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NURS 518 > Midterm > Flashcards

Midterm Flashcards

1
Q

What are the steps of the enhanced Calgary Cambridge guide for effective clinical interviewing

A

Initiating - gathering information - physical exam - explain and plan - close session

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2
Q

What does FIFE stand for and where is it in the clinical interview

A

Feelings, Ideas, Functions and expectations. Part of gathering information

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3
Q

What are the 5 R’s of cultural humility

A

Reflection, respect, regard, relevance, resiliency

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4
Q

What does VINDICATE stand for and what is its use

A

used for ruling out DDx. Vascular, Infectious, Neoplastic, Drug related. Inflammatory/idopathic/iatrogenic, Congenital, Autoimmune/allergic, Trauma/toxic, Endocrine/metabolic

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5
Q

What is the difference between a diagnostic and therapeutic plan

A

diagnostic plan is rationale for evaluating each DDx whereas therapeutic plan is rationale for managing a chronic or known condition

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6
Q

What are the two components of the dual process theory for clinical reasoning

A

The non analytical and the analytical model

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7
Q

in the dual process theory for clinic reasoning, which model is the fast system and which is the slow system

A

non analytical is fast and analytical is slow

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8
Q

What are heuristics

A

mental shortcuts or cognitive strategies that are automatic and unconsciously applied

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9
Q

What is validity

A

does the test accurately identify whether a patient has a disease, measured with the 2X2 table

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10
Q

what is sensitivity

A

true positive. the probability that a person with disease has a positive test

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11
Q

what is specificity

A

true negative. the probability that a non diseases persion and a negative test

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12
Q

A negative result from a test with high sensitivity usually: includes or excludes disease

A

excludes

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13
Q

What does SNOUT stand for for measuring sensitivity and specificity

A

a Sensitive test with a Negative result rules OUT disease

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14
Q

What does SpPIN stand for for measuring sensitivity and specificity

A

a Specific test with a Positive results rules IN disease

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15
Q

what are predictive values

A

how useful is the test in telling us whether the disease is absent or present

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16
Q

what is a positive predictive value

A

true positive. Probability that a person with a positive test has the disease

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17
Q

what is a negative predictive vaule

A

true negative. Probability that a person with a negative test doesnt have the disease

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18
Q

if prevalence is low in a population, will there be more and less false positives of a test

A

more false positives

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19
Q

what are liklehood ratios

A

the probability of obtaining a given test result in a diseased pt divided by the probability of obtaining a given test result in a non diseased pt

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20
Q

pre and post test probability are based on ___

A

likelihood ratios

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21
Q

LR values >1 are associated with positive or negative LR’s

A

positive

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22
Q

LR values <1 are associated with positive or negative LRs

A

negative

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23
Q

what is the coefficient of variation and when is it used

A

statistics used to characterize precision and often used in lab tests

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24
Q

what is the most abundant extracellular electrolyte

A

sodium

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25
Q

what is the most abundant intracellular electrolyte

A

potassium

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26
Q

where is the best location to list for S3 and mitral stenosis

A

Apex

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27
Q

is the PMI felt at the apex or base of the heart

A

Apex

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28
Q

Where, anatomically, can the PMI usually be felt

A

5th intercostal just medial to left midclavicular line

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29
Q

What would cause the PMI to be on the right side

A

dextrocardia

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30
Q

what length is considered an abnormally large PMI and what can cause it

A

> 2.5 cm caused by LVH from HTN or dilated cardiomyopathy

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31
Q

Why might a COPD patient have a displaced PMI

A

RV hypertrophy

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32
Q

What would a PMI displaced more than 10cm from the midclavicular line indicated

A

LVH or ventricular dilation from MI or HF

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33
Q

what are the AV valves

A

mitral and tricuspid

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34
Q

what are the semilunar valves

A

aortic and pulmonic

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35
Q

in Adults, S3 correlated to (systolic or diastolic) HF and S4 correlates to (systolic or diastolic)

A

S3 correlates to systolic and S4 correlated to diastolic HF

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36
Q

What is an Ej sound and when is it heard

A

early systolic ejection sound accompanying opening or aortic valves heard in some pathologic conditions

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37
Q

the mitral and tricuspid valves close during (s1 or s2)

