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Clinical Methods > Final A > Flashcards

Final A Flashcards

1
Q

What are the fissures on the left lung? How many lobes are there?

A

Oblique fissure splits the left lung into 2 lobes

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2
Q

What is visceral pleura?

A

The serous membrane that covers the outer surface of each lung

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3
Q

What is parietal pleura?

A

The membrane that lines the inner rib cage and upper surface of the diaphragm

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4
Q

What is the primary muscle of inspiration?

A

Diaphragm

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5
Q

How does the intrathoracic pressure change during inspiration?

A

It decreases below atmospheric pressure, drawing air in

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6
Q

When the work of breathing is increased, which accessory muscles are most important for respiratory effort?

A

Sternocleidomastoids

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7
Q

What is hemoptysis?

A

Blood-streaked sputum

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8
Q

Pain in conditions such as pneumonia, pneumothorax, and PE arise from what area of the thoracic cavity?

A

The parietal pleura

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9
Q

What measurement can predict 5 year survival in patients with COPD better than FEV1 can?

A

Degree of dyspnea

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10
Q

What conditions cause wheezing?

A

Asthma, emphysema - partial airway obstructions from secretions, inflammation, or other airway obstruction

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11
Q

How long does an acute cough last?

A

Less than 3 weeks

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12
Q

How long does a subacute cough last?

A

3-8 weeks

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13
Q

How long does a chronic cough last?

A

More than 8 weeks

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14
Q

What is the leading cause of preventable death in the U.S.?

A

Smoking

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15
Q

What is tactile fremitus?

A

Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall when the patient speaks

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16
Q

What does chest percussion during a pulmonary exam help you determine?

A

Whether the underlying tissues are air-filled, fluid-filled, or solid

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17
Q

What are vesicular breath sounds?

A

Normal soft-intensity, low-pitched gentle sighing sounds created by air moving through the smaller airways (bronchioles and alveoli)

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18
Q

When are vesicular breath sounds best heard?

A

On inspiration

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19
Q

What are bronchovesicular breath sounds?

A

Moderate-intensity and moderate-pitched blowing sounds created by air moving through the larger airways (bronchi)

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20
Q

When are bronchovesicular breath sounds best heard?

A

Either inspiration or expiration

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21
Q

What are bronchial/tubular breath sounds?

A

High-pitched, loud, harsh sounds created by air moving through the trachea

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22
Q

When are bronchial/tubular breath sounds best heard

A

Expiration

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23
Q

What do crackles/rales sound like?

A

Fine, short, interrupted crackling, high pitched

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24
Q

What causes crackles/rales?

A

Air passing through fluid or mucus in any airway

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25
Q

When are crackles/rales best heard?

A

On inspiration

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26
Q

Where are crackles/rales most commonly heard?

A

At the base of the lower lung lobes

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27
Q

What do gurgles/rhonchi sound like?

A

Continuous, low-pitched, coarse, harsh - a moaning/snoring quality

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28
Q

When are gurgles/rhonchi best heard?

A

On expiration

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29
Q

Which adventitious/abnormal breath sounds can be altered by coughing?

A

Gurgles (rhonchi)

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30
Q

What causes gurgles/rhonchi?

A

Air passing through narrowed air passages as a result or secretions, swelling, or tumors

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31
Q

Where are gurgles/rhonchi heard?

A

Can be heard at most lung areas but best heard over the trachea and bronchi

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32
Q

What does a friction rub sound like?

A

Superficial grating or creaking sounds

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33
Q

When are friction rubs heard?

A

During both inspiration and expiration

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34
Q

What causes friction rub sounds?

A

Rubbing together of inflamed pleural surfaces

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35
Q

Where are friction rubs heard the best?

A

In areas with the greatest thoracic expansion like the lower anterior and lateral chest

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36
Q

What is stridor?

A

Wheeze-like sounds in the trachea heard when a person breaths

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37
Q

What causes stridor?

A

Blockage of airflow in the trachea or back of throat

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38
Q

What is whispered pectoriloquy?

A

When listening with a stethoscope, there is increased loudness of words that a patient whispers in areas of tissue abnormality

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39
Q

What is bronchophony?

