IPA Cardiac and Pulm exam Flashcards
1
Q
Where is breathing controlled
A
In the brain in the medulla- complex
2
Q
Function of respiration
A
provide O2 and remove CO2 from circulatory system
3
Q
Is experation passive or active?
A
Expiration is passive
4
Q
What factor helps during inspiration and alveolar compliance?
A
Elasticity
5
Q
What is bradypenea
A
abnormal slowing of respiration
6
Q
What is tachypenea
A
abnormal increased rate of respiration
7
Q
What is Apnea
A
temporary cessation of breathing
8
Q
What is hyperpenea
A
increased depth of breathing, usually associated with DKA
9
Q
What are Cheynes-Stokes breathing
A
Abonormal pattern of breathing, progressively deeper and faster breathing, followed by gradual decrease resulting in apnea.
10
Q
What is the abonormal pattern of breathing, progressively deeper and faster breathing, followed by gradual decrease resulting in apnea called
A
Cheynes-stokes breathing
11
Q
Which breathing has a crescendo-decrescendo pattern with apnea between paterns?
A
Cheynes-stokes breathing
12
Q
What is kussmaul breathing
A
Deep, rapid breathing, DKA or kidney failure, deep and rapid cycles of respirations
13
Q
What is the breathing pattern that is deep, rapid breathing, DKA or kidney failure, deep and rapid cycles of respirations
A
Kussmaul breathing
14
Q
What is the most common symptom of lung disease
A
cough
15
Q
What is the earliest manifestation of bronchitis
A
increase in quanity of sputum production
16
Q
How much sputum is secreted by bronchi every day
A
75-100 mL
17
Q
What is coughing up of blood called
A
hemoptysis
18
Q
What is the most common cause of hemoptysis
A
bronchitis
19
Q
What are secondary causes of hemoptysis
A
- Broncheictasis
- Bronchiogenic carcinoma
20
Q
Hemoptysis vs hematemesis
A
Coughing up blood vs vomitting blood
21
Q
What is vommiting blood up called
A
Hematemesis
22
Q
What is dyspena
A
shortness of breath
23
Q
What are damaged airways called
A
bronchiectasis
24
Q
What is the sudden onset of shortness of breath occurring at night during sleep
A
Paroxysmal-nocturnal dyspena
25
What is difficulty breathing while lying flat
orthopena
26
What is difficulty of breathing while sitting up and releved by a recumbent position
Platypenea
27
What is a condition where patients are more comfortable laying on one side
trepopnea
28
When does wheezing usually present in the cycle of breathing
during expiration when bronchoconstriction occurs
29
When does central cyonisis occur
When inadequate gas exchange occurs in the lungs that results in a significant reduction in arterial oxygenation ( mucous membranes, lips)
30
When does peripheral cyanosis occur
Results from an excessive extraction of oxygen at the periphery ( fingers, toes, nose)
31
Where does chest pain usually occur
usually chest wall or parietal pleura
32
What is a common symptom of inflammation of the parietal pleura
pleuritic pain ( Sharp, stabbing pain felt during inspiration. May be localized to one side).
33
What is snoring associated with
obstructive sleep apnea
34
What is noisy, harsh breathing produced by turbulent airflow through a partially obstructed airway at the level of the glottis or trachea?
Stridor
35
What is stridor considered
a medical emergency
36
What are voice changes caused by
inflammation of the vocal cords or laryngeal nerve issue
37
What is swelling of the ankles indicative of
right sided heart failure, renal disease, liver disease, obstruction of venous flow
38
What is COPD
umbrella term for Emphysema ( pink puffers- severe dyspena with little cough or sputum production) and chronic bronchitis (blue bloaters, cyanotic and have productive cough)
39
What is blue bloaters
chronic bronchitis
40
What is a pink puffer
emphysema (pathologic diagnosis, where alveoli lose their elastic)
41
What are the 4 things we look at for respiration
Rate (12-20
Rythym (regular, irregular)
Depth ( Shallow, normal, deep)
Effort ( normal, distressed, grasping)
42
What do you examine nails for in a thorax and lung exam
clubbing- sign of hypoxia
43
What are you looking for with thoracic expansion
symmetry and normal thoracic expansion
44
What test are you doing using the ulnar side of your hand on the posterior thorax, checking for asymmetry moving down the chest while a patient says 99?
Tactile fremitus
- Air or fluid outside the lung can make this not symmetrical
45
When are tactile fremitus vibrations increased
pnumonia
46
When are tactile fremitus vibrations decreased
unilateral: pneumothorax, pleural effusion, bronchial obstruction, atelectasis
bilateral: COPD, obesity
47
Effusion vs consolidation
Effusion- pleural fluid in pleural cavity
consolidation- fluid in alveoli/lung
48
If you are ascultating and hear loud, harsh, and high pitched sounds that sound like air going through a tube, where are you likely ascultating
You are hearing stridor from the upper respiratory tract
49
If you are listening to a low pitched noise, caused by fluid in the large and medium sized airways, what are you listening to?
Ronchi
Sound like snoring/gurgling
49
If you're hearing scratchy sounds associated with fluid in the alveoli and airways, what are you listening to?
Crackles, rales
50
What are you hearing if you hear a wisteling, high-pitched noise that is loud on expiration, caused by air forced through a narrow airway?
Wheezing
51
If you have an absense of sound in the lungs what is it?
Little air movement, clinical emergency, chronic emphysema, severe asthma, effusions, pneumothorax
52
What is egophony
have patient say letter e while auscultating (if abnormal, will hear like aaaaah. Positive egophany, or e to a change.)