A

S1

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38
Q

the aortic and pulmonic valves close during (S1 or S2)

A

S2

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39
Q

What is an opening snap and what causes is

A

audible opening of the mitral valve from restricted motion caused by mitral stenosis

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40
Q

What does S4 indicate if heard in adults

A

marks atrial contraction and usually from ventricular stiffness cause by HTN or acute MI

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41
Q

Does S1 or S2 splitting vary with respirations and how so

A

S2 splitting is heard during inspiration only, S1 does not vary with respiration

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42
Q

Where is the best anatomical location to hear S2 splitting

A

2nd and 3rd intercostal space close to sternum

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43
Q

Where is the best place to hear S1 splitting

A

lower left sternal border

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44
Q

what causes heart murmurs

A

turbulent blood flow from valvular disease

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45
Q

what is a normal ejection fraction

A

60%

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46
Q

what are some causes of decreased RV preload

A

exhalation, dehydration, pooling of blood in capillary beds or venous system

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47
Q

how can volume overload cause clinical HF

A

pathologic increase in preload and afterload changes ventricular functioning making the heart inneffective as a pump

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48
Q

what is pulse pressure

A

difference between systolic and diastolic pressure

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49
Q

on a JVP graph, what does the A wave and x descent represent

A

A wave = atrial contraction (forcefull push of blood into ventricles) and X descent = atrial relaxation and filling

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50
Q

What can cause prominent A waves in JVP

A

anything that causes increased resitance to atrial contraction like triscupid stenosis, heart blocks, SVT, junctional tachycardia, pulmonary HTN and pulmonic stenosis

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51
Q

what would cause absent A waves in JVP

A

A-fib

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52
Q

What is the V wave in JVP graphe

A

venous filling and atrium tensing

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53
Q

what would cause increased V waves in JVP graph

A

tricuspid regurg, atrial septa defects and constrictive pericarditis

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54
Q

what are cardiac causes of chest pain in a patient with a normal angiogram

A

microvascular coronary dysfunction and abnormal cardiac nocioception

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55
Q

Unstable angina, NSTEMI and STEMI are all branched under what term

A

ACS

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56
Q

what are the life threatening cardiac causes of chest pain

A

MI, PE, dissecting AAA, angina pectoris

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57
Q

what are causes of acute sudden onset dyspnea

A

PE, spontaneous pneumothorax, anxiety

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58
Q

what conditions cause orthopnea and paroxysmal nocturnal dyspnea

A

LV HF, mitral stenosis, obstructive lung disease

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59
Q

what condition can mimick paroxysmal nocturnal dyspnea

A

nocturnal asthma attacks

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60
Q

what is anasarca

A

severe generalized edema extending to the sacrum and abdomen

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61
Q

periorbital puffiness and tight rings indicate what condition

A

nephrotic syndrome

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62
Q

a pathologic enlarged waist line may be caused by what conditions

A

ascites and liver failure

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63
Q

what are some concerning cardiac causes of syncope

A

end stage HF and arrhythmias

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64
Q

what role does JVP findings play in terms of patients with HF

A

predicts elevations in fluid volume

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65
Q

what is the difference between venous and carotid pulsations

A

venous are inward and carotid are outward

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66
Q

what causes a decreased JVP

A

blood loss or decreased venous vascular tone

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67
Q

what causes increased JVP

A

HF (most likely), pulmonary HTN, tricuspid stenosis, AV dissociation, increased venous vascular tone, pericardial compression

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68
Q

what is the angle of Louis

A

vertical distance above sternal angle where JVP is measured

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69
Q

how many CM do you add to the measured height of a JVP

A

5cm

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70
Q

What is an elevated JVP measurement

A

more than 3cm above sternal ankle or more than 8cm total finding (with 5cm add on)

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71
Q

When might you see an elevated JVP on expiration but collapsed veins on inspiration

A

obstructive lung disease, this finding is not indicative of HF

72
Q

why should you not palpate if you auscultate a possible carotid bruit

A

it is indicative of an atherosclerotic plaque and could be dislodged with palpation

