Health Assessment Test 2 Flashcards

Question

How do you measure the symmetry of the ears?

Answer 1

The auricle of the ear should be an imaginary line extending from the inner eye canthus to the occiput. The consistency of auricle should be firm and mobile without nodules.

Answer 2

Mouth/Throat Anatomy

Answer 3

Inflammation of the middle ear resulting in the collection of serous, mucoid, or purulent fluid (effusion) when the tympanic membrane is intact

Answer 4

**Otitis media with effusion. A,** The middle ear filled with serous fluid; note the bulging appearance and distorted light reflex. **B,** Air-fluid levels in upper middle ear. **C,** Acute otitis media. Note the red bulging tympanic membrane with obscured bony landmarks and distorted light reflex

Answer 5

Peri auricular cellulitis due to decreased vascularity pts will need IV abx at hospital. The inflammation in the auditory canal often extends with inflammation of the pinna. Serious.

Answer 6

* Hearing loss resulting from the reduced transmission of sound to the middle ear

Answer 7

* Hearing loss resulting from a disorder of the inner ear, damage to cranial nerve VIII, genetic disorders, systemic disease, ototoxic medication, trauma, tumors, or prolonged exposure to loud noise

Answer 8

* Disorder of **_progressive hearing loss_** that in some cases has a genetic mode of transmission * S/S: Imbalance, fullness in ears, motion sickness, tinnitus, nystagmus

Answer 9

* Illusion of rotational movement by a patient, often due to a disorder of the inner ear (anything involving the inner ear can lead to vertigo) * Ménière disease

Answer 10

Viral rhinosinusitis * Most common URI * Associated with a sore throat, nasal congestion, rhinorrhea, sneezing, cough, and mild malaise

Answer 11

Bacterial rhinosinusitis * Bacterial infection of one or more of the paranasal sinuses * Often complications of viral infection * Associated similar symptoms as viral plus potential _unilateral sinus pain_, _maxillary toothaches sensation that worsened when bending forward_. * _Double sickening – get better than sx starts again_

Answer 12

* Infection of tonsils or posterior pharynx by microorganisms such as group A β-hemolytic streptococci or other streptococcal species, *Neisseria gonorrhea, Mycoplasma pneumoniae* Tonsillitis and Pharyngitis – notice erythema and exudate in crypts of the tonsils

Answer 13

* Deep infection in the space between the soft palate and tonsil – MED EMERGENCY

Answer 14

Centor Criteria Pneumonic - C - Cough (absent) or Can’t Cough (+1) A - Adenopathy Swollen Anterior Cervical Lymph Nodes (+1) F – Fever \> 100.4 (+1) E – Exudate or Enlarged Tonsils (+1) O - \<15 (+1), 15 – 44 = 0, \>45 (-1) Centor Criteria - CDC Recommendations for Adults with Acute Pharyngitis 1 Criteria – No abx, symptomatic trmt 2- 3 Criteria – Rapid test: abx for positives, Symptomatic trmt 4 Criteria – Empiric abx, Symptomatic trmt

Answer 15

* Ask the patient to extend the tongue while you inspect for: * Deviation * Tremor * Limitation of movement * CN XII

Answer 16

* Transillumination of the frontal and maxillary sinuses may be performed if sinus tenderness is present or infection is suspected

Answer 17

* Lips symmetrical, pink without cracking, lesions or maceration. Buccal mucosa, palate, tonsillar pillar pink, moist without lesions. Gingiva without hypertrophy, retraction, or bleeding. Teeth in good repair. Tongue pink, smooth without lesions, midline. CNXII intact. Tonsils grade 2 bilaterally, without exudate or erythema. Uvula elevates midline with phonation, Posterior pharynx without erythema, exudate, postnasal drip or lesions.

Answer 18

Major duct to the salivary glands that opens into the mouth cavity

Answer 19

Visible sebaceous (sweat) glands can be found in genitals and in the mouth. They appear as small, painless, raised, pale, red or white spots or bumps 1-3mm. Normal occurrence. Also appear on the male and female genitials

Answer 20

Full and controlled range of motion. Trachea midline, smooth, non-tender, and movable. Thyroid nonpalpable, and/or free of nodules May describe carotids and jugulars here or with CV system

Answer 21

No edema, erythema, enlargement (adenopathy) or tenderness of nodes

Answer 22

**2**0/20 on Snellen bilaterally. EOMs intact without nystagmus, conjunctiva pink, sclerae white, cornea clear with corneal reflex intact. Visual fields full by confrontation. PERRLA, red reflex present. Optic discs cream colored, borders well defined. 3:5 a:v ratio, no nicking, hemorrhage, or exudate noted

Answer 23

Pinna non-tender to palpation, the external canal is free of cerumen, foreign bodies, without erythema, TM pearly gray; landmarks and cone of light apparent, mobile. Nasal mucosa pink, without discharge, inferior turbinates visible, no septal deviation, nares patent. Frontal and maxillary sinuses nontender to palpation, percussion Lips, tongue, and gums pink and smooth with good dentition noted. Uvula rises equilaterally in the midline. Oral cavity absent of lesions, masses, non-tender to palpation

Answer 24

* External auditory canal in infants shorter than in adults * Eustachian tube in infants wider, shorter, more horizontal than in adults * Salivation increased by 3 months * 22 deciduous teeth by 6 and 24 months, permanent teeth in jaw 6 months, eruption of permanent teeth 6 years old and done by 14 – 15 years old

