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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
General survey
Ht and wt, BMI, WHR, assess body proportion, assess state of health, assess apparent age
25
BMI > 25/30 at risk for...
HTN, dyslipidemia, type 2 diabetes, CVD, stroke, gallbladder dz, osteoarthritis, sleep apnea, CAs **overweight have a decreased risk of death from non CVD
26
Where is fat?
Central--neck, shoulder, chest, upper abdomen | Peripheral-- lower abdomen, pelvic girdle, buttocks, thighs
27
WHR... When it means trouble (HTN, diabetes, atherosclerotic, CVD)
>1.0 in men | >.85 in women
28
Marfan's syndrome
Reduced upper to lower body segment ratio or arm span to height ratio > 1.05 Also see arachnodactyly, pectus excavatum/carinatum, lens dislocation
29
Cachexic
Physical wasting usu assoc w chronic Dz, assess during general survey/ state of health
30
Signs of distress
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
Contour
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
Pulsus paradoxus specificity..
>20 mm Hg--91-100 % specific | >25 mm Hg--99% specific
33
Pulse pressure
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
Positive orthostatic tilt test
Increase in pulse of 30bpm or more, and drop in systolic of >10% OR dizziness, syncope (sxs of hypoperfusion)
35
Orthostatic vital signs
Skin color/turgor/temp, supine/serial/orthostatic vital signs, neck vein signs
36
Orthostatic tilt testing sensitivity
95% for blood loss of 1000mL Up to 15% of total blood loss vol can occur with minimal hemodynamics changes
37
Resp rate
*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
Fever rectal temp
>/= 38C (100.4F)
39
Oral temp fever
>/= 37.5 C (99.5 F)
40
Axillary temp fever
>/= 37.2C (99F)
41
Pyrexia
Grades of fever. Low, moderate, high, hyper- (>42C, 107.6F)
42
Factitious fever
Causes vary based on pt's imagination and skill
43
Relapsing fever
6 days of fever w afebrile interval. Causes: brucellosis, malaria, borreliosis (Lyme), TB
44
Pel ebstein fever
Variant of relapsing fever laying hours or days. Seen in 20% pts w Hodgkins
45
Quotidian fever
Malarial fever w daily paroxysms (2 spikes)
46
Hectic fever
Pm spike w facial flushing. Seen in TB.
47
Temp pulse dissoc
Normal-- increase in temp w 10 bpm increase in heart rate | If not, DDX: salmonella, typhoid, brucellosis, legionella, mycoplasma pneumonia, iatrogenic
48
Pulse oximetry
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
Pulse ox limits
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
Clinical uses of pulse oximetry
COPD, asthma, acute resp infection (community acquired pneumonia, influenza, acute resp distress)
51
Exercise testing
Pulse ox plus 6 min walk. | Abnormal: Post walk desaturation >/= 5% or less than 92%

CPD Lab final (1 decks)

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