Fall Final Flashcards
What is a MS screen?
Focused on whole MS system for complaints of non-specific pain or weakness; looking for normal or abnormal function
What is a focused MS exam?
Focused on a specific joint, limb or region of spine
What does GALS stand for in a MS medical history?
Gait
Arms
Legs
Spine
Do you examine the affected or unaffected side first?
Unaffected to gain a sense or normalcy
What is the rule of 15 in PVD?
15% of patients with PVD develop ulcer on foot
15% of those foot ulcers lead to osteomyelitis
15% of foot ulcers lead to amputation
What is the rule of 50 in PVD?
50% of amputations are trans-femoral or trans-tibial
50% of patients have a second amputation in 5 years
50% of patients die in 5 years or less
What causes ulceration?
Once the skin has thickened and circulation has become compromised
What characterizes an arterial insufficiency ulceration?
Painful discrete edges with punched out appearance rapid development; bone or tendon may be showing
What characterizes a venous insufficiency ulceration?
Painless, medial lower leg
Cobblestone appearance and slower growing
What is the most important finding in an examination of arterial pulses?
Decreased or absence of a pulse
Which pulse are you able to use your thumb for?
Brachial artery
When comparing time of femoral and radial pulse, what is a delayed femoral pulse indicative of?
Coarctation of the aorta
What is the grading of pulses?
0- Absent 1- Diminished 2- Normal 3- Increased 4- Bounding
What is the ankle brachial index (ABI)?
Ratio of BP in the lower legs to the blood pressure in the arms
What is lower BP in ankles compared to arms indicative of?
Peripheral vascular disease
How do you calculate ABI?
Dividing the highest systolic BP at the ankle by the highest systolic BP in the arm
Values for ABI?
1.30 uncompressible calcified vessels
.91-1.29 normal
.41-.9 mild peripheral art. disease
What is the diaphragm best used for?
Hearing high-pitched sounds S1-S2 and most heart murmurs
What is the bell best used for?
Hearing low-pitched sounds S3-S4 and a few murmurs
What causes the S2 split?
The aortic valve closing just before the pulmonic
What is the S2 split noted?
A2 (aortic) P2 (pulmonic)
What is the S3 heart sound?
A gallop (SLOSH-ing-in)
What causes the S3 sound?
Passive flow of blood from atria to non-compliant LV or dilated LV during rapid ventricular filling
What causes S4 sound?
Diminished ventricular compliance (stiff) increasing resistance to ventricular filling
What is the mnemonic to remember S4 sound?
a-STIFF-wall
What is a thrill?
A vibratory sensation produced by turbulent flow (palpable murmur)
What is a heave?
An upward lifting of your palm (visible)
What is a heave indicative of?
Left ventricular hypertrophy
What has a crescendo-decrescendo shape/sound?
Aortic stenosis
What has a decrescendo sound?
Aortic regurgitation
What has a holosystolic shape/sound?
Tricuspid regurgitation
Which heart murmurs are increased in inspiration?
Increased venous return so right side of the heart
Which heart murmurs are increased with expiration?
Left sided heart sounds
What does valsalva do?
Increase intra-thoracic pressure decreasing heart murmurs except for mitral prolapse and hypertrophic obstructive cardiomyopathy
What increases afterload on the heart?
Hand grip
Squatting (pre and afterloads)
When does ejection click occur and what causes it?
Early systole
Abrupt halting of the semilunar valves/decreased mobility
When does opening snap occur and what causes it?
Early diastole
Abrupt deceleration of mitral leaflet
What causes mid-systolic click?
Prolapsed mitral valve
What is dyspnea?
Shortness of breath
What is pectus excavatum?
Sunken in sternum
What is pectus carinatum?
Sternum protruding
What is the order of examination in a MS exam?
Inspection Palpation Range of motion Strength assessment Neurological assessment
What is the Stanford scale of aortic aneurysms?
Type A: includes the ascending aorta
Type B: begins after the brachiocephalic vessels
What causes wheezing?
Air going through an airway diminished in size typically due to mucous
What is rhonchi?
Wet coarse sounding
What is Cheyne-Stokes?
Respirations that gradually increase, then decrease in volume interspersed with periods of apnea
What is Kussmaul breathing?
Deep and labored breathing pattern
What is biot?
Abnormal pattern characterized by groups of quick, shallow inspirations followed by periods of apnea
What is hyperpnia?
Deep fast breathes for metabolic demand
What is stridor?
Wheeze high pitch from blocked trachea
Do you do PA or AP x-ray?
PA because it makes the heart the correct size (AP makes heart larger)
What is radio dense?
X-rays are absorbed making a white figure on film
What is radio lucent?
X-rays pass through the empty space looks black