73
Q

high grade stenosis have higher or lower frequencies

A

lower

74
Q

lower frequencies are better heard with the bell or diaphragm

A

bell

75
Q

what are causes of bruits

A

atherosclerotic stenosis, tortorous carotid artery, aortic stenosis

76
Q

Are bruits indicative of clinically significant underlying disease

A

no

77
Q

What may be seen when assessing carotid arteries if the artery is tortorous or kinked

A

A unilateral pulsatile bulge

78
Q

what are causes of decreased carotid pulsation

A

decreased stroke volume form shock or MI, local atherosclerotic narrowing, occlusion

79
Q

what is one possible negative side effect of applying pressure to the carotid sinus

A

reflex bradycardia and hypotension

80
Q

a normal carotid upstroke follows S1 or S2

A

S1

81
Q

what causes a thready or weak carotid pulse

A

cardiogenic shock

82
Q

what causes a bounding carotid pulse

A

regurg

83
Q

what causes a delayed carotid upstroke

A

aortic stenosis

84
Q

what condition causes thrills

A

aortic stenosis

85
Q

what is pulsus alternans and what does it indicate

A

rhythm is regular but alternating force of arterial pulse, usually indicates severe left ventricular dysfunction

86
Q

How can you determine pulsus alternans with blood pressure

A

loud and soft korotkoff sounds or a sudden doubling of the apparent heart rate as the cuff pressure declines. Especially seen when patient is upright

87
Q

what is a paradoxical pulse

A

greater than normal drop in systolic blood pressure during inspiration

88
Q

what would you expect for a patient with pulsus paradoxis with increased JVP, dyspnea, tachycardia, HoTN, and muffled heart sounds

A

cardiac tamponade

89
Q

what is the difference between blood pressure amounts throughout the respiratory cycle that constitutes pulsus paradoxus

A

10-12

90
Q

what are causes of pulsus paradoxus

A

pericardial tamponade, acute asthma, obstructive pulmonary disease, constrictive pericarditis, PE

91
Q

which condition varies with respirations: pulsus paradoxus or pulsus alternans

A

pulsus paradoxus

92
Q

What causes a diminished S1

A

first degree heart block

93
Q

what causes a diminished S2

A

aortic stenosis

94
Q

what causes lateral displacement of the PMI

A

ventricular dilation from HF, cardiomyopathy, ischemic heart disease, and mediastinal shift

95
Q

midsystolic murmurs typically arise from blood flow acros the semilunar or AV valves

A

semilunar

96
Q

murmurs that coincide with a carotid upstroke are systolic or diastolic

A

systolic

97
Q

a Crescendo, decrescendo, cresceno-decrescedno or plateau of a murmur is describing what quality

A

shape of the murmur

98
Q

when grading a systolic murmur, what levels require a palpable thrill

A

4-6

99
Q

a medium pitches, grade 2/4, blowing decrescendo diastolic murmur best heart in the fourth left intercostal space with radiation to the apex is describing what type of murmur

A

aortic regurgitation

100
Q

right sided heart murmurs generally increase with inspiration or expiration

A

inspiration

101
Q

left sided heart murmurs generally increase with inspiration or expiration

A

expiration

102
Q

what is the only murmur that increases during the strain phase of the valsalva and during squatting to standing

A

hypertophic cardiomyopathy

103
Q

the square wave response, where blood pressure remains elevated during phase 2 of valsalva but during during phase 4, is highly correlated with what

A

volume overload and elevated left ventricular end diastolic pressure

104
Q

what murmur is heard at the apex and radiates to the axilla

A

mitral regurg

105
Q

what classic feature of PAD do only 10% of patients present with

A

pain in legs with exertion relieved with rest

106
Q

What does the ankle brachial index test for

A

PAD

107
Q

edema with low protein content is more likely to be non pitting or pitting

A

pitting

108
Q

what kind of edema is hard an non pitting with skin thickening

A

lymphedema

109
Q

what causes bounding carotid, radial and femoral pulses

A

aortic regurg

110
Q

what is pulsus tardus and what causes it

A

a sluggish pulse caused by aortic stenosis or low cardiac output

111
Q

what is pulsus parvus and what causes is

A

a weak pulse, caused by ahterosclerotic PVD

112
Q

What is ABI and what is it used for

A

raiot of blood pressure in foot and arm, used to assess PAD

113
Q

what patients may have an artificially high BP reading on an ABI

A

elderly or diabetic due to fibrotic or calcified vessels

114
Q

what is a normal ABI

A

0.9-1.4

115
Q

what ABI value is diagnostic for PAD

A

less than 0.9

116
Q

what is the triangle of safety

A

formed by lateral border of pectoralis major anteriorly, lateral border of the latissumus dorsi posteriorly and the nipple like where it is safe to insert a chest tube

