Final Flashcards
(114 cards)
1
Q
Temperature Difs
A
Rectal>oral>axillary
Tympanic closest to core temp
2
Q
Temperature Difs
A
Rectal>oral>axillary
Tympanic closest to core temp
3
Q
Hyperpyrexia
A
> 41.1/106
4
Q
Hypothermia
A
5
Q
Smoking and oral temp
A
increase by .2C for 30 mins
6
Q
Irregular HR should be measured by
A
auscultation at apex for 60s
7
Q
Bradypnea
Tachypnea
Hyperapnea
A
25 Rapid and SHALLOW= pna, restrictive lung disease
>25 rapid and DEEP-Met acidosis, anxiety
8
Q
Cheyne Stokes
A
Breathing that alternates every 20-30s between tachypnea and bradypnea
9
Q
Kussmail breathing
A
metabolic acidosis- fast, slow or normal
varied rate and depth
10
Q
Trepopnea
A
lateral decubitus tachypnea/dyspnea
Healthy lung better down, right side if CHF,
11
Q
Platypnea
A
dyspnea worse when sitting, better supine (opp of orthopnea)
due to r to l cardiac shunt, PE or pericardia effusion
12
Q
Pulses Weak Bounding Paradoxus Alterans
A
Weak- hypovolemia, aortic stenosis, increased peripheral resistance (CHF, cold)
Bounding- increased stroke volume/decreased resistance. Fever, anemia, hyperthyroidism, agint, aortic insufficiency,
Pulsus paradoxus- Drop in systolic BP>10 during inspiration from cardiac tamponade or constrictive pericarditis
Pulsus alterans- pulses have different amplitude -caused by LV systolic impairment
13
Q
Auscultatory gap
A
Korotkoff sound disappears between systolic and diastolic
increased atherosclerosis and venous congestion
14
Q
Bilatera UE BP differences
A
aortic dissection
15
Q
Pulse pressure- narrow vs wide
A
narrow= low CO, aortic stenosis,chf(rt)
Wide: aortic insufficiency, stiff arteries
16
Q
Fevers Sustained intermittent remittent hectic relapsing resistant
A
sustained- lobar pna
intermittent- malaria
remittent (varies but never returns to normal)- typhoid
hectic- chronic TB, pyogenic abscess
Relapsing- prior infection, hodgkin, borrelia,
resistant- misdiagnosed infection, resistant organism.
17
Q
O2 saturation misreading
false desat
false saturation
unable to read
A
false desat- venous pulsation (right heart disease, tricuspid regurg)
False sat- met/carboxy hemoglobinemia
unable to read- poor perfusion (vascular disease/hypotension)
18
Q
Orthostatic criteria
A
Systolic decrease by >20 or diastolic >10
19
Q
BP cuff too small/large
A
too small= higher reading
too large- lower reading
20
Q
5th vital sign
A
patient pain level
21
Q
Hyperpyrexia
A
> 41.1/106
22
Q
Hypothermia
A
23
Q
Smoking and oral temp
A
increase by .2C for 30 mins
24
Q
Irregular HR should be measured by
A
auscultation at apex for 60s
25
Opthalmic exam:
- optic disk - what is it
- cup:disk ratio
- Vessel diameter ratio
convergence of arteries and veins
cup:disk= 1:3
Artery: vein= 2:3
artery reflect light more than veins
26
leukokoria
white reflex
| cataracts, retinal detachment, chorioretinitis, retinoblastoma
27
Kussmail breathing
metabolic acidosis- fast, slow or normal
| varied rate and depth
28
Trepopnea
lateral decubitus tachypnea/dyspnea
| Healthy lung better down, right side if CHF,
29
Platypnea
dyspnea worse when sitting, better supine (opp of orthopnea)
due to r to l cardiac shunt, PE or pericardia effusion
30
```
Pulses
Weak
Bounding
Paradoxus
Alterans
```
Weak- hypovolemia, aortic stenosis, increased peripheral resistance (CHF, cold)
Bounding- increased stroke volume/decreased resistance. Fever, anemia, hyperthyroidism, agint, aortic insufficiency,
Pulsus paradoxus- Drop in systolic BP>10 during inspiration from cardiac tamponade or constrictive pericarditis
Pulsus alterans- different amplitude from LV systolic impairment
31
Lips
- swollen
- painful vesicles that crust
- firm lesion that might ulcerate
- irregular/plaque nodule
- red spot
- brown spots
- scaling/fissures at corner of mouth
- swollen= angioedema
- painful vesicles that crust- HSV1
- firm lesion that might ulcerate- Syphilitic chancre
- irregular/plaque nodule=cancer
- red spot-hereditary telangiectasia (nasal/Gi bleeding)
- brown spots-Peutz Jeghers syndrome (intestinal polyps)
- scaling/fissures at corner of mouth- angular cheilitis= riboflavin def
32
Bilatera UE BP differences
aortic dissection
33
Tracheal deviation
Atelectasis pulls trachea
| pneumothorax, pleural effusion-pushes trachea
34
```
Fevers
Sustained
intermittent
remittent
hectic
relapsing
resistant
```
sustained- lobar pna
intermittent- malaria
remittent (varies but never returns to normal)- typhoid
hectic- chronic TB, pyogenic abscess
Relapsing- prior infection, hodgkin, borrelia,
resistant- misdiagnosed infection, resistant organism.
