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CPD Lab final > Final > Flashcards

Final Flashcards

0
Q

Inferior border

A

Ant to 6th rib at mid clavicular line, 8th rib at midaxillary line

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1
Q

Apex

A

2-4 cm above clavicle

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2
Q

Lower border

A

T10 posterior resting, T12 maximum respiration

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3
Q

R transverse fissure

A

5th rib midaxillary, 4th rib anteriorly

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4
Q

Trachea

A

Bifurcates at T4 in the back and at the sternal angle in front

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5
Q

Pos thorax exam

A

Arms crossed.
Inspect: barrel chest, rate and rhythm, tachypnea, hypernea
Palpation: tenderness, expansion, tactile fremitus, rib fractures
Percussion: notes and diaphragmatic excursion
Auscultation: not through gown, normal breath sounds, adventitious sounds, abnormal sounds

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6
Q

Anterior thorax exam

A

Inspection: labored, accessory muscles, tripod, pursing, trachea midline, pigeon/funnel/barrel
Palpation: tender, assess expansion, tactile fremitus
Percussion: don’t forget RML
Auscultation: same as pos thorax

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7
Q

Signs in pneumonia

A

Egophony– 8.6 positive LR
Dullness to percussion–4.3 positive LR

*negative LR not such hot predictors

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8
Q

Stethos

A

Breast

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9
Q

Skopein

A

To view

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10
Q

Inventor of stethoscope

A

Rene Laennec, 1816.

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11
Q

Normal breath sounds

A

Bronchial and vesicular

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12
Q

Abnormal breath sounds

A

Absent or transmission of bronchial breath sounds due to atelectasis or lobar consolidation

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13
Q

Vocal sounds

A

Bronchophony, egophony, whispered pectoriloquy

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14
Q

Adventitious breath sounds

A

Superimposed
Crackles: sudden opening of collapsed airways or movement of air through excess airway secretions
Wheezes: high pitched vibrations secondary to narrowing of airways
Rhonchi: low pitched continuous sounds
Stridor: inspiratory wheeze heard over large airways. Croup and epiglottitis
Pleural rub: grating sound d/t inflamed pleural surfaces rubbing

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15
Q

Lobar pneumonia vital signs

A

Increased Resp rate and pulse. Bad sick

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16
Q

Atelectasis appearance and vital signs

A

Trachea deviated. Increased resp rate and pulse, possible, cyanosis

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17
Q

Bronchial breath sounds indicate…

A

Pneumonia

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18
Q

Decreased breath sounds..

A

Pneumothorax, pleural effusion

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19
Q

Random monophonic wheeze

A

Asthma. If wheezes go away could be they just can’t breathe deeply enough. Check Peak Flow meter

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20
Q

Sensitive signs upon percussion and auscultation

A

Pretty much none.

21
Q

Specific tests for percussion and auscultation

A

Dullness, egophony, bronchial breath sounds

22
Q

Good LRs of findings in COPD

A 
Early inspiratory crackles +LR=14.6
Combined findings (smoked 70+ pack yrs, Hx of chronic bronchitis, diminished breath sounds) +LR=25.7
23
Q

When BMI betrays you

A

Body builder, taller than 6’3, Women of African descent

24
Q

General survey

A

Ht and wt, BMI, WHR, assess body proportion, assess state of health, assess apparent age

25
Q

BMI > 25/30 at risk for…

A

HTN, dyslipidemia, type 2 diabetes, CVD, stroke, gallbladder dz, osteoarthritis, sleep apnea, CAs

**overweight have a decreased risk of death from non CVD

26
Q

Where is fat?

