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assessment test 1 > hammond review > Flashcards

hammond review Flashcards

1
Q

define raynauds phenomenon

A

smallest arteries that bring blood to the fingers or toes constrict (go into spasm)

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2
Q

what causes raynauds

A

emotional upset or cold exposure

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3
Q

who does raynauds most commonly affect

A

women between ages 18-30

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4
Q

raynauds is considered a certain disorder

it often is associated with

A

constrictive disorder

smoking

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5
Q

what are the grades of pulses

A

0 = absent or not able to palpate

+1 diminished or weaker than expected

+2 brisk, expected or normal (try not to use normal in any description)

+3 bounding

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6
Q

define thrombophlebitis

A

blood clot in an inflamed vein- most commonly in the legs but can occur in the arms

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7
Q

does the clot for thrombophlebitis have to be superficial or deep

A

it can be superficial or deep.

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8
Q

what are the thrombophlebitis symptoms

A

swelling, pain , tenderness, redness and warmth

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9
Q

define varicose veins

A

dilated, twisted veins from incompetent valves. allows for backward flow of blood.

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10
Q

symptoms of varicose veins

A

bruising, sensations of burning or aching

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11
Q

name the three type of people with a propensity to varicose veins

A

those that stand for extended periods of time

obesity

pregnancy

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12
Q

deep vein thrombosis can occur from what major things

A

orthopedic surgery malignancy, HF, smoking pregnancy, oral contraceptives , hormonal use .advanced age. clotting disorders.

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13
Q

diagnostic studies for DVT include

A

calf measurements>3cm

duplex doppler ultrasound.

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14
Q

signs of symptoms of DVT

A

swelling, tenderness, inflammation of calf, pain at rest and with compression and raised vein pattern.

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15
Q

what are varicose veins a precursor to

A

chronic venous insufficiency

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16
Q

ectopic pregnancy patient history

A

amenorrhea, severe RLQ or LLQ pain

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17
Q

ectopic pregnancy diagnosis

A

a pregnancy outside the uterus, usually the tube +HCG, +US, rebound tenderness

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18
Q

what is levins signs

A

fist to chest during chest pain.

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19
Q

CO=

bp=

A

svxHR

coxsvr

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20
Q

Arterial insufficiency

A

Decreased pulse - little or reduced blood flow to the distal portion

No edema

Severe pain – ischemia or like angina

Temp-cool

Color-pale when elevated and dusky red on dependency. This is a mechanical function

Skin is thin atrophic risk of slow wound healing

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21
Q

Venous insufficiency

A

Blood goes down but does not return. Pools in the distal area

Pulses are normal

Color is cyanotic on dependence,

Temperature is normal or warm

Skin is thickened, hyper-pigmented

Pain is minimal

Swelling is often increased in the evening. Elevation is mechanical and helps pooling

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22
Q

For an adult how do you look in the ear

A

pull the auricle up and back for an adult

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23
Q

for a infant or child how do you look in the ear

A

pull the auricle down and out for an infant or child

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24
Q

what is otitis externa

A

cellulitis of the external auditory canal that may extend to the auricle.

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25
Q

what is otitis externa caused by

A

excessive moisture or any condition that compromises the integrity of the external ear

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26
Q

management of otitis externa

A

topical antibiotics- cortisporine otic suspension, pain control with saids, wick may be necessary

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27
Q

objective findings of otitis externa

A

redness and irritation of the canal, slough, or exudate present, edema of the canal.

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28
Q

subjective findings of otitis externa

A

pain and tenderness of the external ear and or canal , itching of the ear

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29
Q

frequent pathogens associated otitis externa

A

pseudomonas and fungal organisms

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30
Q

otitis externa is seen common in what two situations

A

swimming as well as trauma (cotton tipped swabs)

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31
Q

Leukoplakia

A

whitened hyperkeratotic plague on the tongue or in the buccal areas, may be cancerous, will not scrape off with tongue depressor

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32
Q

Candidiasis

A

white lesions in the buccal areas, tongue, hard/soft palate that will scrape off, may be painful and cause the mouth to be sore. Infants will not feed will with candidiasis

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33
Q

what is the treatment for candidiasis

A

nystatin - swish and swallow

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34
Q

when does presbycusis start

A

starts at age 65

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35
Q

why does presbycusis happen

A

diminished hairy cell function within cochlea

decreased elasticity of the TM

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36
Q

how is presbycusis diagnose

A

by exclusion

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37
Q

what is otosclerosis

A

degenerative changes to the bony structures of the middle ear and result in the gradual onset of hearing deficits as the bones lose their vibratory ability.

