General appearance

Question 1

What is an appearance of Lethargy? Technique?

Answer 1

Appears drowsy but opens eyes and looks at you, responds to questions, then falls asleep
***Speak in loud voice

Question 2

What is an appearance of obtundation? Technique?

Answer 2

• Opens eyes and looks at you but responds slowly and is confused
• Alertness and interest in environment decreased
• ***Shake gently

Question 3

What is an appearance of Stupor? Technique?

Answer 3

• Arousals from sleep only after painful stimuli
• Verbal responses slow or absent
• Lapses into unresponsive state when stimulus ceases
• Minimal awareness of self / environment
• **Painful stimuli

Question 4

What is an appearance of Coma? Technique?

Answer 4

Remains unarousable with eyes closed

• No evident response to inner need or external stimuli
• **Repeated painful stimuli

Question 5

What is normal breathing?

Answer 5

Adults: 14-20 breaths per minute
Infants: up to 44

Question 6

What is bradypnea? Causes?

Answer 6

“Slow breathing”

1. Diabetic coma
2. Drug induced respiratory depression
3. Increased intracranial pressure

Question 7

What does sighing respiration indicate?

Answer 7

• Hyperventilation syndrome

- Common cause of dyspnea and dizziness

Question 8

What is tachypnea? Causes?

Answer 8

• Rapid, shallow breathing
  1. Rest. lung disease
  2. Pleuritic chest pain
  3. Elevated diaphragm

Question 9

What is Cheyne Stokes breathing? Causes?

Answer 9

• Periods of deep breathing alternating with apnea
  1. Youth / old age
  2. CHF
  3. Uremia
  4. Drug induced respiratory depression
  5. Brain damage

Question 10

What obstructive breathing?

Answer 10

Prolonged expiration from narrowed airways increasing resistance to flow
- Seen in obstructive lung disease

Question 11

What is hyperpnea?

Answer 11

• Hyperventilation: Rapid deep breathing
  1. Exercise
  2. Anxiety
  3. Metabolic acidosis

Question 12

What is kusmaul breathing?

Answer 12

Deep breathing due to metabolic acidosis

Question 13

What is Blot’s breathing?

Answer 13

“Ataxic breathing”

• Irregular breathing of varying periods and depths
  1. Respiratory depression
  2. Medullary brain damage

Question 14

Examples of irregularly irregular heart beats?

Answer 14

No discernible regularity

1. A fib
2. A Flutter

Question 15

Examples of sporadic heart rates?

Answer 15

1. PVC
2. PAC
3. Sinus arrhythmia

Question 16

Examples of regularly irregular heart beats?

Answer 16

Ventricular trigeminy

Question 17

Examples of bradycardic conditions and rates?

Answer 17

1. Sinus Brady

Question 18

Examples of tachycardia?

Answer 18

1. Sinus tachy
2. SVT
3. Atrial flutter w/ normal V response
4. V tach

Question 19

Examples of irregular beats?

Answer 19

1. PVC
2. PAC
3. Sinus arrhythmia
4. Ventricular trigeminy
5. A fib
6. A Flutter

Question 20

How does rate vary with inspiration and expiration?

Answer 20

Inspiration: speeds
Expiration: slows

Question 21

What happens in SVT?

Answer 21

• P wave comes more quickly than expected possibly on T

- There’s pause before P resumes at normal rate again

Question 22

What is a sporadic or regularly irregular beat?

Answer 22

• Beat of VENTRICULAR origin earlier than expected
• Pause then normal rhythm
• S1/2 are likely split

Question 23

What happens in irregularly irregular beats?

Answer 23

• No P waves and fibrillation waves on EKG

- Ventricular rhythm totally random

Question 24

What does S1/2 correspond to?

Answer 24

S1: QRS
S2: T