fremitus absent

63
Q

Sounds of pleural effusion

A

Dull percussion, trachea shifted toward opposite side, breath sounds decreased, decreased tactile fremitus

64
Q

Sounds of pneumothorax

A

Hyperresonant percussion, trachea shift toward opposite side, decreased breath sounds, decreased tactile fremitus

65
Q

Sounds of COPD

A

Hyperresonant percussion diffuse, midline trachea, decreased breath sounds, decreased tactile fremitus

66
Q

Sounds of asthma

A

Resonant or hyperresonant percussion, midline trachea, wheezes, decreased tactile fremitus

67
Q

X ray colors

A

Bone–white
Tissue–grey
Air–black

68
Q

Location of gastric bubble

A

Left side of x ray

69
Q

Diaphragm on X ray

A

Right hemidiaphrgam slightly higher due to liver

70
Q

Otitis media with effusion

A

Inflammation of middle ear resulting in collection of purulent fluid when tympanic membrane is intact
Fluid clear and weber is positive to affected ear
Commonly associated with URI or allergic rhinitis

71
Q

Acute otitis media

A

inflammation of middle ear associated with middle ear effusion that becomes infected by bacteria
Fluid ourulent

72
Q

Otitis externa

A

Inflammation of auditory canal and external surface of tympanic membrane
Red ear canal, purulent discharge, edema, pain on exam

73
Q

Cholesteatoma

A

Trapped epithelial tissue behind the tympanic membrane that is often the result of untreated or chronic recurrent otitis media
Noncancerous skin growth in middle ear

74
Q

Hashimoto disease

A

Autoimmune antibodies against thyroid gland, caused by hypothyroidism

75
Q

Graves disease

A

Autoimmune antibodies to thryoid stimulating hormone receptor, leading to overactive thyroid

76
Q

Horner syndrome

A

Ptosis, anhidrosis (loss of sweating), miosis

77
Q

Diabetic retinopathy

A

Dot hemorrhages or microaneurysms due to development of new vessels as result of anoxic stimulation

78
Q

Lymphatic filariasis

A

Elephantiasis

Massive accumulation of lymphedema throughout body

79
Q

Migraine

A

Pulsating, duration of 72 hours, unilateral, N/V, disabling
Phototobia, phonophobia, lightheadedness, vertigo
Neuro exam normal, negative carotid bruit

80
Q

Tension headaches

A

Bilateral, pressing, tightening, nonpulsating, mild to moderate, not aggravated by activity, no N/V,

81
Q

When is neuroimaging needed for headache

A

Onset >40, sudden onset, change in apttern , progressive neuro symptoms, thunderclap headache, double vision

82
Q

Cluster headache

A

5 attacks of severe unilateral orbital or supraorbital or temporal pain lasting 15-180 minutes; with one of lacrimation, nasal congestion, eyelid edema, forehead and facial sweating, miosis or ptosis

83
Q

Ceremun impaction

A

Pain, itching, hearing loss, tinnitus

Medium to dark honey colored cerumen; may see mild erythema and ipsilateral decreased hearing

84
Q

TMJ disorder

A

Facial or TMJ pain, locking or catching of jaw, decreased ROM, headache, neck pain

85
Q

Allergic rhinitis

A

Nasal congeston, rhinorrhea, itching of nose, eyes, ears, and palate
Allergic shiners, rhinorrhea clear, pale and boggy blue gray nasal mucosa
Nasal saline helps along with 2nd gen antihistamines

86
Q

Conjunctivitis

A 
Conjunctival injection, sensation of foreign body, eyelid sticking or crusting, discharge may be unilateral or bilateal
If herpes--burning
If allergic--constant itching 
Dont wear contacts until resolved
Change mascara and all eye make up
87
Q

Corneal abrasion

A

Sudden onset of eye pain, phototobia, sensation of foreign body, blurring vision, conjunctival injection, usually unilateral
Visual acuity affected, conjunctival injection, increased tearing
No contacts until resolved

88
Q

Closed angle glaucoma

A

Acute, severe eye pain with blurred vision and eye redness, halo around lights, frontal headache, N/V, compromised peripheral vision then central
Fundoscopy shows congestion, cupping, atrophy of optic nerve, pain with eye movement, sluggish pupillary reaction

89
Q

Open angle glaucoma

A

Painless, slowly progressive, central field loss comes late in disease

90
Q

Cataracts

A

Decreased visual acuity, blurred vision, distortion or ghosting of images
Lens opacity, nystagmus, strabismus

91
Q

Hordeolum

A

Localized inflammation of eyelid or surrounding skin; sensation of foreign body; itching
Warm compresses common tx

92
Q

Chalazion

A

Palpable, non-tender nodule, firm, nonerythemic, nonfluctuant

93
Q

Pharyngitis

A

Sore throat, painful swallowing, cough, fever
Enlarged tonsils, scarlet fever rash maybe, exudates if bacterial
Usually due to GAS if bacterial

94
Q

Macular degeneration

A

Distortion of central vision, straight lines look crooked

Must stop smoking

95
Q

Mono

A

Fatigue, fever, chest pain, gray white exudate on tonsils, petechiae on soft palate, rash on trunk and upper arms

96
Q

Confluent lesions

A

Run together

Hives, urticaria

97
Q

Discrete lesions

A

Remain separate

Molluscum

98
Q

Aconthosis nigricans

A

nonspecific reaction pattern associated with obesity, certain endocrine syndromes or malignancies

99
Q

Alopecia areata

A

Sudden, rapid, patchy loss of hair

100
Q

Clubbing of nails

A

Occurs with congenital chronic cyanotic heart disease and COPD

101
Q

Herpes

A

Burning or tingling sensation prior to vesicles erupting
Recurrent outbreaks
Primary lesions are clustered vesicles

102
Q

Tinea

A

Itching, pain, fissure, scaly and eczema looking

Tx lasts 4-6 weeks

103
Q

Scabies

A

Intense itching that may be worse at night

Linear, erythemic, small red papules; may form vesicles and can erode or crust

104
Q

Impetigo

A

Fluid filled lesions show up rapidly, burst and crust over
No fever or lymphadenopathy
Bulae or vesicles/pustules, honey colored custing, weeping, shallow, red ulcers

105
Q

Folliculitis

A

Red bumps that may itch, usually recent shaving or been in hot tub
Red papules that progress into pustules, erode and crust over

106
Q

Molluscum contagiosum

A

Burning and itching over the trunk and extremities; often in contact sports
Smooth, pink or flesh colored lesion
Caused by benign virus–very contagious but self limiting

107
Q

Psoriasis

A

Plaques with overlying silvery scales; salmon colored, well-demarcated

108
Q

Cellulitis

A

Localized area of edamatous, erythemic, indurated and warm skin

109
Q

5 Is of geriatrics

A

Intellectual impairment, immobility, instability, incontinence, iatrogenic disorders

Advanced Health Assessment (4 decks)

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