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38
Q

what is otosclerosis related to

A

estrogen and can be accelerated by pregnancy

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39
Q

otosclerosis
presbycusis
tell me which one is conductive hearing loss and which is sensorineural hearing loss

A

oto- conductive

presbycusis-sensor

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40
Q

symptoms of otosclerosis

A

bilateral hearing loss and tinnitus may be present

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41
Q

what is an acoustic neuroma

A

sensorineural hearing loss

nonmalignant tumors affecting the acoustic nerve CN8

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42
Q

when is the onset of symptoms for acoustic neuroma

A

occurs after age 30

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43
Q

interventions for acoustic neuroma

A

surgery and radiation

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44
Q

what is otitis media

A

infection of the fluid in the middle ear space.

-streptococcus pneumonias, haemophilus influenza, mortadella catarrhalis.

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45
Q

interestingly enough otitis media has a low case of being bacterial- just how low

A

only 25%

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46
Q

what is the first line treatment for otitis media

A

amoxicillin

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47
Q

how does the TM present for otitis media

A

decreased or absent ability of the TM is diagnostic

erythema of the TM, bulging TM with obscured landmarks

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48
Q

signs and symptoms of otitis media

A

pain, hearing loss, stuffiness of the ear, conjestion

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49
Q

mononucleosis is caused by what virus

A

epstein - barr virus

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50
Q

mono diagnostics-

A

abc testing for heterophil antibodies (mono spots)

treatment is supportive, steroids may improve symptoms caution against contact sprots

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51
Q

epiglottitis defined

A

acute inflammation of the epiglottis and surrounding structures cause by a bacterial , viral, or thermal injury to the area

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52
Q

what organisms are responsible for epiglottitis

A

b hemolytic streptococcus, aspergillus, h influenza, klebsiella, candida.

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53
Q

epiglottitis S/s

A 
sudden sore throat
fever
cough
difficulty swallowing
drooling
stridor.
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54
Q

immunization to prevent epiglottitis

A

HIB immunization

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55
Q

red eyes- conjunctivitis-

A

most common cause of eye redness is conjunctivitis- inflammation of one or more areas of the conjunctiva.

56
Q

corneal absasions

A

more likely to be contaminated to become infected.

57
Q

foreign body

A

eye redness is often prominent - these foreign bodies can be retained in or on the cornea.

fluorescein staining may be helpful in locating the object.

58
Q

subconjunctival hemmorrhage-

A

impressive benign self limiting condition. can be caused by coughing sneezing or rubbing eyes.

also scuba diving or childbirth.

59
Q

uveitis

A

inflammation of the uveal tract to include the iris- caused by infection or part of a systemic disorder reaction

60
Q

keratitis

A

inflammation of the cornea and can lead to blindness in the affected eye- herpetic and other infections.

61
Q

scleritis and episcleritis

A

inflammatory problems involving the sclera and epislera. associated with chronic autoimmune disorders.

62
Q

where is the best place to palpate for tactile fremitus

A

posteriorly at the second or third intercostal space.

at the level of bronchi separate.

63
Q

when palpating for tactile fremitus- what do you ask the patient to say

A

99

64
Q

decreased or absent fremitus=

A 
bronchial obstruction 
pneumothorax
emphysema
consolidation
infection  
edema
65
Q

increased tactile fremitus=

A

harsher or louder vibration,
pulmonary fluid
mass/tumor
copious non obstructive bronchial secretions

66
Q

when measuring diaphragmatic excursion what must you keep in mind

A

that the diaphragm is higher on the right side

67
Q

what is normal diaphgramtic excursion

A

3-5cm

68
Q

how to do diaphmatic excursion

A

ask pt take deep breath and hold
start at 2nd 3rd intercostal space percuss until dull
next ask patient to exhale all the way and hold it
percuss and measure

69
Q

what should you hear when percussing lungs

A

resonance should be heard all over areas of the posterior lungs.
dullness- associated with Pneumo, infection or asthma.
hyper resonance -emphysema, pneumothorax or asthma

70
Q

what is pleurisy

A

inflammation of the pleura often related to underlying infectious process

71
Q

S/s of pleurisy

A

patient will splint chest- sever and sharp pleuritic pain with acute onset. pain noted with cough, respirations or maneuvers that cause chest motion.