- Accompanies pneumonia
53
What do you perform if bronchophony is present
a whispered pectoriloquy
whisper 99
abnormal if you can hear
54
What causes barrel chest
COPD, aging
55
What causes flail chest
3 or more adjacent rib fractures
56
When your injured ribs cave in with inspiration and outward with expiration what is this called
flail rib
57
What is kyphoscoliosis
scoliosis and forward curving spine
58
What are decreased or absent breath sounds, fine crackles called
Atelectasis- complete or partial collapse of lung or lobe
59
What is the PMI and where is it
right at left niple line, mid-clavicular, 5th intercostal space. Apex of tip of heart
60
What is S1 produced by
closure of tricuspid and mitral valves
61
What is S2 produced by
closure of aoritc andpulmonic semilunar valves
62
What are the 2 components of S2
A2 (aortic valve closure which happens 1st)
P2 (Pulmonic valve closure which happens 2nd)
63
What part of the heart do extra heart sounds usually arise from
usually Left ventricle, rarely R
64
What is S3 usually associated with
heart failure- too much volume, fill L ventricle too quickly.
65
Most common cause of left ventricular hypertophy? How does this sound on auscultation?
long standing hypertension ( atrial kick, gallop because of stiff heart)
66
Which part of the stethescope do you use to listen for S3 and S4
Bell
67
Most murmors are ?/6 ?
2-3/6
68
What part of the stethescope for high pitched sounds vs low pitched sounds
High pitched- diaphragm
Low pitched- Bell
69
What is Homan's sign
Extend pt's knee, check for calf tenderness after sudden dorsiflexion of foot- pain could be associated w DVT
70
What is the Allen Test
determine patency of radial and ulnar arteries- check for arterial insufficiency
71
What are vibratory sensations you feel when palpating the heart
Thrills
Associated with murmors
72
what are impules that rythymically lift your fingers when you palpate the heart
Heaves
73
Which side of the stethescope do you use to listen for murmors
Bell
74
When do you hear ventricular septal defect
during all of systole
75
What sound do you hear if you have pericardial disease
rubs usually
76
Thick and stiff arteries are called what
Arteriosclerosis
77
Plaque buildup in the arteries, causing narrowing, (a type of arteriosclerosis) is called what
Atherosclerosis
78
What is a common vasospastic disorder
Raynaud disease (Turn white-->cyanotic(blue) -->rubor (red)
79
What disease is categorized by the 5 P's and what are the 5 P's
Arterial occlusion
5P's
-Pain
-Pallor
-Paresthesia
-Paralysis
-Pulselessness
80
What is the high-pressure delivery system of the body
the left side of the heart and arteries
81
What is the area of exchange in the body
capillaries
82
What is the low-pressure return system in the body
the Right side of the heart and veins
83
What are the 2 layers of the pericardial sac
1. Visceral pericardium- the cells of the heart
2. The parietal pericardium- outer layer/sac
84
Blood flow through the heart
IVC/SVC--> Right atrium-->Tricuspid valve-->Right ventricle -->Pulmonic semilunar valve-->Pulmonic artery--> Lungs-->Pulmonic veins--> Left atrium-->Bicuspid valve-->Left ventricle--> Aortic semilunar valve--> Aorta
85
What is S1 produced by
Closing of mitral valve(Bicuspid valve, between L atrium and ventrical), and tricuspid valve; occurs at the same time as a pulse does
86
Where is S2 heard
As the pulmonic and aortic valves shut
87
What is the QRS complex demonstrating
ventricular contraction
88
If you hear a sound between S1 and S2, what is this?
Systolic murmor
89
When is S3 heard
At the end of filling with the opening of the tricuspid and mitral valves
Right after S2 (when these close)
Very beginning of diastole
90
When is S4 heard
end of diastole, also called an atrial kick or gallop.
91
Ejection click vs opening snap
Ejection click occurs during systole (opening of aortic valve between S1 and S2)
Opening snap is opening of the AV valves because of stenosis, occurs during diastole
92
What are the systolic murmors
- Aortic or pulmonary stenosis
- Mitral or tricuspid regurgitation
Between S1-S2
93
What are the diastolic murmors
-Aortic or pulmonary regurgitation
- Mitral or tricuspid stenosis
Between S2-->S1
94
What are palpable cords
thrombosed veins
95
What are thrills associated with
murmors
96
pectus excavatum vs pectus carinatum
excavatum- funnel chest (think "cave")
Carinatum- pigeon chest
97
Effusion vs consolidation in terms of where fluid is
Effusion-->Fluid in pleural cavity
Consolidation--> Fluid in lung
98
Signs of Effusion vs consolidation with auscultation, percussion, fremitus, and egophony
Effusion: Decreased auscultation, no breath signs. Dull percussion. Decreased Fremitus. Absent egophony
Consolidation: Bronchial breath sounds. Dull percussion. Increased Fremitus. Present egophony
Key differences: Same for percussion (dull), opposite for everything else.
99
When do effusion and consolidation give the same sign
percussion- both are dull
100
Do you hear ronchi on inspiration or expiration
Inspiration- air moving through lungs on inspiration- sounds like snoring/gurgling
101
What are crackles (rales) due to
Scratchy sounds associated with fluid in alveoli and airways. Rales occur at the end of the lung in the alveoli.
102
Where are rales vs ronchi
Rales in tales (end of lung) and ronchi in the bronchi
103
Wheezing vs stridor, insperation vs expiration?
Wheezing is in expiration, stridor is inspratory
104
How is chronic bronchitis classified
three consecutive months of bronchitis, 2 years in a row
105
What do a pnumothorax, hemothorax, pleural effusion, atelectisis, and emphysema have in common
They can have absent breath sounds
- Pleural effusion, Hemothorax, and Atelectasis can all have decreased or absent breath sounds
-Atelectasis is accompanied by fine crackles
106
