Health Assessment

Question 1

Angle of Louis

Answer 1

manubriosternal angle, the articulation of the manubrium and body of the sternum, continuous with the 2nd rib.

Question 2

Bronchitis

Answer 2

inflammation of the bronchi with partial obstruction of bronchi due to XS mucus secretion

Question 3

Bronchial (Tracheal)

Bronchovesicular

Vesicular

Answer 3

3 normal breath sounds heard while auscultating different areas of the lungs

High Pitch (short in, long out)

Moderate Pitch (equal in/out)

Low Pitch (long in, short out)

Question 4

Bronchophony

Egophony

Whispered Pectoriloquy

Answer 4

• spoken voice sound heard through the stethoscope-sounds soft, muffled, indistinct over normal lung tissue (“99”)
• the voice sound of “eeee” heard through the stethoscope (“aaa” over consolidation)
• normally response is faint, muffled, almost inaudible (“1,2,3” sounds very clear when consolidation is present)

Question 5

Crackles

Answer 5

abdnormal, discountinous adventitious lung sounds heard on inspiration

(heard: atelectasis, pneumonia, bronchitis, HF-base of lungs, TB-upper lobes, PE, ARDS)

Question 6

Crepitus

Answer 6

coarse crackling palpable over the skin when air abnormally escapes from the lung and enters the subcutaneous tissue

Question 7

Hyperventilation

Hypoventilation

Answer 7

=deep respirations with rate greater than 24-precipitated by fear, hypoxia, hypoglycemia, acidosis and infection

Causes decrease in CO₂, increase in pH=alkalosis

Causes a rise in CO₂, decrease in pH=acidosis

Question 8

Ronchi

Answer 8

low-pitched adventitious lung sounds cause by airflow obstruction from secretions (mucous)

(Heard: ARDS)

Question 9

Wheeze

Answer 9

High-pitched, musical, squeaking adventitous lung sound

(Heard: bronchitis, emphysema, asthma, PE)

Question 10

Resonance

Hyperresonance

Dull

Answer 10

nomal

too much air (emphysema, pneumothorax)

dull (abnormal density in lungs-pneumonia, pleural effusion, atelactisis, tumor)

Question 11

Precordium

Answer 11

area on anterior chest directly over-lying the heart and great vessels

(pericardium=fibrous, double-walled sac that surrounds and protects the heart)

Question 12

Apical Impulse

Answer 12

produced during contraction, when heart beats against chest wall-5th intercostal, mid-clavicular=PMI

heave or lift during ventricle systole if ventricular hypertrophy is present

Question 13

Abnomally high pressure in the right side of the heart

Left side

Answer 13

shows in the neck veins and abdomen

=pulmonary congestion

Question 14

S₃

S₄

Answer 14

occurs when the ventricles are resistant to filling during early, rapid filling phase (immediately after S₂) abnormal after age 35-may be an early sign of HF

occurs at the end of diastole when ventricle is resistant to filling (just before S₁)-caused by CAD

Question 15

CO = SV x HR

Question 16

Preload

Afterload

Answer 16

the venous return that builds during diastole

the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure

Question 17

Starling’s Law

Answer 17

the greater the stretch, the stronger the heart’s contraction-to a point-after which it won’t go back=cardiomyopathy

Question 18

Age related ECG changes

Answer 18

Prolonged P-R interval, prolonged QT interval, QRS interval is unchanged

Question 19

carotid bruit

Answer 19

audible when 1/2-2/3 occluded. disappears when completely occluded.

Question 20

Thrill

Answer 20

a palpable vibration-signifies turbulent blood flow and accompanies loud murmurs.

Question 21

Cardiac Enlargement

Answer 21

HTN, CAD, HF, cardiomyopathy

Question 22

Sinus arrhythmia

Answer 22

occurs normally in young adults and children=rhythm varies with breathing-increasing at peak of inspiration, slowing with expiration

Question 23

Pulse Defecit

Answer 23

Apical Rt-Radial Rt= Pulse Defecit

(signals weak ventricular contraction; occurs with A-fib, premature beats and heart failure)

Question 24

Heart Failure

Answer 24

dilated pupils

skin-pale, gray, cyanotic

dypsnea, SOBOE

orthopnea (can only breath sitting up)

crackles, wheeze

cough (frothy pink or white sputum)

decreased BP (causes increased HR and increase force of contraction)

N/V (peristalsis slows-bile and fluids back-up)

Ascites

Dependent, pitting edema

anxiety (from pulmonary congestion)

falling O₂ saturation

Jugular vein distension (venous congestion)

infarct

fatigue

S₃ gallop, tachy

enlarged spleen, liver (from venous congestion-causes pressure on breathing)

decreased urine output (as kidneys compensate for decreased cardiac output by retaining Na and H20)

weak pulse, cool moist skin (as peripheral vasoconstriction shunts blood to vital organs)

Question 25

modified Allen Test

Answer 25

0cclude radial and ulnar pulses to check for adequacy of collateral circulation bf cannulating the radial artery.

Question 26

Arterial-Ischemic Ulcer

Answer 26

deep muscle pain in calf or foot, claudication (pain with walking), coolness, pallor, elevational pallor, dependent rubor, diminished pulses, systolic bruits, signs of malnutrition (thin, shiny skin, thick-ridged nails, muscle atrophy), distal gangrene. Ulcers occur at toes, metatarsal heads, heels, lateral ankle, characterized by pale ischemic base, **well defined edges**, no bleeding.

Question 27

Venous (stasis) Ulcer

Answer 27

after acute DVT or chronic incompetent valves in deep veins aching pain in lower calf, worse at end of day, firm, brawny edema, coarse, thickened skin, pulses normal, brown pigment discoloration, petechiae, dermatitis, increased venous pressure--RBC's leak out of veins and onto skin, RBC breakdown=hemosiderin (iron deposits) behind=brown pigment deposits, weepy, pruritic statis dermatitis may be present ulcers occur at medial malleolus and are characterized by **bleeding, uneven edges**.

Question 28

atherosclerosis

Answer 28

risk factors: obesity, smoking, HTN, diabetes mellitus, elevated serum cholesterol, sedentary, family history of hyperlipidemia

Question 30

cholecystits

Answer 30

inflammation of the gallbladder

Question 31

Pyrosis

Answer 31

=Heartburn

Question 32

Tympany

Answer 32

high-pitched, musical, drumlike heard when percussiing over the stomach and intestine. dull over liver and spleen, distended bladder, adipose tissue, fluid or a mass hyperresonance=gaseous distention

Question 33

Abdomen

Answer 33

1. inspection 2. auscultation 3. percussion 4. palpation

Question 34

Blumberg's Sign

Answer 34

rebound tenderness-accompanies appendicitis-peritoneal inflammation

Question 35

Costovertebral angle (CVA) tenderness

Answer 35

sharp pain=inflammation of kidney

Question 36

Murphy Sign

Answer 36

pain felt when taking a deep breath while examiner's fingers are on the approximate location of inflamed gallbladder.

Question 37

Ascites

Answer 37

occurs with HF, portal HTN, cirrhosis, hepatitis, pancreatitis, cancer, renal failure

Question 38

involuntary rigidity

Answer 38

constant, board-like hardness of the muscles-protective mechanism accompanying acute inflammation of the peritoneum; may be unilateral, painful upon sitting

Question 39

Fremitus

Answer 39

decreased fremitus: COPD, pneumothorax, pleural effusion, tumors, fibrosis of lung increased fremitus: consolidation-lobar pneumonia

Question 40

Split S₂

Answer 40

Normal at end of inspiration