35
O2 saturation misreading
false desat
false saturation
unable to read
false desat- venous pulsation (right heart disease, tricuspid regurg)
False sat- met/carboxy hemoglobinemia
unable to read- poor perfusion (vascular disease/hypotension)
36
Orthostatic criteria
Systolic decrease by >20 or diastolic >10
37
BP cuff too small/large
too small= higher reading
| too large- lower reading
38
palmar crease palor
anemia
39
BMI
kg/m2
25-30= overweight
Obese>30
Morbidly obese>40
40
Waist to hip ratio- normal is:
women .85 or less
| Men 1 or less
41
Normal pupil diameter
R&L within .4mm
10yrs-7mm
40yrs-6mm
80-4mm
42
anisocoria
unequal pupil size
43
hippus
"restless" pupils, in young people, during illumination
44
Opthalmic exam:
- optic disk
- cup:disk ration
- Vessel diameter ration
convergence of arteries and veins
cup:disk= 1:3
Artery: vein= 2:3
artery reflect light more than veins
45
leukokoria
white reflex
| catarcts, retinal detachment, chorioretinitis, retinoblastoma
46
optic disk cupping
glaucoma
47
swollen disk/vessels
venous stasis from papilledema
48
Accurate JVP when
measure patient's RIGHT side during expiration.
| >3cm (total 8cm from RA) of sternal angle is abnormal
49
Falsely small/large thyroid
Normal size
50
Lips
- swollen
- painful vesicles that crust
- firm lesion that might ulcerate
- irregular/plaque nodule
- red spot
- brown spots
- scaling/fissures at corner of mouth
- swollen= angioedema
- painful vesicles that crust- HSV1
- firm lesion that might ulcerate- Syphilitic chancre
- irregular/plaque nodule=cancer
- red spot-hereditary telangiectasia (nasal/Gi bleeding)
- brown spots-Peutz Jeghers syndrome (intestinal polyps)
- scaling/fissures at corner of mouth- angular cheilitis= riboflavin def
51
eye auscultation
bruit can indicate intracranial aneurysm
52
Tracheal deviation
towards atelectasis
| away from pna, effusions
53
Carotid pulse
- delayed upstroke
- bounding upstroke
- bruit
-delayed upstroke- carotid setnosis
-bounding upstroke- aortic insuf
bruit- atherosclerotic narrowing
54
Pretibial myxedema
raised pink/brown plaques over skin= hyperthyroidism
55
Spider angioma- also might see
hepatocellular disease, vit b def, pregnancy
| palmar erythema has same etiology
56
caput medusae
hepatocellular disease
57
palmar crease palor
anemia
58
Delphian node
| Sentinel node
Delphian node; single enlarged node above thyroid isthmus= thyroid cancer
Sentinel: supraclavicular-abd or thoracic malignancy
59
Normal hearing range
60
Waldeyers ring
lymph: palatine, lingual and adenoid tonsils
61
Total teeth
32
62
proximal nail fold
1/4 of nail bed
63
allergic rhinitis-
| viral rhinitis
swollen pale= allergic
| swollen red= viral
64
smooth tongue, papilla loss
vita B/ Fe deficiency
65
Pembertons Sign
goiter at thoracic inlet= goiter with dyspnea, dysphagia, cough, hoarseness (esp with arms raised)
66
Substernal goiter
= tracheal deviation
67
myxedema
non pitting puffiness- can be sign of hypothyroidism
68
Normal chest shape
AP: lateral diameter .7-.75
69
Barrel chest
| Normal vs abnormal
Normal: old/infants
Abnormal: COPD
70
Flail Chest
Rib fracture
| Inward on inspiration, outward with expiration
71
Pectus excavatum
funnel chest- depression of lower part of sternum
72
Pectus carinatum
Pigeon chest
| anterior sternum
73
Asynchronous breathing
Caused by obstruction, COPD,
Expiration: usually inward abdominal movement
Instead expriration causes inward then outward movement
74
Resp alterans
inspiration has abdominal movement, expiration has thoracic movement
75
paradoxical abd movement