Answer 25

1/3 of adults \> 65 years old have hearing loss (presbycusis) as a result * Degeneration of hair cells in the organ of Corti * Degeneration of the cochlear conductive membrane * Decreased vascularization of the cochlea * Loss of cortical and organ of Corti auditory neurons Sensory hearing loss first occurs with high frequency sounds and then progresses to lower frequency (presbycusis)

Answer 26

* Excess deposition of bone cells along the ossicle chain, causing fixation of the staples in the oval window * Cerumen impaction * Sclerotic tympanic membrane

Answer 27

**CONDITION** External Otitis **HISTORY** More common in adults, especially with DM, swimmers, and “ear pickers” CC: bilateral itching, pain **PHYSICAL FINDINGS** Discharge, inflamed swollen external canal, pain with movement of the pinna TM normal or not visible DIAGNOSTIC STUDIES NONE

Answer 28

**CONDITION** Acute otitis media (AOM) **HISTORY** More common in children \<6 Hx of smoke exposure, recent URI **PHYSICAL FINDINGS** CC: severe or deep pain, unilateral sensation of fullness Red, bulging TM, decreased or loss of light reflex, opaque TM, decreased TM mobility DIAGNOSTIC STUDIES **None initially**

Answer 29

**CONDITION -** Serous Otitis **HISTORY -** More common in children, but will occur in adults with recent URI. **PHYSICAL FINDINGS -** CC: unilateral pain, sensation of crackling, or decreased hearing, Decreased TM mobility. Fluid line or air observed behind TM. Conductive hearing loss DIAGNOSTIC STUDIES **-** None initially

Answer 30

**CONDITION** Cholesteatoma (epidermal cyst in middle ear) **HISTORY** **PHYSICAL FINDINGS** CC: hearing loss Pearly white lesion on or behind TM, commonly located in superior anterior quadrant of TM **DIAGNOSTIC STUDIES** Immediate referral to ENT

Answer 31

**CONDITION -** Mastoiditis **HISTORY** - Recent OM: chronic otitis **PHYSICAL FINDINGS -** CC**_: pain behind ear_** **DIAGNOSTIC STUDIES -** Swelling and tenderness over mastoid process. Fever, erythema X-ray of mastoid sinus reveals cloudiness Referral

Answer 32

**CONDITION -** Foreign Body or cerumen impaction **HISTORY**Vague sensation of discomfort, decreased hearing **PHYSICAL FINDINGS -** Visualize foreign body or cerumen, may detect foul odor, conductive hearing loss **DIAGNOSTIC STUDIES -** NONE

Answer 33

**CONDITION -** Barotrauma **HISTORY -** History of flying, diving **PHYSICAL FINDINGS -** CC: severe pain, hearing loss, sensation of fullness Retraction or bulging of TM, perforation of TM, fluid in canal **DIAGNOSTIC STUDIES** - Tympanogram – indirectly measures pressure in middle ear

Answer 34

**CONDITION -** TMJ disorder **HISTORY -** CC: discomfort to severe pain, typically worse in AM. Usually unilateral **PHYSICAL FINDINGS -** Maloccclusion, bruxism, normal external and middle ear structures and function. Jaw click DIAGNOSTIC STUDIES- NONE

Answer 35

Disturbance of the normal pitch by processes that affect the structure or function of the vocal cords. Describes rough, harsh, or deep voice. May be an early sign of local disease or a manifestation of systemic illness. **_It is a cardinal symptom for laryngeal disease_**

Answer 36

**CONDITION -** Acute laryngitis **HISTORY -** Voice overuse, exposure to environmental irritants, recent URI **PHYSICAL FINDINGS -** Voice quality, aphonia, cervical lympadenopathy, erythema of pharynx, edema and redness of vocal cords DIAGNOSTIC STUDIES - None, if duration of hoarseness is less than 3 weeks

Answer 37

**CONDITION -** Chronic laryngitis **HISTORY -** Chronic history of smoking, ETOH use, exposure to environmental irritants, duration of hoarseness more than 3 weeks **PHYSICAL FINDINGS -** Edema of vocal cords, nodules may be present **DIAGNOSTIC STUDIES -** Lateral and AP views of the neck, laryngoscopy (ENT referral)

Answer 38

**CONDITION -** Neoplasm **HISTORY -** Smoking, airborne exposure, chronic ETOH use, history of chronic cough, hoarseness for more than 3 weeks **PHYSICAL FINDINGS -** Tracheal deviation, pain with advanced tumor, hoarseness may be only sign DIAGNOSTIC STUDIES - ENT referral for biopsy

Answer 39

**CONDITION -** GERD **HISTORY** **PHYSICAL FINDINGS -** History of UGI burning and cough, especially at night, chronic use of ETOH, NSAIDS, or aspirin, history of ulcer disease, smoker, frequent clearing of throat. May have epigastric tenderness on palpation, vocal cord inflammation or ulcers DIAGNOSTIC STUDIES - Referral for endoscopy if symptoms not relieved by medications and dietary alterations

Answer 40

Most often result of an inflammation of the mucosa of the oropharynx, secondary to an infectious cause (viral, bacterial, fungal)

