hammond review Flashcards
define raynauds phenomenon
smallest arteries that bring blood to the fingers or toes constrict (go into spasm)
what causes raynauds
emotional upset or cold exposure
who does raynauds most commonly affect
women between ages 18-30
raynauds is considered a certain disorder
it often is associated with
constrictive disorder
smoking
what are the grades of pulses
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
define thrombophlebitis
blood clot in an inflamed vein- most commonly in the legs but can occur in the arms
does the clot for thrombophlebitis have to be superficial or deep
it can be superficial or deep.
what are the thrombophlebitis symptoms
swelling, pain , tenderness, redness and warmth
define varicose veins
dilated, twisted veins from incompetent valves. allows for backward flow of blood.
symptoms of varicose veins
bruising, sensations of burning or aching
name the three type of people with a propensity to varicose veins
those that stand for extended periods of time
obesity
pregnancy
deep vein thrombosis can occur from what major things
orthopedic surgery malignancy, HF, smoking pregnancy, oral contraceptives , hormonal use .advanced age. clotting disorders.
diagnostic studies for DVT include
calf measurements>3cm
duplex doppler ultrasound.
signs of symptoms of DVT
swelling, tenderness, inflammation of calf, pain at rest and with compression and raised vein pattern.
what are varicose veins a precursor to
chronic venous insufficiency
ectopic pregnancy patient history
amenorrhea, severe RLQ or LLQ pain
ectopic pregnancy diagnosis
a pregnancy outside the uterus, usually the tube +HCG, +US, rebound tenderness
what is levins signs
fist to chest during chest pain.
CO=
bp=
svxHR
coxsvr
Arterial insufficiency
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
Venous insufficiency
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
For an adult how do you look in the ear
pull the auricle up and back for an adult
for a infant or child how do you look in the ear
pull the auricle down and out for an infant or child
what is otitis externa
cellulitis of the external auditory canal that may extend to the auricle.
what is otitis externa caused by
excessive moisture or any condition that compromises the integrity of the external ear
management of otitis externa
topical antibiotics- cortisporine otic suspension, pain control with saids, wick may be necessary
objective findings of otitis externa
redness and irritation of the canal, slough, or exudate present, edema of the canal.
subjective findings of otitis externa
pain and tenderness of the external ear and or canal , itching of the ear
frequent pathogens associated otitis externa
pseudomonas and fungal organisms
otitis externa is seen common in what two situations
swimming as well as trauma (cotton tipped swabs)
Leukoplakia
whitened hyperkeratotic plague on the tongue or in the buccal areas, may be cancerous, will not scrape off with tongue depressor
Candidiasis
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
what is the treatment for candidiasis
nystatin - swish and swallow
when does presbycusis start
starts at age 65
why does presbycusis happen
diminished hairy cell function within cochlea
decreased elasticity of the TM
how is presbycusis diagnose
by exclusion
what is otosclerosis
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.
what is otosclerosis related to
estrogen and can be accelerated by pregnancy
otosclerosis
presbycusis
tell me which one is conductive hearing loss and which is sensorineural hearing loss
oto- conductive
presbycusis-sensor
symptoms of otosclerosis
bilateral hearing loss and tinnitus may be present
what is an acoustic neuroma
sensorineural hearing loss
nonmalignant tumors affecting the acoustic nerve CN8
when is the onset of symptoms for acoustic neuroma
occurs after age 30
interventions for acoustic neuroma
surgery and radiation
what is otitis media
infection of the fluid in the middle ear space.