A

Central–neck, shoulder, chest, upper abdomen

Peripheral– lower abdomen, pelvic girdle, buttocks, thighs

27
Q

WHR… When it means trouble (HTN, diabetes, atherosclerotic, CVD)

A

> 1.0 in men

>.85 in women

28
Q

Marfan’s syndrome

A

Reduced upper to lower body segment ratio or arm span to height ratio > 1.05
Also see arachnodactyly, pectus excavatum/carinatum, lens dislocation

29
Q

Cachexic

A

Physical wasting usu assoc w chronic Dz, assess during general survey/ state of health

30
Q

Signs of distress

A

Resp: tachypnea, use of accessory muscles
Cardiac: Levines sign 80% sensitive for MI
Toxic: anxious, flushed, sweaty, febrile. [DDX: sepsis, poisoning, thyroid storm, heat stroke]

31
Q

Contour

A

Changes in pulse amplitude
Pulsus alternans: Regular rate w varying amplitude, seen with L CHF
Pulsus paradoxus: drop in pulse amplitude (or systolic BP) w inspiration, seen in pericardial tamponade or status asthmaticus

32
Q

Pulsus paradoxus specificity..

A

> 20 mm Hg–91-100 % specific

>25 mm Hg–99% specific

33
Q

Pulse pressure

A

Normal difference between Sys and diastolic= 25-50%
Abnormally wide pulse pressure= hyperkinetic heart syndrome, high stroke volume, aortic regurgitation, patent ductus arteriosis, exercise, fever, anemia, beriberi, paget’s dz, cirrhosis, pregnancy
Abnormally narrow pulse pressure=decreased left ventricular stroke vol, cardiac tamponade, pericarditis

34
Q

Positive orthostatic tilt test

A

Increase in pulse of 30bpm or more, and drop in systolic of >10% OR dizziness, syncope (sxs of hypoperfusion)

35
Q

Orthostatic vital signs

A

Skin color/turgor/temp, supine/serial/orthostatic vital signs, neck vein signs

36
Q

Orthostatic tilt testing sensitivity

A

95% for blood loss of 1000mL

Up to 15% of total blood loss vol can occur with minimal hemodynamics changes

37
Q

Resp rate

A

*sham taking of the pulse
Normal: 14-20 bpm
Tachypnea: Resp > 20 bpm. Many heart/lung dzs and pulmonary embolism
Hypernea: Kussmaul’s respirations. Rapid and deep, DKA
Hypopnea: shallow, assoc w obesity. Pickwickian syndrome
Apnea: absence for 20 sec, associated w airway obstruction

38
Q

Fever rectal temp

A

> /= 38C (100.4F)

39
Q

Oral temp fever

A

> /= 37.5 C (99.5 F)

40
Q

Axillary temp fever

A

> /= 37.2C (99F)

41
Q

Pyrexia

A

Grades of fever. Low, moderate, high, hyper- (>42C, 107.6F)

42
Q

Factitious fever

A

Causes vary based on pt’s imagination and skill

43
Q

Relapsing fever

A

6 days of fever w afebrile interval. Causes: brucellosis, malaria, borreliosis (Lyme), TB

44
Q

Pel ebstein fever

A

Variant of relapsing fever laying hours or days. Seen in 20% pts w Hodgkins

45
Q

Quotidian fever

A

Malarial fever w daily paroxysms (2 spikes)

46
Q

Hectic fever

A

Pm spike w facial flushing. Seen in TB.

47
Q

Temp pulse dissoc

A

Normal– increase in temp w 10 bpm increase in heart rate

If not, DDX: salmonella, typhoid, brucellosis, legionella, mycoplasma pneumonia, iatrogenic

48
Q

Pulse oximetry

A

Uses differential of light by oxy and delxyhemoglobin to estimate oxygen saturation.
Frank cyanosis occurs at 67% arterial oxygen saturation (deoxy at 5g/dL)

49
Q

Pulse ox limits

A

Does not assess ventilation. Large acute decrease in PaO2 not detected quickly. In acute settings must be supplemented w PaO2 and PaCO2
Inaccuracy: motion from shivering, seizures; ambient light; electromagnetic radiation; abnormal hemoglobin; nail polish, dark skin, poor perfusion; carbon monoxide poisoning, severe anemia

50
Q

Clinical uses of pulse oximetry

A

COPD, asthma, acute resp infection (community acquired pneumonia, influenza, acute resp distress)

51
Q

Exercise testing

A

Pulse ox plus 6 min walk.

Abnormal: Post walk desaturation >/= 5% or less than 92%

CPD Lab final (1 decks)

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