Answer 41

**CONDITION -** Viral Pharyngitis **HISTORY -** Scratchy, sore throat, malaise, myalgias, headache, chills, cough, rhinitis **PHYSICAL FINDINGS -** Erythema, edema of the throat, **_tender posterior cervical nodes_** **DIAGNOSTIC STUDIES** - NONE

Answer 42

**CONDITION -** GABHS pharyngitis **HISTORY -** Most common in 5-15 year old, check for known exposure, fall/winter season, sudden onset of fever, severe sore throat, malaise, absence of cough and URI symptoms **PHYSICAL FINDINGS -** Fever \> 38.5 (101.5), exudate, **_anterior cervical lymphadenopathy_** **DIAGNOSTIC STUDIES** - Positive rapid strep, strep culture

Answer 43

**CONDITION -** Mononucleosis **HISTORY -** (Epstein-Barr virus) **PHYSICAL FINDINGS -** Young Adults, slow onset of malaise, low-grade temperature, mild sore throat **DIAGNOSTIC STUDIES** - _+_ pharyngeal exudate, palatine petechiae, **_posterior cervical lymphadenopathy_**, splenomegaly Positive monospot, CBC with differential: \> 50 % leukocytes

Answer 44

**CONDITION -** Candidiasis **HISTORY -** Immunosuppressed, person tx’ed with antibiotics, diabetes, HIV **PHYSICAL FINDINGS -** CC sore mouth, throat, difficulty swallowing Curdy, white plaques that bleed when scraped off **DIAGNOSTIC STUDIES** - KOH smear shows hyphae Culture

Answer 45

**CONDITION -** Epiglottitis **HISTORY -** d/t (H. influenza type b) **PHYSICAL FINDINGS -** Sore throat, difficulty with secretions, unable to lie flat, can’t talk Respiratory distress, drooling, toxic appearance. Do not examine pharynx **DIAGNOSTIC STUDIES** - Immediate referral to ENT

Answer 46

Diaphram External intercostal muscles increase the anteroposterior chest diameter and create negative pressure during inspiration. Expiration is a passive process where the thoracic muscles relax leading to a decrease in thoracic pressure. healthy lungs recoil. Accessory muscles are the sternocleidomastoid, trapezius, scalenes, pectoralis, and serratus

Answer 47

Filtered Humidified Warmed

Answer 48

Ribs are flexible to support lungs. Higher rate of 02 consumption. More likely to use accessory muscles in time of distress and high metabolic demand. Nasal flaring

Answer 49

"O" observation, because I caused that pain

Answer 50

Flat diaphragm causes barrel chest with 1:1 ratio

Answer 51

Verticle axis - invisible line to make vertical locations, count the ribs and interspaces; sternal angle is the best guide and horizontal

Answer 52

Chest circumference at birth is 1:1 then goes to 1:2 at 2 years old

Answer 53

Rib cage relaxes increased chest expansion, the diaphragm goes up. Respirations rate remains the same with deeper breathing

Answer 54

* Barrel chest from loss of muscle strength in thorax and diaphragm and loss of lung resiliency * Skeletal changes emphasizing dorsal curve of thoracic spine (Kyphosis) * Alveoli less elastic, higher risk for fatigue and dyspnea on exertion Muscles are not as strong.

Answer 55

When there is a barrel chest there is more dead space. In this dead space oxygen fills it up but the oxygen does not move in and out it is referred to as residual volume. Residual volume increased and vital capacity decreases Increase in the Anteroposterior diameter 1:1

Answer 56

Chronic dry cough continuous

Answer 57

Acute cough is \< 3 weeks Chronic cough is \> 8 weeks

Answer 58

* Hemoptysis * Smoker age \>45 with new cough, change in cough or coexisting voice disturbance * Adults age 55–80 with a 30-pack year history or who have quit less than 15 y ago * Dyspnea, especially at rest or at night * Hoarseness * Systemic symptoms: continuous fever, unintentional weight loss, peripheral edema with weight gain * Dysphagia * Vomiting * Recurrent pneumonia * Abnormal physical exam or chest x-ray

Answer 59

Systolic murmur

Answer 60

Hemoglobin of at least an 8

Answer 61

Ask about smoking at each visit Advise patients regularly to stop smoking using a clear, personalized message Assess patient readiness to quit Assist patients to set stop dates and provide educational materials for self-help Arrange for follow-up visits to monitor and support patient progress Ask, Advise, Assess, Assist, Arrange

Answer 62

* Tobacco use * Use of alcohol/drugs * Employment * Home environment * Exposure to respiratory infections, influenza, TB * Nutritional status * Use of complementary and alternative therapies * Regional/travel exposures * Hobbies * Exercise tolerance

Answer 63

* Low birth weight and prematurity * Coughing and sudden-onset shortness of breath * Possible ingestion of kerosene, antifreeze, or hydrocarbons in household cleaners * Apneic episodes; use of apnea monitor * Swallowing dysfunction * Gastroesophageal reflux * History of pneumococcal and influenza vaccination

Answer 64

Inspect Palpate Percuss Auscultate

Answer 65

* Shape and symmetry * Chest wall movement * Superficial venous patterns Inspect the chest for: * Prominence of ribs * Sternal protrusion * Spinal deviation * Anteroposterior vs. transverse diameter * Expected: 1:2 * Barrel chest: 1:1 * Observe respiration * Estimate costal angle

Answer 66

Expected findings: * Symmetricaland elliptical without lesions, scars or deformities * Symmetrical rise and fall of chest wall * AP is 1:2 in adult * Respiration between 12 to 20, even quiet and unlabored * Costal angle is less than 90 degree