A

When words that a patient says in a normal voice are heard clearly with a stethoscope

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40
Q

What is egophony?

A

When the patient says the vowel “e”, it sounds more like a nasal “a” when listening with a stethoscope

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41
Q

What causes egophony?

A

Consolidated lung tissue

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42
Q

What is the most common congenital deformity of the anterior chest wall?

A

Pectus excavatum

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43
Q

What is pectus excavatum?

A

When several ribs and the sternum grow abnormally and produce a caved in or sunken appearance of the chest wall

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44
Q

What is pectus carinatum?

A

A deformity of the chest characterized by protrusion of sternum and ribs

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45
Q

What is pectus carinatum also called?

A

Pigeon chest

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46
Q

What is the normal ratio of anteroposterior to transverse diameter of an adult chest?

A

1:2

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47
Q

What is the chest diameter ratio in patients with barrel chest?

A

1:1

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48
Q

What is flail chest?

A

A portion of the chest caves in - normally due to a blunt chest injury

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49
Q

What type of breathing is caused by flail chest?

A

Paradoxical - the chest wall collapses in during inhalation and moves out during exhalation (opposite in normal breathing)

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50
Q

What is the definition of functional residual capacity?

A

The volume of air left in the lungs after a passive exhalation - 30mL/kg

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51
Q

What does spirometry measure?

A

The volume and/or flow of air that can be inhaled and exhaled

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52
Q

What lung diseases can be diagnosed using spirometry?

A
  • Asthma
  • Bronchitis
  • Emphysema
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53
Q

Which common complaint can be investigated using a spirometry test?

A

Shortness of breath

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54
Q

Which test of respiration can measure whether exposure to chemicals at work affects lung function?

A

Spirometry

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55
Q

Which test of respiratory checks lung function before someone has surgery?

A

Spirometry

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56
Q

What lung volumes cannot be measured using spirometry?

A

FRC and RV

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57
Q

Average tidal volume

A

500mL

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58
Q

Average residual volume (RV)

A

1200mL

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59
Q

Average volume for Total Lung Capacity (TLC)

A

6000mL

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60
Q

Average volume for Vital Capacity (VC)

A

4800mL

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61
Q

Average volume for Functional Residual Capacity

A

2400mL

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62
Q

What is FEV1?

A

Forced expiratory volume - the volume of gas exhaled in 1 second by a force expiration after a full inspiratory

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63
Q

What is the most commonly used parameter to predict survival in COPD patients?

A

FEV1

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64
Q

What is FVC?

A

Forced vital capacity - vital capacity measured with a forced expiration

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65
Q

What is a normal FEV1/FVC ratio?

A

80%

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66
Q

What does the FEV1/FVC ratio measure?

A

The percent of forced vital capacity that is exhaled in the first second

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67
Q

What is the issue in obstructive lung disease?

A

There is difficulty exhaling all the air from the lungs because of damage to the lungs or narrowing of the airways inside the lungs

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68
Q

What is the issue in restrictive lung disease?

A

There is an underlying condition that causes stiffness in the lungs and a restriction with lung expansion

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69
Q

How is FEV1 changed in patients with obstructive lung diseases?

A

Decreased

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70
Q

How is the FEV1/FVC ratio changed in patients with obstructive lung disease?

A

Decreased

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71
Q

The diagnosis of COPD is made with the FEV1/FVC ratio is less than __%

A

70

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72
Q

How is the FEV1/FVC ratio changed in patients with restrictive lung disease?

A

It remains the same or may even be increased because both FEV1 and FVC are equally reduced. FVC may decline more - causing the ratio to increase

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73
Q

What test is used to determine gas exchange?

A

Arterial blood gas

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74
Q

Supplemental oxygen should be administered at a PaO2 less than __mmHg

A

60

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75
Q

A patient is at risk of death with a PaO2 less than __mmHg

A

26

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76
Q

Normal ABG pH range

A

7.35-7.45

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77
Q

Normal ABG pCO2 range

A

35-45

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78
Q

Normal ABG pO2 range

A

80-100

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79
Q

Normal ABG HCO3 range

A

22-26

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80
Q

List materials found in an X-ray in order of most radiodense (white) to least radiodense (black)

A

Metal, bone, soft tissue, fat, air

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81
Q

What instrument used for lung testing is contraindicated in cases of severe bronchospasm and bleeding?

