Health Assessment Midterm Flashcards
Occlusion and inflammation of the salivary gland leads to
Sialadenitis
What is the most common neurologic problem caused by Lyme disease
A Bell’s palsy-like facial paralysis
Signs & symptoms of Hyperthyroidism
Nervousness, irritability, weight loss, tachycardia, heat intolerance, smooth/ silky skin, fine hair (with frequent loss), thin nails, loose stools
Signs and symptoms of Hypothyroidism
Periorbital edema, facial edema, bradycardia, weight gain, lethargy, cold intolerance, muscle weakness, coarse/ brittle hair, osteoporosis, constipation, menorrhagia, pitting edema of LE
Diagnostic test for CHF
Brain natriuretic peptide (BNP)
Differential Dx for chest pain
Pneumonia
Apply pressure downward & slightly upward on the liver. Up to 30 seconds of pressure. Watch for jugular vein distention. (If present, it should recede within seconds. Abnormal if JVD stays while you are pressing on the liver). This checks for right-sided heart failure
Hepatojugular Reflux
Most common valve abnormality in adults. Develops gradually. Decreased HR, faint pulse (Crescendo-decrescendo) systolic murmur. Radiates to the carotids. Heard @ 2nd ICS RSB
Aortic Stenosis (Systolic Murmur)
Most common in women w/ rheumatic heart disease. Atrial dilation & hypertrophy, thrombi formation from fibrillation (Rumbling decrescendo) diastolic murmur. Heard @ Apex, PMI, 5th ICS MC
Mitral Stenosis (Diastolic Murmur)
Seen in RHD, bacterial endocarditis, syphilis ( blowing decrescendo murmur in 3rd & 4th ICS) bounding peripheral pulses (Corrigan pulses). Heard @ 3rd & 4th ICS/ ERBs point
Aortic Regurgitation (Diastolic Murmur)
Caused by MVP, RHD, ineffective endocarditis, MI, Marfan syndrome (Loud holosystolic murmur at APEX) Left ventricular dilation/ hypertrophy, atrial dilation/fibrillation. Heard @ the Apex
Mitral Regurgitation (Systolic Murmur)
Lab test for myocardial damage
Troponin
Common cause of tricuspid regurgitation
Pulmonary HTN
Signs/ symptoms of right sided heart failure (“right = GI”)
JVD (normal< 4cm), enlarged spleen, enlarged liver causing anorexia, nausea and abdominal pain, LE edema
Signs/ symptoms of left sided heart failure (“left = lung”)
Crackles, cough, dyspnea, dullness to percussion, paroxysmal nocturnal dyspnea, orthopnea, non-productive cough & wheezing
MI, elevated BP, smoking, dyspnea w/ exertion lead to
Left-sided heart failure = decreased cardiac output
Most common causes of S4
Left ventricular hypertrophy (LVH), normal in some elderly, poorly controlled HTN, unstable angina
Most common causes of S3
CHF, pregnancy, possible thyrotoxicosis, possible normal for adolescent athletes, always abnormal if occurs > 35yo “Kentucky” - best heard at pulmonic area (AKA ventricular gallop or S3 gallop)
S3 ( Use Bell to hear)
“Kentucky” - best heard at the pulmonic area (AKA ventricular gallop or S3 gallop)
S4 ( Use Bell to hear)
Occurs late is diastole and best heard at apex with bell (Tennessee) (atrial gallop or atrial kick)
Closure of AV- mitral/ tricuspid (lub)
M =(mitral valve)
T= (tricuspid valve)
AV= (atrioventricular valves)
S1 = systole
Closure of semilunar - aortic/ pulmonic valves (dub)
A= (aortic)
P= (pulmonic)
S= (semilunar)
S2 = diastole
Grading of murmurs
Grade I = Barely audible
Grade II = Audible but faint
Grade III = Moderately loud, easily heard (as loud as S1)
Grade IV = Loud, associated with a thrill
Grade V = Very loud, heard one corner of the stethoscope off the wall
Grade VI = Loudest heard w/o a stethoscope
Occurs in severe anemia, dehydration & becomes louder when lying down
Physiologic Murmur
Systolic murmurs (MR Peyton Manning AS MVP)
MR Peyton Manning AS MVP MR = mitral regurgitation ( radiates to axilla) P/M = physiologic murmur AS = aortic stenosis ( radiates to neck) MVP = mitral valve prolapse
DIastolic murmurs (ARMS)
ARMS
AR = aortic regurgitation
MS = mitral stenosis
JNC- 8 Guidelines
Implement lifestyle modifications
BP goal
Anyone w/ DM or CKD < 140/90
No DM or CKD < 150/90
JNC-8 Guidelines (MEDS)