Answer 67

Congenital posterior displacement of lower aspect of sternum. "hollowed-out" appearance. Concave appearance of the lower sternum NO SYMPTOMS - DOES NOT INVOLVE OTHER CONDITIONS

Answer 68

At birth or Post CABG Mid childhood and 11-14 year old pubertal males undergoing a growth spurt. Some parents report that their child's pectus seemingly popped up 'overnight‘. Convex deformity **Associated with comorbidities - MVP, scoliosis, asthma**

Answer 69

On inspiration, the lower thorax is drawn in, and on expiration, the opposite occurs The paradoxical chest movement occurs when, instead of moving downward on the inhale and upward on the exhale (as is the case in normal diaphragmatic breathing), the diaphragm moves upward on the inhale and downward on the exhale.

Answer 70

* When the chest wall seems to cave in at the sternum, between the ribs, at the suprasternal notch, above the clavicles, and at the lowest costal margins * Suggests an obstruction to inspiration at any point in the respiratory tract

Answer 71

Techniques * For masses, tenderness crepitus use the pads of 4 fingers. * For tactile fremitus Palms of your open hands or the ulnar portion of your hand over the left superior anterior lung "99"

Answer 72

* Masses * Tenderness * Crepitus * Tactile fremitus

Answer 73

* Tactile fremitus : tactile fremitus is palpable vibration of the chest wall produce by speech. * Ask patient to say 99 while palpating. * Compare the vibration symmetrically

Answer 74

* Increased: Presence of consolidation, fluids or solids * Decreased: Excess air in lungs (pleural effusion, pneumothorax, COPD)

Answer 75

**_Expected report_** Resonance to percussion * Throughout the anterior and axillary chest * Dullness over liver and precordium **_Unexpected findings:_** Dullness: tumor, fluids so cancer, * Pneumonia, pleural effusion Hyper-resonance: excess air (COPD, Asthma, pneumothorax) Tympany: Pneumothorax

Answer 76

•All sounds can be characterized in the same manner as the percussion notes: * Intensity * Pitch * Quality * Duration Listen with the diaphragm of the stethoscope

Answer 77

Vesicular: Normal - soft and low pitched; usually heard over most of both lungs

Answer 78

Bronchial: Normal - louder and higher in pitch; usually heard over the manubrium

Answer 79

Bronchovesicular: Normal - intermediate intensity and pitch; usually heard over the **_1st and 2nd interspaces_**

Answer 80

Tracheal: Normal - over the trachea and neck, very loud

Answer 81

Bronchial sound over peripheral lung field Consolidation such as pneumonia, pulmonary edema -Rhonchi are low-pitched snore-like sounds, often characterized by secretions within the large airways Sometimes cleared with a cough - Wheezes are continuous, high-pitched, musical, sounds that are produced by air flowing through narrowed bronchi. Predominantly expiratory - Rales: A crackling sound, may indicate pneumonia - Stridor is a loud, rough, continuous, high-pitched sound that is pronounced during inspiration. Indicates proximal airway obstruction

Answer 82

Normal lung findings include symmetric chest expansion, resonant percussion tones, vesicular breath sounds over the peripheral lung fields, muffled voice sounds, and no adventitious sounds.

Answer 83

Produced by air passing over airway secretions. A crackle is a discontinuous sound, as opposed to a wheeze, which is continuous. The popping sounds produced are created when air is forced through respiratory passages that are narrowed by fluid, mucus, or pus. Crackles are often associated with inflammation or infection of the small bronchi, bronchioles, and alveoli. Crackles that don't clear after a cough may indicate pulmonary edema or fluid in the alveoli due to heart failure or adult respiratory distress syndrome (ARDS).May indicate pneumonia, fluid overload Crackles are often described as fine, medium, and coarse. Fine crackles are soft, high-pitched, and very brief. You can simulate this sound by rolling a strand of hair between your fingers near your ear, or by moistening your thumb and index finger and separating them near your ear. Coarse crackles are somewhat louder, lower in pitch, and last longer than fine crackles. They have been described as sounding like opening a Velcro fastener.

Answer 84

Rhonchi are low-pitched snore-like sounds, often characterized by secretions within the large airways Sometimes cleared with a cough Rhonchi are continuous, best heard during expiration but may also be heard during inspiration and expiration.

Answer 85

Wheezes are continuous, high-pitched, musical, sounds that are produced by air flowing through narrowed bronchi. Predominantly expiratory These wheezes occur when airways are narrowed, such as may occur during an acute asthmatic attack.

Answer 86

Stridor is a loud, rough, continuous, high-pitched sound that is pronounced during inspiration. Indicates proximal airway obstruction Stridor is caused by obstruction of the upper airway, is a sign of respiratory distress and thus _requires immediate attention_

Answer 87

**Abnormal indicates: Consolidation** such as pneumonia, pulmonary edema

Answer 88

when there is no airflow to the region being auscultated This can occur in a pneumothorax, hemothorax, pleural effusion, or parenchymal consolidation, which includes the feeding airway

Answer 89

Occurs outside the respiratory tree Dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration Caused by inflamed, roughened surfaces rubbing together

Answer 90

Not a reliable method ## Footnote - Diaphragmatic excursion: Not a reliable methods. - Pt takes a deep breath in - Percuss downward from beneath the right scapula - Listen for change in sound from resonant to dullness. - Ask patient to take anPt takes a deep breath in - Percuss downward from beneath the right scapula - Listen for change in sound from resonant to dullness. - Ask patient to take another deep breath and blow out all the way out and hold it. - Begin at the first mark and Percuss again upward on the scapular line - other deep breath and blow out all the way out and hold it. - Begin at the first mark and Percuss again upward on the scapular line - Measure the distance between two line: normal 3 to 6 cm.