72
Q

with pleurisy what will you hear when auscultating

A

pleural friction rub

73
Q

peritonsillar abscess

A

infection of peritonsillar space
can occur as a complication of tonsillitis.
but can develop without hx of tonsillitis.

74
Q

peritonsillar abscess s/s

A

sore throat, fever malaise, sore throat will spread to one side. drooling. unable to swallow.

75
Q

what is the treatment for peritonsillar abscess

A

referred to a specialist to aspirate the abscess.

76
Q

what different things can cause a nose bleed

A 
trauma
mediations
hematological disorders
intranasal drug use
mucosal dryness
77
Q

how to control a nose bleed

A

nasal packing, artery ligation, head forward

apply pressure and cold.

78
Q

why do you palpate the PMI

A

(“heave” or “lift”)

use palm of your hand to palpate any large areas of sustained outward motion

79
Q

if you can palpate heave or lift with PMI what does that mean

A

ventricular hypertrophy

80
Q

what is a MUGA scan used for

A

stands for multiple gated angiography
Determines ejection fraction
Almost always automatically done with MPI now

81
Q

qt prolongation

A

(Congenital, drug-induced, acquired)

82
Q

grades of murmur

A

Grade I = lowest intensity, not heard by inexperienced listener
Grade II = low intensity, usually audible to everyone
Grade III = medium intensity but no palpable thrill
Grade IV = medium intensity with a thrill
Grade V = loudest murmur audible when stethoscope is on the chest. Has a thrill
Grade VI = loudest intensity, audible when stethoscope is removed from the chest. Has a thrill

83
Q

causes of tachycardia (4)

A

Acute myocardial ischemia/infarct
Chronic Coronary artery disease
Cardiomyopathy
Prolonged QT interval (Congenital, drug-induced, acquired)

84
Q

Right Upper Quadrant

A 
Liver
Gallbladder
Duodenum
Head of the pancreas
Right kidney and adrenal
Part of the ascending and transverse colon (Umbilical)
85
Q

Left Upper Quadrant

A 
Stomach (Epigastric)
Spleen
Left lobe of the liver
Body of the pancreas (Epigastric)
Left kidney and adrenal
Part of the transverse and descending colon (Umbilical)
86
Q

Right Lower Quadrant

A 
Cecum
Appendix
Right ovary and tube
Right ureter
Right spermatic cord
87
Q

Left Lower Quadrant

A 
Part of the descending colon
Sigmoid colon
Left ovary and tube
Left ureter
Left spermatic cord
88
Q

Bartholin’s Cysts

A

between vagina and rectum
Swollen and painful
Usually I&D, antibiotic and C&S

89
Q

7 F’S OF ABDOMINAL DISTENTION

A 
Fat- remember, fat is symmetrical
Flatus- after eating? No bowel sounds?
Fluid- ascites, ileus
Fetus- “I can’t believe I am pregnant”
Feces- hmmm
Fetal growth- refer to above
Fibroid- Tumor? asymmetrical
90
Q

appendicitis Assessing for peritoneal irritation

Check for Rovsing’s sign

A

referred rebound tenderness in the right lower quadrant when the left lower quadrant is palpated and released)- can also hit on bottom of foot

91
Q

Check for Psoas sign appendicitis

A

(the patient flexes his thigh against the examiner’s hand; pain indicates a positive sign)

92
Q

Check for the Obturator sign:APPENDICITIS

A

flex the patient’s thigh and rotate the leg internally at the hip; pain indicates a positive sign) hypogastric pain with the hip and knee flexed and the hip internally rotated

93
Q

(Blumberg’s sign)

A

Check for involuntary guarding and rebound tenderness (Blumberg’s sign) in the RLQ (Pushing perpendicular on the abdomen in a site away from the pain. Release of the pressure will cause pain).

94
Q

appendicitis

A

Acute pain may begin in the umbilicus area and become greater in intensity and move into the right lower quadrant.

95
Q

pancreatitis seen most commonly in

A

alcoholics- 80%

HLD, drugs, toxins, infection, structural abnromailite.

96
Q

diverticulitis

A

prevalent in pt over 60.

common in western countries- due to raised intraluminal colonic pressures.

97
Q

what are patients with diverticulitis at risk for

A

peritonitis- watch for signs of sepsis.