-streptococcus pneumonias, haemophilus influenza, mortadella catarrhalis.
interestingly enough otitis media has a low case of being bacterial- just how low
only 25%
what is the first line treatment for otitis media
amoxicillin
how does the TM present for otitis media
decreased or absent ability of the TM is diagnostic
erythema of the TM, bulging TM with obscured landmarks
signs and symptoms of otitis media
pain, hearing loss, stuffiness of the ear, conjestion
mononucleosis is caused by what virus
epstein - barr virus
mono diagnostics-
abc testing for heterophil antibodies (mono spots)
treatment is supportive, steroids may improve symptoms caution against contact sprots
epiglottitis defined
acute inflammation of the epiglottis and surrounding structures cause by a bacterial , viral, or thermal injury to the area
what organisms are responsible for epiglottitis
b hemolytic streptococcus, aspergillus, h influenza, klebsiella, candida.
epiglottitis S/s
sudden sore throat fever cough difficulty swallowing drooling stridor.
immunization to prevent epiglottitis
HIB immunization
red eyes- conjunctivitis-
most common cause of eye redness is conjunctivitis- inflammation of one or more areas of the conjunctiva.
corneal absasions
more likely to be contaminated to become infected.
foreign body
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.
subconjunctival hemmorrhage-
impressive benign self limiting condition. can be caused by coughing sneezing or rubbing eyes.
also scuba diving or childbirth.
uveitis
inflammation of the uveal tract to include the iris- caused by infection or part of a systemic disorder reaction
keratitis
inflammation of the cornea and can lead to blindness in the affected eye- herpetic and other infections.
scleritis and episcleritis
inflammatory problems involving the sclera and epislera. associated with chronic autoimmune disorders.
where is the best place to palpate for tactile fremitus
posteriorly at the second or third intercostal space.
at the level of bronchi separate.
when palpating for tactile fremitus- what do you ask the patient to say
99
decreased or absent fremitus=
bronchial obstruction pneumothorax emphysema consolidation infection edema
increased tactile fremitus=
harsher or louder vibration,
pulmonary fluid
mass/tumor
copious non obstructive bronchial secretions
when measuring diaphragmatic excursion what must you keep in mind
that the diaphragm is higher on the right side
what is normal diaphgramtic excursion
3-5cm
how to do diaphmatic excursion
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
what should you hear when percussing lungs
resonance should be heard all over areas of the posterior lungs.
dullness- associated with Pneumo, infection or asthma.
hyper resonance -emphysema, pneumothorax or asthma
what is pleurisy
inflammation of the pleura often related to underlying infectious process
S/s of pleurisy
patient will splint chest- sever and sharp pleuritic pain with acute onset. pain noted with cough, respirations or maneuvers that cause chest motion.
with pleurisy what will you hear when auscultating
pleural friction rub
peritonsillar abscess
infection of peritonsillar space
can occur as a complication of tonsillitis.
but can develop without hx of tonsillitis.
peritonsillar abscess s/s
sore throat, fever malaise, sore throat will spread to one side. drooling. unable to swallow.
what is the treatment for peritonsillar abscess
referred to a specialist to aspirate the abscess.
what different things can cause a nose bleed
trauma mediations hematological disorders intranasal drug use mucosal dryness
how to control a nose bleed
nasal packing, artery ligation, head forward
apply pressure and cold.
why do you palpate the PMI
(“heave” or “lift”)
use palm of your hand to palpate any large areas of sustained outward motion
if you can palpate heave or lift with PMI what does that mean
ventricular hypertrophy
what is a MUGA scan used for
stands for multiple gated angiography
Determines ejection fraction
Almost always automatically done with MPI now
qt prolongation
(Congenital, drug-induced, acquired)
grades of murmur
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
causes of tachycardia (4)
Acute myocardial ischemia/infarct
Chronic Coronary artery disease
Cardiomyopathy
Prolonged QT interval (Congenital, drug-induced, acquired)
Right Upper Quadrant
Liver Gallbladder Duodenum Head of the pancreas Right kidney and adrenal Part of the ascending and transverse colon (Umbilical)
Left Upper Quadrant
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)
Right Lower Quadrant
Cecum Appendix Right ovary and tube Right ureter Right spermatic cord
Left Lower Quadrant
Part of the descending colon Sigmoid colon Left ovary and tube Left ureter Left spermatic cord
Bartholin’s Cysts
between vagina and rectum
Swollen and painful
Usually I&D, antibiotic and C&S
7 F’S OF ABDOMINAL DISTENTION
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
appendicitis Assessing for peritoneal irritation
Check for Rovsing’s sign
referred rebound tenderness in the right lower quadrant when the left lower quadrant is palpated and released)- can also hit on bottom of foot
Check for Psoas sign appendicitis
(the patient flexes his thigh against the examiner’s hand; pain indicates a positive sign)
Check for the Obturator sign:APPENDICITIS
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
(Blumberg’s sign)
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).