Answer 91

Resonance over lung fields Flat over spinous process, scapula Diaphragmatic excursion measures between 3 to 6 cm

Answer 92

* Bronchophony: patient repeat 99 in normal voice while NP auscultates * Negative (normal) findings: Muffled sounds * Positive: Voice become clearer and distinct

Answer 93

* Whispered Pectoriloquy:patient repeats 99 in a whisper while NP auscultates * If Bronchophony is negative so will whispered pectoriloquy * Positive: Extreme bronchophony where even a whisper can be heard clearly through the stethoscope

Answer 94

* Egophony: patient repeats “eeee” in normal voice while NP auscultates * Negative: Hear the sound eeeeeee’s * Positive: Intensity of the spoken voice is increased and there is a nasal quality. eeeee’s become stuffy broad ayyy’s ( like sheep sounds)

Answer 95

2-3 cm smaller than head circumference

Answer 96

* Coughing is rare; sneezing is frequent * Hiccups are also frequent * At first, breathing is primarily diaphragmatic; use of intercostal muscles is gradual * Paradoxic breathing (the chest wall collapses as the abdomen distends on inspiration) is common, particularly during sleep

Answer 97

Breath sounds * More resonant * Hyperresonance common * Easy to miss dullness * Bronchovesicular sounds may predominate

Answer 98

increases her ventilation by breathing more deeply, not more frequently

Answer 99

•Chest expansion decreased Respiratory muscle weakness General physical disability Sedentary lifestyle Calcification of rib articulations Bony prominences marked Kyphosis with flattening of lumbar curve Increased anteroposterior diameter Hyperresonance common

Answer 100

Lungs: Chest: CTA/P B/L all lobes; (–) W/R/R. Detailed: used if presenting with a lung/thoracic issue AP diameter

Answer 101

* Inflammation of the large airways * Viral origin (Most often)

Answer 102

* History: * Headache, nasal congestion * Cough for \>5 days and no evidence of pneumonia, asthma, exacerbation of COPD * Cough is initially dry and nonproductive, then productive; later, mucopurulent sputum, which may indicate secondary infection. * Dyspnea (especially on exertion), wheeze, and fatigue may occur. * Possible contact with others who have respiratory infections (1) it is an infection and will spread * Fever: None or low grade, high grade fever may suggest pneumonia or influenza infection * Substernal chest pain with cough, have them take a deep breath and cough out to hear wheeze * Cough may last up to 6 weeks Key history and PE: * Mildly ill appearance * Pharynx injected, Lung exam may be normal or Rhonchi, wheezes with deep breath, clear with cough. * No evidence of lung consolidations. During history: you need to make sure you r/o pneumonia, influenza

Answer 103

* Viral acute onset infection * Can affect nose, throat and sometimes lungs Patients look and feel like hell

Answer 104

* Signal symptoms: * Systemic symptoms: * Myalgias * Malaise * Fatigue, anorexia * Fever above 100. F * Elderly may present with low grade fever or no fever but increase confusion, fatigue * Headache (scalp pain) * Sore throat * Cough PE: * Physical exam is not specific for influenza. * Physical examination should exclude complications such as otitis media, pneumonia, sinusitis, and tracheobronchitis.

Answer 105

* Otitis media * Sinusitis * Acute myositis * Pneumonia * Exacerbation of chronic illness (asthma, COPD)

Answer 106

•Bacterial but can be viral infection Signal symptoms: * Myalgias, anorexia, malaise * Headache * Cough: productive Clear/yellow/reddish. * If red think strept pneumonia * Chills, Fever above 100F * Elderly may present with low grade fever or no fever but increase confusion, fatigue * Pleural pain

Answer 107

* High fever, tachycardia, tachypnea (fast respirations) * Ill appearing * Claminess * Accessory muscle use, increased tactile fremitus, Crackles, Positive bronchophony, egophony CANNOT DIAGNOSE A PNEUMONIA WITHOUT A CHECK XRAY SHOWING INFILTRATES OR CONSOLIDATION LRI, GENERAL MALAISE CAN BE USED

Answer 108

* Contagious bacterial infection caused by Bordetella pertussis * 3 stages disease

Answer 109

Classic pertussis has three phases, which occur over 6 to 10 weeks: •Catarrhal phase: rhinorrhea, mild cough, low-grade fever * •Apnea and cyanosis: Infants * Paroxysmal phase: Severe Cough occurs in bursts, with increased intensity and frequency, often followed by an inspiratory whoop and/or posttussive vomiting. * Convalescent phase: Coughing paroxysms decrease in frequency and intensity. * In the absence of paroxysms or complications, the physical exam may be normal.