98
Q

s3 is called

A

ventricle gallop

99
Q

s4 is called

A

atrial gallop

100
Q

s3 and s4 occur during systole or diastole

A

both occur during diastole.

101
Q

when is an s3 normal

A

children young adults and pregnant women <30

102
Q

when is s3 abnormal

A

decrease myocardial contractility, HF, volume overload, and mitral or tricuspid regurgitation.

103
Q

troponin I normal value

A

<0.35ng/ml

104
Q

significance of troponin I

A 
Unique to heart muscle
Released with very small amounts of damage as early as 1-3 hrs. after injury
Peaks in 12-48 hrs.
Levels return to normal in 7-10 days.
Useful in delayed diagnosis of MI also
105
Q

troponin T normal value

A

<0.2mg/l

106
Q

troponin T significance

A

May also elevate in unstable angina, myocarditis, chronic renal failure, acute muscle trauma, rhabdomyolysis, polymyositis, and dermatomyosis.

107
Q

u wave=

A

hypokalemia

108
Q

peaked T wave

A

hyperkalemia

109
Q

t wave inversion

A

ischemia

110
Q

qt prolongation

A

toxic drugs

111
Q

st elevation

A

acute injury

112
Q

q wave

A

transmural mi

113
Q

(NA) Increases:

A

dehydration, increased NA intake

114
Q

(NA) Decreases:

A

volume overload, decreased NA intake, diuretics

115
Q

(K) decreases:

A

diuresis, decreased K intake, diarrhea, nausea and vomiting, gastric suction, hypoglycemia, alkalosis

116
Q

(K) increases:

A

renal failure, dehydration, acidosis, hyperglycemia, increased K intake, ACE inhibitors, RBC hemolysis

117
Q

What causes a diastolic murmur

A
  1. Mitral and tricuspid stenosis

2. Aortic or pulmonic regurgitation

118
Q

What 2 sounds does a systolic murmur fall between?

A

The murmur falls between S1 and S2 (sounds like LUB-shhh-dub)

119
Q

Systolic murmurs are heard under what two physiological conditions?

A

These are ejections murmurs

  1. May be caused by turbulence across the aortic or pulmonic valves if they are stenosed.
  2. May be caused by turbulence across the mitral or tricuspid valves if they are incompetent (regurgitant)
120
Q

Heart murmur sounds _____ through _____ must have an accompanying thrill

A

4 – 6

121
Q

What position and what part of the stethoscope is used to determine if S3 and S4 are present?

A

While listening at the apex and left lower sternal border with the bell, you’ll be able to determine if an S3 or S4 are present.

122
Q

If you cannot hear an S4 heart sound, what is it indicative of?

A

You only hear an S4 if the ventricle is stiff and non-compliant. Thus, to not hear one is indicative of a normal heart.

123
Q

where do you listen for s1

s2

A
  • S1: heard best at apex

- S2: heard best at base

124
Q

What type of sounds is the diaphragm of the stethoscope used for?

A

The diaphragm is best for detecting high-pitched sounds like S1, S2, S4, and most murmurs

125
Q

What type of sounds is the bell of the stethoscope used for

A

The bell is best for detecting low-pitched sounds like S3 and the rumble of mitral stenosis.

126
Q

Large PMI indicative of what

A

A PMI that is over 3 cm diameter indicates left ventricular hypertrophy and is 86% predictive of increased left ventricular end diastolic pressure

127
Q

infectious pharyngitis most cases come from

A

viruses

128
Q

the bacterial cause of infectious pharyngitis=

A

strep throat

129
Q

where do you hear aortic stenosis

A

2nd intercostal space- client leaning forward.

130
Q

tonsillitis infections organism

A

group a beta hemolytic streptococcal/EBV

131
Q

pharyngitis infectious organisms

A

Viral causes include Epstein-Barr,
influenza, and CMV.

Bacteria causes include steptococcus pyogenes A, C, and G

B-hemolytic streptococcus being the most common agent.

132
Q

Aphthous stomatitis

A

ulcers- unclear cause

Topical steriods such as Kenalog, dexamethasone elixir, avoidance of spicy foods

133
Q

Herpes Labialis

A

Caused by HSV – 1 or HSV 2, Acyclovir and valacyclovir are effective treatments.

134
Q

Candidiasis

A

Caused by Candida albicans, Nystatin oral suspension is effective

135
Q

Cheilitis

A

Cheilitis – painful fissures at the corners of the mouth from excessive saliva, candidiasis

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