A

Flexible bronchoscopy

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82
Q

What procedure is done under general anesthesia and is used to remove large tissue samples for biopsy or when severe airway bleeding is present?

A

Rigid bronchoscopy

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83
Q

What is the purpose of a VQ scan?

A

To evaluate the circulation of air and blood within a patient’s lungs in order to determine the ventilation/perfusion ratio

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84
Q

A VQ scan is commonly done to check for the presence of what abnormalities in the airways?

A

Blood clots or abnormal blood flow due to a pulmonary embolism

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85
Q

What layer of the skin is supplied with blood and contains sweat glands and hair follicles?

A

Dermis

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86
Q

Skin color depends on what 4 pigments?

A
  • Deoxyhemoglobin
  • Oxyhemoglobin
  • Carotene
  • Melanin
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87
Q

An increase in which skin pigment causes cyanosis?

A

Deoxyhemoglobin

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88
Q

What are the 2 types of hair found on the skin?

A
  • Vellus (short, fine)

- Terminal (scalp, eyebrows)

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89
Q

What are the only skin surfaces where sebaceous glands are not present?

A

Palms and soles

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90
Q

What are the 2 types of sweat glands?

A
  • Eccrine: widely distributed and open onto surface, control body temp
  • Apocrine: axillary and genital regions, stimulated by stress
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91
Q

What are the ABCDEs when screening moles for melanoma?

A 
A - asymmetry
B - irregular borders
C - color change and variation
D - diameter
E - elevation or enlargement
92
Q

Moles greater than or equal to __mm are indicative of possible melanoma

A

6

93
Q

6 or more cafe-au-lait spots with diameters greater than 1.5 cm suggests what underlying condition?

A

Neurofibromatosis

94
Q

What skin disease is characterized by depigmented macules on face, hands, or feet?

A

Vitiligo

95
Q

What is Tetralogy of Fallot?

A

A birth defect of the heart consisting of four abnormalities that results in insufficiently oxygenated blood pumped to the body

96
Q

Cyanosis visible peripherally in the fingertips can be indicative of what underlying diseases?

A
  • CHF

- Raynaud’s disease

97
Q

Central cyanosis can be present in the case of what underlying condition?

A

Congenital heart disease

98
Q

What causes jaundice?

A

Liver disease or hemolysis of RBCs

99
Q

What is erythema?

A

A red hue on the skin caused by increased blood flow to the area

100
Q

What skin disease occurs when the immune system mistakes skin cells as a pathogen?

A

Psoriasis

101
Q

What is the most common form of psoriasis?

A

Plaque psoriasis

102
Q

What allergic skin disease is associated with asthma?

A

Atopic eczema

103
Q

What skin rash presents in the shape of a butterfly and involves with bridge of the nose?

A

Lupus-Malar rash

104
Q

What name is given to a patch of closely grouped skin papules more than 1 cm across

A

Plaque

105
Q

What is a cyst?

A

A nodule filled with expressible material, either liquid or semisolid

106
Q

What is a wheal?

A

A skin elevation caused by swelling that can itch - associated with an allergic reaction

107
Q

What is angioedema?

A

A vascular reaction representing localized edema caused by dilation and increased permeability of capillaries

108
Q

What skin rash is defined as a raised lesion less than 5mm across and filled with clear fluid - seen in herpes or chicken pox?

A

Vesicles

109
Q

What are vesicles more than 5mm across called?

A

Bulla

110
Q

What is erythema multiforme?

A

A skin condition possibly mediated by deposition of immune complex (mostly IgM) on microvasculature of the skin and oral membranes

111
Q

What are 2 forms of erythema multiforme?

A
  • Stevens-Johnson syndrome

- Toxic epidermal necrolysis

112
Q

What is lichenification?

A

Rough, thick epidermis with exaggerated skin lines

113
Q

What is a keloid?

A

Hypertrophic scarring that extends beyond the borders of the initiating injury

114
Q

What term is given to a nonscarring loss of superficial epidermis - usually found with chickenpox?

A

Erosion

115
Q

What is excoriation?