Answer 110

Differential diagnosis * Pneumonia * Asthma * Bronchiolitis (Children) * Croup (children) Other causes of chronic cough. * •Postnasal drip * •GERD * •TB

Answer 111

* Inflammation of bronchial airways from various diseases * RSV (Respiratory syncytial virus) 70 to 85% of cases

Answer 112

* Irritability * Anorexia * Fever * Noisy breathing (due to rhinorrhea) * Cough * Grunting * Cyanosis * Apnea * Vomiting

Answer 113

* Tachypnea * Retractions (increased work of breathing), nasal flaring, grunting * Rhinorrhea * Wheezing * Upper respiratory findings: pharyngitis, conjunctivitis, otitis

Answer 114

* Other pulmonary infections such as pertussis, croup, or bacterial pneumonia * Aspiration * Vascular ring * Foreign body * Asthma * Heart failure * Gastroesophageal reflux * Cystic fibrosis

Answer 115

_Emphysema_ •Condition in which the lungs lose elasticity and alveoli enlarge in a way that disrupts function _Chronic bronchitis_ * Large airway inflammation, usually a result of chronic irritant exposure; more commonly, a problem for patients older than 40 * Productive cough most days for 3 months duration, 2 successive years.

Answer 116

* SH: History of smoke exposure * Symptoms Slow and progressive with occasional exacerbation: * Fatigue * Dyspnea * Exercise intolerance * Cough * Sputum production Xray: Indicative of COPD Trapped air, blunted costophrenic angle-\> Flat diaphragm End stage-\> Core pulmonale (right sided Heart failure-\> Enlarged heart Definite diagnosis: * Spirometry measurement: FEV1 (amount able to exhale)/FVC (total amt of air in lungs)\<0.70 (if over 70% there isn't COPD)

Answer 117

•Syndromes: episodic reduction or cessation of airflow during sleep

Answer 118

•Common associated conditions: Obesity, Adenotonsillar hypertrophy,GERD, Allergic rhinitis, medications (Sedatives, seizures)

Answer 119

Nocturnal symptoms: * Loud snoring * Witnessed apneic episodes * Frequent arousal * Disruptive sleep

Answer 120

Day time symptoms: * Sleepiness, fatigue * Lack of concentration * Frequent URI/Ear infections * Hyponasal voice

Answer 121

* High BMI * Short neck, enlarged tongue, soft palate edema, Enlarged tonsils, deviated nasal septum * In severe cases: Failure to thrive s/s.

Answer 122

Differential diagnosis: * Narcolepsy, Depression, Asthma, COPD, CHF, GERD

Answer 123

Chronic airway inflammation with two key features: * History of respiratory sx * Wheezing * Dyspnea * Cough * Chest tightness * Variable airways limitation Sx worsened at night Triggered by exertion or exposure

Answer 124

May be unremarkable HEENT: S/S of seasonal allergies Skin: May have s/s of eczema Lungs: During exacerbation * Use of accessory muscles, expiratory wheezing. S/S of trapped air. Decreased tactile fremitus * Long term asthma; positive clubbing

Answer 125

Intermittent = all 2's Mild = all 2's except 3-4 nighttime awakenings Persistent Moderate = Daily Persistent Severe = Through the day

Answer 126

Angina of the legs

Answer 127

Anything over a 0.91 is good. Quick reference is that the ankle should be higher than the arm _ANKLE_ BRACHIAL

Answer 128

Edema Color Clubbing Palpate the arterial pulses in distal extremities, comparing characteristics bilaterally for the following: * Rate * Rhythm * Contour * Amplitude

Answer 129

* Color, skin texture, and nail changes * Presence of hair * Muscular atrophy * Edema or swelling * Varicose veins

Answer 130

(7) Carotid Brachial Radial Femoral Popliteal Dorsalis pedis Posterior tibial

Answer 131

Rate and rhythm Pulse contour (waveform) Amplitude (force) Symmetry Obstructions Variations

Answer 132

4: Bounding, aneurysmal 3: Full, increased 2: Expected 1: Diminished, barely palpable 0: Absent, not palpable

Answer 133

* Temporal * Carotid * Abdominal aorta * Renal * Iliac * Femoral

Answer 134

* Radiation of murmurs * First noted during the cardiac examination * Aortic stenosis murmur * Obstructive arterial disease * Evidence of local obstruction

Answer 135

Pain that results from muscle ischemia ## Footnote * Dull ache * Muscle fatigue and cramps * Usually appears during sustained exercise, such as walking a distance or climbing several flights of stairs * A few minutes of rest will ordinarily relieve it * It recurs again with the same amount of activity * Continued activity causes worsening pain

Answer 136

NO PULSE, venous, looking at waves Increased in CHF Cutoff point is 4cm above the sternal angle Central venous pressure is the JVP +5cm b/c the atrium is 5cm away If JVP is + (more than 4 have to do HJR)

Answer 137

* If JVP is elevated conduct a hepatojugular reflux * Apply 10 to 15 seconds of pressure over liver * The hepatojugular reflux is exaggerated is highly indicative of right atrium increased pressure and heart failure and right-sided if it is a choice. WILL SEE A 1 CM RISE IN HEALTHY THAT DISAPPEARS AFTER COMPRESSION OF THE LIVER STOPS

Answer 138

* Thrombosis * Homan sign * Calf pain with passive dorsiflexion of the foot * Peripheral Edema * Grading 1+ through 4+ * Varicose veins

Answer 139

Increased cardiac output in first trimester Increasing blood volume in second semester JVP remains normal