appendicitis
Acute pain may begin in the umbilicus area and become greater in intensity and move into the right lower quadrant.
pancreatitis seen most commonly in
alcoholics- 80%
HLD, drugs, toxins, infection, structural abnromailite.
diverticulitis
prevalent in pt over 60.
common in western countries- due to raised intraluminal colonic pressures.
what are patients with diverticulitis at risk for
peritonitis- watch for signs of sepsis.
s3 is called
ventricle gallop
s4 is called
atrial gallop
s3 and s4 occur during systole or diastole
both occur during diastole.
when is an s3 normal
children young adults and pregnant women <30
when is s3 abnormal
decrease myocardial contractility, HF, volume overload, and mitral or tricuspid regurgitation.
troponin I normal value
<0.35ng/ml
significance of troponin I
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
troponin T normal value
<0.2mg/l
troponin T significance
May also elevate in unstable angina, myocarditis, chronic renal failure, acute muscle trauma, rhabdomyolysis, polymyositis, and dermatomyosis.
u wave=
hypokalemia
peaked T wave
hyperkalemia
t wave inversion
ischemia
qt prolongation
toxic drugs
st elevation
acute injury
q wave
transmural mi
(NA) Increases:
dehydration, increased NA intake
(NA) Decreases:
volume overload, decreased NA intake, diuretics
(K) decreases:
diuresis, decreased K intake, diarrhea, nausea and vomiting, gastric suction, hypoglycemia, alkalosis
(K) increases:
renal failure, dehydration, acidosis, hyperglycemia, increased K intake, ACE inhibitors, RBC hemolysis
What causes a diastolic murmur
- Mitral and tricuspid stenosis
2. Aortic or pulmonic regurgitation
What 2 sounds does a systolic murmur fall between?
The murmur falls between S1 and S2 (sounds like LUB-shhh-dub)
Systolic murmurs are heard under what two physiological conditions?
These are ejections murmurs
- May be caused by turbulence across the aortic or pulmonic valves if they are stenosed.
- May be caused by turbulence across the mitral or tricuspid valves if they are incompetent (regurgitant)
Heart murmur sounds _____ through _____ must have an accompanying thrill
4 – 6
What position and what part of the stethoscope is used to determine if S3 and S4 are present?
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.
If you cannot hear an S4 heart sound, what is it indicative of?
You only hear an S4 if the ventricle is stiff and non-compliant. Thus, to not hear one is indicative of a normal heart.
where do you listen for s1
s2
- S1: heard best at apex
- S2: heard best at base
What type of sounds is the diaphragm of the stethoscope used for?
The diaphragm is best for detecting high-pitched sounds like S1, S2, S4, and most murmurs
What type of sounds is the bell of the stethoscope used for
The bell is best for detecting low-pitched sounds like S3 and the rumble of mitral stenosis.
Large PMI indicative of what
A PMI that is over 3 cm diameter indicates left ventricular hypertrophy and is 86% predictive of increased left ventricular end diastolic pressure
infectious pharyngitis most cases come from
viruses
the bacterial cause of infectious pharyngitis=
strep throat
where do you hear aortic stenosis
2nd intercostal space- client leaning forward.
tonsillitis infections organism
group a beta hemolytic streptococcal/EBV
pharyngitis infectious organisms
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.
Aphthous stomatitis
ulcers- unclear cause
Topical steriods such as Kenalog, dexamethasone elixir, avoidance of spicy foods
Herpes Labialis
Caused by HSV – 1 or HSV 2, Acyclovir and valacyclovir are effective treatments.
Candidiasis
Caused by Candida albicans, Nystatin oral suspension is effective
Cheilitis
Cheilitis – painful fissures at the corners of the mouth from excessive saliva, candidiasis