A

Linear or punctate erosions caused by scratching or picking at a primary lesion

116
Q

What are the 4 stages of pressure ulcers?

A

1) Skin not broken but is discolored
2) Epidermis is broken, creating a shallow open sore
3) Break in skin extends through dermis into subQ and fat
4) Breakdown extends into muscle

117
Q

What is cellulitis?

A

Localized or diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin

118
Q

In what patients is cellulitis common?

A

Diabetes and immunocompromised

119
Q

What vascular lesions are associated with liver disease, pregnancy, and vitamin B deficiency?

A

Spider angioma

120
Q

What are 1st degree burns?

A

The least serious burns that cover only the outer layer of skin but not all the way through

121
Q

What are 2nd degree burns?

A

When the first layer of skin has been burned through and the second layer of skin is also burned

122
Q

What are 3rd degree burns?

A

The most serious burns involving all 3 layers of the skin that causes permanent tissue damage

123
Q

Where does the spinal cord begin and end?

A

From the medulla in the brain to the 1st or 2nd lumbar vertebra

124
Q

What is the cauda equina?

A

The region where the nerve roots fan out like a horses tail at the end of the spinal cord (L1-L2)

125
Q

What is cauda equina sydrome?

A

When damage to the cauda equina causes loss of function to the lumbar plexus - can lead to severe back pain, bowel/bladder dysfunction, sexual dysfunction, etc

126
Q

What part of the peripheral nervous system coordinates involuntary operations of the GI tract?

A

Enteric nervous system

127
Q

Name and function of cranial nerve I

A

Olfactory - sensory - smell

128
Q

Name and function of cranial nerve II

A

Optic - sensory - vision

129
Q

Name and function of cranial nerve III

A

Olfactory - motor - pupillary reactions, extraocular movements and eyelid movement

130
Q

What can be caused by damage to cranial nerve III?

A
  • Strabismus (lazy eye)
  • Ptosis (drooping)
  • Diplopia (double vision)
131
Q

Name and function of cranial nerve IV

A

Trochlear - motor - downward movement of eye

132
Q

What can be caused by damage to cranial nerve IV?

A
  • Diplopia

- Strabismus

133
Q

Name and function of cranial nerve V

A

Trigeminal - mixed - sensory for eye area, motor for temporal and masseter area

134
Q

Name and function of cranial nerve VI

A

Abducens - motor - proprioception and lateral movement of eyeball

135
Q

Name and function of cranial nerve VII

A

Facial - mixed - sensory for taste on anterior 2/3 of tongue, motor for facial expression, closing eyes and mouth

136
Q

What can be caused by injuries to cranial nerve VII?

A
  • Bell’s palsy
  • Loss of taste
  • Decreased salivation
  • Loss of ability to close eyes
137
Q

Name and function of cranial nerve VIII

A

Vestibulocochlear - sensory - equilibrium/balance, hearing

138
Q

What can be caused by injuries to cranial nerve VIII?

A
  • Vertigo
  • Atasia
  • Nystagmus
  • Tinnitus
  • Deafness
139
Q

Name and function of cranial nerve IX

A

Glossopharyngeal - mixed - sensory for posterior 1/3 of tongue and breathing rate and gag reflex, motor for swallowing and speech

140
Q

Name and function of cranial nerve X

A

Vagus - mixed - sensory for taste/breathing rate/visceral sensations/gag reflex, motor for swallowing, coughing, speaking

141
Q

Name and function of cranial nerve XI

A

Accessory - motor - swallowing, head and shoulder movement

142
Q

Name and function of cranial nerve XII

A

Hypoglossal - motor - movement of tongue during speech and swallowing

143
Q

Spinal nerves involved in upper abdominal reflex

A

T7-T9

144
Q

Spinal nerves involved in lower abdominal reflex

A

T10-T11

145
Q

Spinal nerves involved in cremaster reflex

A

T12-L2

146
Q

What is the cremaster reflex?

A

Testicle and scrotum rise when inner thigh of male is stroked

147
Q

Spinal nerves involved in plantar reflex

A

L4-S2

148
Q

What is the plantar reflex?