Answer 140

* Swelling and tenderness over the muscles * Pain worsened while standing and improve with leg elevation * Peripheral edema * Engorgement of superficial veins while standing * Erythema and/or cyanosis * Thickening of the skin

Answer 141

* Dorsalis pedis and posterior tibial pulses may be more difficult to find * Superficial vessels are more apt to appear tortuous and distended

Answer 142

•An inflammatory disease of the branches of the aortic arch including the temporal arteries. Inflammation of the arteries that supply the eye Painful, red, inflamed, refer to ENT for steroids

Answer 143

Stenosis of the blood supply to the extremities by atherosclerotic plaques

Answer 144

Exaggerated spasm of the digital arterioles (occasionally in the nose and ears) usually in response to cold exposure and anxiety

Answer 145

Atrial fibrillation can lead to clot formation within the atrium, which may be dispersed throughout the arterial system

Answer 146

* Sudden or gradual with varying severity of symptoms * Can be the result of trauma or prolonged immobilization

Answer 147

Venous Ulcers

Answer 148

* In mediastinum * Left of midline * Above diaphragm * Between medial/lower borders of lungs * Behind sternum * 3rd to 6th intercostal cartilage More horizontal in pregnant women

Answer 149

* Heart positioned to the right, either rotated or displaced, or as a mirror image * If the heart and stomach are placed to the right and the liver to the left, this habitus is termed situs inversus

Answer 150

* Right and left atria ¾upper chambers * Right and left ventricles¾lower chambers

Answer 151

Blood Supply to the Heart Muscle Blood Supply to the Conduction System Right coronary artery supplies Right atrium, right ventricle, inferior portion of the left ventricle, Left anterior descending Anterior: (the widow maker infarction) * Supplies left ventricle

Answer 152

* **_Tricuspid valve_**, which has three cusps (or leaflets), separates the right atrium from the right ventricle * **_Mitral valve,_** which has two cusps, separates the left atrium from the left ventricle

Answer 153

Two semilunar valves, each has three cusps ## Footnote **_Pulmonic valve_** separates the right ventricle from the pulmonary artery **_Aortic valve_** lies between the left ventricle and the aorta

Answer 154

Electrical conductivity of the heart

Answer 155

Pressure build up toward the systemic system liver, spleen, peripheral

Answer 156

Lungs - coughing, Ruddy - coughing

Answer 157

Mother Pacemaker of the heart keeping it 60-100

Answer 158

Accounts for 25% of EF and disappears with Afib

Answer 159

Hypertrophic heart

Answer 160

7 yo Less that 7yo listen at the 4th intercoastal space

Answer 161

* Ductus arteriosus and interatrial foramen ovale close * Right ventricle assumes pulmonary circulation * Left ventricle assumes systemic circulation

Answer 162

* Stiffness and decreased compliance * **Isolated systolic hypertension 170/60 BP** * Heart size may decrease * Left ventricular wall thickens * Valves fibrose and calcify * Heart rate slows * Stroke volume decreases * Cardiac output during exercise declines by 30% to 40% (decreased cardiac Reserve) * Endocardium thickens * Myocardium becomes less elastic * Electrical irritability may be enhanced

Answer 163

* Inspecting * Palpating * Percussing the chest (rare) * Auscultating the heart Remember to auscultate last

Answer 164

Point of maximal impulse (PMI): Point at which the apical impulse is most readily seen or felt. If it is more vigorus than expected it is a heave (forceful) or lift (less forcefull). Thrill: a fine, palpable, rushing vibration; a palpable murmur Should be visible at about the midclavicular line in the fifth left intercostal space * In some patients, it may be visible in the fourth left intercostal space * It should not be seen in more than one space if the heart is healthy * Obscured by obesity, large breasts, or muscularity

Answer 165

By the location of the apical pulse

Answer 166

Anteriorposterior

Answer 167

•Location: * Aortic, pulmonic, triscupid and mitral * Identify S1 and S2 (lup dup) * Assess overall rate and rhythm * Intensity * Pitch * Pathologies

Answer 168

"Lub"' = Closure of the AV valves Beginning of Systole Radial & Carotid pulse coincides with S1 Low pitch sound (S1) heard best at apex

Answer 169

"DUB" = Closure of the Semilunar Diastole High Pitch Sound (Diaphram) heard best at base S2 increases with inspiration

Answer 170

S1 split – Hard to hear- Most often occurs during deep inspiration (best heard tricuspid area)

Answer 171

Split increases with **inspiration and decreases or disappear on expiration.** If split remains throughout expiration: Fixed split possibly indicating valvular diseases. Best heart at the base of the heart: especially at the pulmonic area.

Answer 172

Listen for abnormal sounds: S3, S4, murmurs, pericardial friction rubs

Answer 173

* Aortic valve area * Second right intercostal space at the right sternal border * S2\>S1 * Pulmonic valve area * Second left intercostal space at the left sternal border * S2\>S1 * Erb’s point * Third intercostal space at the left sternal border * S2=S1 * Tricuspid area * Fourth left intercostal space along the lower left sternal border * S1\>S2 * Mitral (or apical) area * Apex of the heart in the fifth left intercostal space at the midclavicular line * S1\>S2

Answer 174

Left Lateral Decubitus

Answer 175

Ventricular gallop Low pitched sound (Bell) very faint best heard with EXPIRATION Left lateral position listen with bell over apex, ask pt to suspend respirations Compliant heart. Sound of blood hitting a flexible or compliant heart. Sign of systolic heart failure or floppy heart. Heart failure (mostly systolic), acute valve regurgitation, cardiomyopathy, high output state such as anemia, hyperthyroidism, renal failure Myocardial ischemia without ventricular dysfunction or volume overload is not a cause of an S3. You may hear a S3 in children, pregnant and **young olympian athlete** \>40 a S3 is pathological

Answer 176

Low pitched sound heard before S1 The sound made by a non-compliant thick left ventricle Diastolic Heart Failure maintaining EF Best heard Left Lateral with Bell over apex and ask pt to suspend respirations. Always Pathologic: Diastolic HF

Answer 177

When chambers contract and the valves are not patent or blood is not flowing through valves well. Abnormal turbulent blood flow.