due to bilateral diaphragm weakness
| abdomen move in and chest move out (loss of synchrony)
76
Where to put hole/tube
1. tension pneumothorax
2. chest tube
1. 2nd intercostal space= tension pneumothorax
| 2. 4th- chest tube
77
Tactile fremitus
| non pathologic absence
non patho- women, high pitch/soft voice, thick chest wall
78
grunting
resp muscle fatigue, untreated pna
79
expiratory wheeze
| inspiratory wheeze
exp: low airway obstruction
Insp: stridor, upper airway obstruction
80
Costal paradox=
hoovers sign = thoracic expansion is opposite (hands come together
COPD, weak diaphragms (basically chest can't expand any more)
81
Tactile fremitus- pathologic
Increased
Decreased
Increased= consolidation, ie PNA
| Decreaed: Space between chest wall and lung= effusion, pneumothorax, COPD, neoplasm
82
Percussion sounds
| flat, dull, resonant, tympanic
flat-bone, muscle
dull- liver
resonant- lung
tympanic- abd (bowel gas)
83
Normal range of diaphragm
percussion- 3-6cm
radiograph 5-7cm
lung disease=
84
Vesicular breath sounds
| Bronchial breath sounds
Vesicular- lower pitch, inspiratory, over most of lungs
| Bronchial= higher pitch, expiratory, harsh, loud. Over trachea and apex of RT lung
85
```
Wheezes
Crackles
Rales
Rhonchi
Rubs
```
```
Wheeze=high pitch
Crackle- non musical sound
---fine- high pitch= interstitial fibrosis
---coarse- low pitch
Rales=aka crackles
Rhonchi= low pitch snore
Rub- continuous low pitch crackle
```
86
Crackles loudest in
lower chest
87
Clavicle rise
>5mm= COPD
88
Flat/dull percussion of lung
consolidation (pna), pleural effusion, atelectasis, diaphragm paralysis
89
Hyperresonant percussion of lung
pneumothorax, COPD, emphysema, -increased air
90
Tympanic percussion of lung
large pneumothorax - increased air
91
Breath sounds increased/decreased/bronchial
Increased=pna
Decreased= pleural effusion, pneumothorax, COPD, asthma
Bronchial: pna
92
Wheeze
high pitch exp
lower airway obstruction
asthma, chronic bronchitis, left heart failure
93
Crackle
lower lung
early
late
lower lung= interstitial fibrosis, left heart failure
late inspiratory- consolidation, interstitial fibrosis
early insp= asthma, chronic bronchitis
94
Interstitial fibrosis
fine late inspiratory crackle
95
Pleural rub
pleural effusion, pna, malignancy
96
Rhonchi
chronic bronchitis
97
Vocal resonance and diseases
pna, effusion= egophony, whispered, bronchophony
98
absent vocal resonancy
atelectasis
99
stridor
exp wheeze, loud in neck
100
Hyperkinetic pulsation
"thrust"= ASD, pectus excavatum, fever
| or thin walled chest, ventricular aneurysm
101
Sustained pulsation
"heave or lift"- abnormal RV from pulm htn, ASD, enlarged left atrium, vent aneurysm, LVH, cardiomyopathy aortic stenosis/regurg
102
palpable p2
possible pulm htn (if patient has mitral stenosis)
103
abnormal apical impulse- def
| normal chnage
>2.5cm diameter
| displaced to left in pregnancy
104
Diaphragm vs bell
```
Diaphragm= high pitch
bell= low pitch
```
105
S1 vs S2 (normal
S2- louder, higher pitched. possible split 20-30ms normal
106
S3=
early diastole
107
S4
late diastole
108
diffuse PMI
CHF, R/L Ventricular hypertrophy
109
hyperkinetic/increased diameter/duration/amplitude
LV failure, CHF, ventricular aneurysm
110
retraction of PMI
restrictive pericarditis, tricusp regurg
111
double cardiac impulse
ventricular aneurysm
112
vent aneurysm
Diffuse, hyperkinetic, sustain, or double PMI
113
patients with emphysema may have cardiac percussion
errors exaggerated
114
palpation from aortic/pulm stenosis
2nd intercostal space thrills