A

Toes should flex with stroking of lateral aspect of the foot

149
Q

What sign are you looking for when testing the plantar reflex?

A

Babinski sign - a dorsiflexion of big toe when testing the plantar reflex

150
Q

Spinal nerves involved in biceps reflex

A

C5-C6

151
Q

Spinal nerves involved in brachioradialis reflex

A

C5-C6

152
Q

Spinal nerves involved in triceps reflex

A

C6-C8

153
Q

Spinal nerves involved in patellar reflex

A

L2-L4

154
Q

Spinal nerves involved in achilles reflex

A

S1-S2

155
Q

What level of consciousness (LOC) does a patient have if they are only aroused with painful stimuli?

A

Stupor

156
Q

What LOC does a patient have if they are aroused with gentle shaking?

A

Obtundation

157
Q

What LOC does a patient have if they will recognize you when you speak with a loud voice?

A

Lethargy

158
Q

What things should you be assessing during a mental status exam?

A
  • Attention
  • Language
  • Memory
  • Higher cognitive abilities
  • Cortical functions
159
Q

What cranial nerves are you testing by observing pupil size, shape, and reaction to light?

A

3, 4, 6

160
Q

How can you test function of cranial nerve V?

A

Palpate the strength of muscle contractions over temporal and masseter areas while patient clenches teeth

161
Q

How can you test function of cranial nerve VII?

A

Inspect symmetry of facial expression

162
Q

How can you test function of cranial nerve XI?

A

Inspect for atrophy or fasciculations in trapezius muscles

163
Q

How can you test function of cranial nerve XII?

A

Inspect for tongue midline with protrusion, strength of tongue, quality of speech

164
Q

What does a grade of 0 on a muscle strength test indicate?

A

No muscular contraction

165
Q

What does a grade of 3 on a muscle strength test indicate?

A

Active movement against gravity

166
Q

What does a grade of 5 on a muscle strength test indicate?

A

Active movement against resistance

167
Q

How can you test stereognosis?

A

Have patient identify familiar objects in their hands with their eyes closed

168
Q

How can you test graphesthesia?

A

Write on a patient’s hand with something blunt and have them identify number or letter you wrote

169
Q

How can you test two-point localization?

A

Find the minimal distance on a patient’s finger or thumb that they are able to discriminate between two points

170
Q

What does a 4+ grade for a deep tendon reflex represent?

A

Very brisk, hyperactive, with clonus

171
Q

What does a 3+ grade for a deep tendon reflex represent?

A

Brisker than average, possibly but not necessarily indicative of disease

172
Q

What does a 2+ grade for a deep tendon reflex represent?

A

Average, normal

173
Q

What does a 1+ grade for a deep tendon reflex represent?

A

Somewhat diminished, low normal

174
Q

What is Brudzinski’s sign? What does it suggest?

A

Pain with flexion of hips and knees while patient is supine, suggests meningeal inflammation

175
Q

What is Kernig’s sign?

A

Pain and increased resistance with straightening the knee while supine

176
Q

What are the s/s of a CVA?

A 
Brain - confusion, trouble talking, dizziness, loss of balance
Eyes - trouble seeing
Face/arms/legs - numbness or weakness
Stomach - throwing up
Body - feeling tired
Legs - trouble walking
177
Q

What is a focal seizure?

A

A seizure that starts in one area of the brain

178
Q

What is a generalized seizure?

A

A seizure that involves both hemispheres of the brain

179
Q

What are the symptoms of a seizure?

A
  • Blackout
  • Involuntary movement of limbs
  • Hallucinations
  • Odd sounds and sensations
  • Episodes of staring
180
Q

What seizure drug is a first line treatment for all seizure types?

A

Lamotrigine

181
Q

What type of seizures is Topiramate used for?

A

Tonic-clonic and focal

182
Q

What type of seizure is Oxcarbazepine used for?

A

Focal

183
Q

What branch of the vagus nerve is stimulated by a vagus nerve stimulator?

A

Left

184
Q

What is multiple sclerosis?

A

The body’s immune system attacks myelin covering the nerves which interrupts nerve impulses traveling to and from the brain

185
Q

What are the anesthetic considerations for a patient with multiple sclerosis?