Answer 178

The axilla

Answer 179

Systolic: occurring at or after S1 but finishing before S2 Innocent or physiologic grade 1,2,3

Answer 180

Diastolic: occurring at or after S2 but finishing before S1 ALWAYS PATHOLOGIC

Answer 181

HEART MURMUR MNEMONICS Diastolic MS ARD

Answer 182

When it occurs in the cardiac cycle If a murmur occurs with the radial pulse its SYSTOLIC if you don't feel a thrill then can only be grade 1,2,3 and its benign As soon as you feel a THRILL its no longer benign its pathological THE ONLY MURMUR THAT IS NOT PATHOLOGICAL AND IS BENIGN IS A SYSTOLIC GRADE 1,2,3

Answer 183

* I – Very faint, may not be heard in all positions * II – Quiet, but heard upon placing stethoscope on the chest * III – Moderately heard without thrill * IV – Loud with thrill * V – Very loud with stethoscope partly off the chest with thrill * VI – Heard without stethoscope/ palpable thrill and heave * Harsh – Well heard with bell/diaphragm * Rumble – Low, best heard with bell * Blowing – High, best heard with diaphragm * Musical – Vibratory quality

Answer 184

Pathological (AORTIC STENOSIS and MITRAL REGURGITATION)

Answer 185

Mitral Regurgitation Aortic Stenosis Mitral Valve Prolapse All benign if Grade 1,2,3 (NO THRILL)

Answer 186

Mitral Stenosis Aortic Regurgitation Aortic Stenosis ALWAYS PATHOLOGICAL

Answer 187

Audible splitting of S1 and S2

Answer 188

Pathological b/c it has to do with a stiff heart which is more common in older adults indicating decreased left ventricular compliance

Answer 189

The heart cannot supply the coronary arteries for the increased demand on the heart.

Answer 190

Predictable with exertion and improves with rest

Answer 191

Aka Acute Coronary Syndrom New-onset Increase in frequency, duration or lower threshold for symptoms Chest pain at rest

Answer 192

Substernal pressure Abdominal pain Heaviness SOB Radiates to jaw or arm If you make them move and increase metabolic demand it exacerbates pain

Answer 193

Back up into systemic circulation. Heart fails to propel blood forward with its usual force resulting in congestion in the pulmonary circulation Blood in liver spleen

Answer 194

Back up in pulmonary circulation b/c heart is not propelling blood forward with its usual force. Ruddy cough, Productive cough

Answer 195

EF \<40% Inotropic abnormality due to MI or dilated cardiomyopathy Results in diminished systolic emptying (EF\<40%)

Answer 196

A compliance abnormality, due to HTN, cardiomyopathy. Ventricular relaxation is impaired (EF\>50%)

Answer 197

Treat comorbidity: HTN, diabetes

Answer 198

Right sided HF Right side of heart has to push harder to get blood into heart so right ventricle enlarges Results from high pressure in the lungs from COPD

Answer 199

Dyspnea on exertion, cannot exercise. Easily fatigued. Nocturnal nonproductive cough, orthopnea, paroxysmal nocturnal dyspnea, frothy pink sputum. Wheezing (esp nocturnal) without hx of asthma Cheyne-Stokes respirations Pain in URQ (Hepatic congestion) Nausea - poor appetite (advanced)

Answer 200

S3 gallop Hepatomegaly Jugular venous distension Hepatojugular reflux Ascites Displaced PMI Poor cardiac output Hypotension Pulsus alternans Narrow pulse pressure cook extremities

Answer 201

Squeezing of the heart from excessive accumulation between the outer later of the heart Causes Dyspnea, Syncope/Dizzyness, Altered mentation, N/V from hepatic engorgement

Answer 202

Pulses paradoxus Tachycardia JVD Hypotension

Answer 203

Distant heart sounds hypotension, distended neck veins

Answer 204

Acute pericarditis (at least two of four criteria) * Typical (pleuritic) chest pain * Pericardial friction rub * ECG changes with widespread ST elevation * New/ increasing pericardial effusion

Answer 205

Leaning forward and sitting up Pain is NOT relieved with nitrates

Answer 206

paroxysmal or continuous supraventricular tachyarrhythmia characterized by rapid, uncoordinated atrial electrical activity and an irregularly irregular ventricular response.

Answer 207

* Symptoms vary from none to mild (palpitations, light-headedness, fatigue, poor exercise capacity) to severe (angina, dyspnea, syncope). * AFib: irregularly irregular heart rate and pulse, frequently tachycardiac, pulse deficit Lose atrial kick and 25% of cardiac output, blood pools there and a clot can develop

Answer 208

Left ventricular hypertrophy