Non AA= thiazide or ACEI/ ARB or CCB alone or in combo
AA = thiazide or CCB alone or in combo
CKD = ACEI or ARB alone or in combo w/ other class
CENTOR critieria
Absence of cough Tonsillar exudate Anterior cervical adenopathy Hx of fever Age Score > 2 screen for strep
Sudden onset of floaters associated with looking through a curtain sensation w/ sudden flashes of light (photopsia)
Retinal Detachment
Acute onset of severe eye pain with redness & vision changes. Accompanied by headache, N/V, halos around lights & decreased vision. Cornea appears cloudy. Funduscopic exam reveals cupping of optic nerve
Acute Angle Closure Glaucoma (Opthalmological emergency)
Gradual onset increased IOP greater than 22. Presents with a gradual change in peripheral vision
Open Angle Glaucoma
Gradual or sudden loss of central vision in one or both eyes. Straight lines become distorted or curved (scotoma)
Macular degeneration
Causes by EBV. Symptoms (3F’s & an L) fever, fatigue, pharyngitis, lymphadenopathy sore throat, enlarged posterior cervical nodes, peak ages 15-24
Mononucleosis
Chronic inflammation of meibomian gland, painless nodule with gradual onset. Tx I &D or corticosteroid injections
Chalazion
Acute onset swollen, red and warm abscess on the eyelid may spontaneously rupture & drain purulent exudate. Caused by staph. Tx w/ hot compresses & erythromycin
Hordeoleum (stye)
Confusion of new onset Blood urea nitrogen > 19 Respiratory rate > 30 Blood pressure diastolic < 90 or systolic < 60 Age 65 or older
CURB 65 (Pneumonia)
PPD x Years =
Packs per year
COPD: FEV1/ FVC < 70
Mild > 80
Moderate < 50
Severe < 30
Increased tactile fremitus
Indicates consolidation
Functional murmurs
Are due to increased blood flow. Normal in children @ 2nd- 3rd L ICS. Will disappear with sitting
Risk factors for pulmonary emboli
Hx of A-fib, pregnancy, recent travel, smoking, prolonged inactivity, birth control, estrogen therapy, surgery, cancer, long bone fx
Midsternal chest pain, numbness/ tingling left jaw, pain provoked by eating heavy meals or exercise. Pain or discomfort at rest. Women present w/ fatigue, sleep disturbance, anxiety, dyspnea, weakness, back pain, nausea & syncope
ACS (acute coronary syndrome)= STEMI, NSTEMI & unstable angina
What type of pain can you reproduce?
Muscloskeletal pain
Three factors that can cause thrombus formation (Virchow Triad)
Vessel wall injury
Blood flow abnormalities
Altered blood constituents leading to hypercoagulability
Alveolar damage from loss of elastic recoil lungs, chronic cough (2 yrs), chronic sputum production, SOB worse w/ exertion, barrel chest, weight loss, hyperresonance upon precision, tactile fremitus & egophony are decreased, hyperinflation w/ CXR. (* pack per year smoker*)
COPD
Thrombi developed from stasis, trauma, inflammation or coagulation. Gradual onset of swelling in LE after prolonged sitting, painful, red, warm, swollen extremity. (If PE abrupt onset CP, dyspnea, dizziness or syncope. + Homan’s sign
Deep vein thrombosis (DVT)
Narrowing or occlusion of medium to larger arteries in LE
Arterial insufficiency
Worsening pain on ambulation instantly relived by rest (claudication- angina of calf muscles). Thin skin, hairless toes, thick toenails/ discolored, decreased or absent dorsal pedal pulse
Peripheral artery disease (PAD)
What crescendo- decrescendo murmur presents in older patients with syncope, angina & dyspnea (SAD), or calcified valve? These murmurs radiate to the carotids
Aortic Stenosis
What holosystolic murmur presents in a patient with Hx of Rheumatic fever? This murmur radiates to the axilla.
Mitral regurgitation
What holosystolic murmur presents in patients with Hx of intervenous drug abuse (IVDA)?
Tricuspid Regurgitation
What murmur has an opening snap sound and presents in a patient with Hx of Rheumatic fever?
Mitral Stenosis
What murmur presents in young women w/ psychiatric Hx ( anxious or depressed)? Has a mid-systolic click. Can be caused by myxomatous valve disease
Mitral valve prolapse