A
  • Local anesthetics can exacerbate symptoms
  • NDMBs can be used in normal doses
  • Temperature maintenance is important, demyelinated axons are more sensitive to heat
186
Q

What is Parkinson’s disease?

A

Slow loss of dopamine-producing neurons

187
Q

What are the clinical features of Parkinson’s?

A

Tremors, rigidity, bradykinesia, dementia

188
Q

What are the anesthetic concerns associated with ALS?

A
  • General anesthesia can cause ventilatory depression post op
  • Regional contraindicated in patients with motor neuron disease for fear of exacerbating disease
189
Q

What is myasthenia gravis?

A

Autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatiguability

190
Q

What is the first noticeable symptom of myasthenia gravis?

A

Weakness of the eye muscles

191
Q

What are the anesthetic considerations in patients with myasthenia gravis?

A
  • Resistance to depolarizing NMB drugs, may need to increase dose
  • Sensitivity to non-depolarizing NMB drugs, need only 10% normal dose
  • Avoid cholinesterase inhibitors
192
Q

What is a cholinergic crisis?

A

Muscles stop responding to bombardment of Ach leading to flaccid paralysis, respiratory failure, and SLUDGE

193
Q

What are the anesthetic considerations for patients with muscular dystrophy?

A
  • Avoid sux and volatiles due to risk of hyperkalemic cardiac arrest and rhabdomyolysis
  • A general must be a TIVA
  • Avoid shivering and increased O2 demand
194
Q

Where is mitral valve best heard

A

Apex

195
Q

Where is tricuspid valve best heard

A

Lower left sternal border

196
Q

Where is pulmonic valve best heard

A

2nd/3rd interspaces left of sternum

197
Q

Where is aortic valve best heard

A

2nd interspace right of sternum

198
Q

Normal PR interval

A

0.12-0.2 seconds

199
Q

What pressure is reflected by jugular venous pressure?

A

Right atrial pressure

200
Q

What are thrills

A

Humming vibration felt during palpation carotid

201
Q

What are bruits

A

Murmur sound of vascular origin heard with diaphragm of stethoscope

202
Q

What sounds are heard with diaphragm of stethoscope

A

High pitched S1 and S2, regurgitation

203
Q

What sounds are heard with bell of stethoscope

A

Low pitched S3 and S4, stenosis

204
Q

What causes S1 sounds

A

Closure of mitral and tricuspid valves

205
Q

What causes S2 sounds

A

Closure of aortic and pulmonic valves

206
Q

What causes S3 sounds

A

Rapid movement of blood against ventricular walls

207
Q

What conditions could cause S3 heart sounds

A
  • Anemia
  • Fever
  • Pregnancy
  • Thyrotoxicosis
208
Q

Grade I murmur

A

Very faint

209
Q

Grade II murmur

A

Quiet but heard immediately

210
Q

Grade III murmur

A

Moderately loud

211
Q

Grade IV murmur

A

Loud with palpable thrill

212
Q

Grade V murmur

A

Very loud, thrill, heard w/ stethoscope partly off chest

213
Q

Grade VI

A

Very loud, thrill, heard with stethoscope entirely off chest

214
Q

Common systolic murmurs

A
  • Aortic stenosis
  • Mitral valve prolapse
  • Mitral regurg
  • Tricuspid regurg
215
Q

Common diastolic murmurs

A
  • Aortic regurgitation

- Mitral stenosis

216
Q

What is skin mobility

A

Ease with which skin lifts up

217
Q

What is skin turgor

A

Speed with which skin returns into place

218
Q

Discharge rate for junctional pacemakers

A

40-60bpm

219
Q

Heart rhythm that results in sudden death

A

Ventricular fibrillation

220
Q

Most common cause of sinus arrhythmia

A

Inspiration and expiration

221
Q

Murmur shape of aortic stenosis

A

Crescendo/decrescendo

222
Q

Murmur shape of mitral regurgitation

A

Plateau

223
Q

Murmur shape of aortic regurgitation

A

Decrescendo

224
Q

Murmur shape of mitral stenosis

A

Crescendo

225
Q

Which murmurs are pansystolic

A

Mitral and tricuspid regurg

Clinical Methods (4 decks)

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