117
Q

What would cause foul smelling sputum

A

anaerobic lung abscess

117
Q

What is levine sign

A

a clenched fist over the sternum

118
Q

What causes delayed expiration

A

COPD

119
Q

What is diaphragmatic excursion

A

descent of the diaphragm measured by percussion

120
Q

what does a high level of diaphragmatic excursion indicate

A

pleural effusion, atelectasis or phrenic nerve paralysis

121
Q

what does a gap between inspiratory and expiratory breath sound ssuggest

A

bronchial breath sounds

122
Q

how are vesicular breath sounds described

A

soft and low pitched through inpiration and expiration

123
Q

how are bronchial breath sounds described

A

louder, harsher, higher pitch, short silence between inspiratory and expiratory

124
Q

what conditions cause wheezing

A

asthma, COPD, bronchitis

125
Q

what sounds are described with the term rhonchi

A

sounds from secretion in large airways that change with coughing

126
Q

what kind of lung sounds would you expect to hear in pneumonia

A

bronchial or bronchovesicular

127
Q

what is egophony and what causes is

A

A to E lung sounds from pneumonia

128
Q

What would you expect to see with lower motor neuron disease

A

decreased muscle tone, fasciculations, atrophy, hyporeflexia

129
Q

what would you expect to see with upper motor neuron disease

A

increased muscle tone, hyperreflexia

130
Q

what parts of the nervouse system are included in lower motor neuron

A

cranial nerves, spinal nerve roots, peripheral nerves

131
Q

the corticospinal tract is part of the upper or lower motor neurons

A

upper

132
Q

if damage occurs to upper motor neuron before the medulla, would symptoms be on the same side or opposite side

A

opposite side because it is before the crossover in the medulla

133
Q

what are the differences in symptoms for diabetics with small fibre neuropathy versus large fiber neuropathy

A

small fiber reports sharp, burning or shoot foot pain and large fiber reports numbness or tingling

134
Q

which reflexes connect to the cervical spinal segment

A

tricep, brachioradialis and bicep

135
Q

which reflex connects to the lumbar spinal segment

A

knee

136
Q

which reflex connects to the sacral spinal segment

A

ankle

137
Q

what causes a dull headache with increase by coughing and sneezing

A

brain tumor or abscess

138
Q

when is a migraine suspicious for stroke

A

atypical presentation of a patients usual migraine symptoms especially in women taking birth control

139
Q

what does the acronym POUND stand for and when is it used

A

used to assess likelyhood of migraine and migrain is likely is at least 3 are present. Stands for Pulsatile, one day duration, unilateral, nausea, disabiling

140
Q

what are spark photopsias, fortifications, and scotomas

A

auras before a migrain: flashes of light, zig zag arcs of light and areas of visual loss

141
Q

what headaches are usually unilateral

A

migraines and cluster

142
Q

what headache usually arises in the temporal areas

A

tension

143
Q

what headache may be retro orbital

A

cluster

144
Q

what is a concerning cause of ataxia, dipolpia and dysarthria

A

TIA or stroke

145
Q

chronic and gradual progression of weakness may be caused by what

A

tumor or ALS

146
Q

what symptoms would you expect to see in a myopathy from drugs or alcohol

A

proximal weakness like difficulty reaching up a shelf or climbing stairs

147
Q

what condition causes fatigable proximal weakness

A

myasthenia gravis

148
Q

what are some examples of distal weakness

A

hand strength opening har, using sciossrs, tripping when walking

149
Q

what condition would you expect to have bilateraly predominatley distal weakness with sensory loss

A

polyneuropathy from diabetes

150
Q

what is the difference between paresthesia and dysesthesia

A

para is pins and needls and dys is distorted sensation

151
Q

a light pin prick causes a burning sensation is an example of what

A

dysesthesia

152
Q

what condition causes stocking glove pattern

A

diabetes

153
Q

what conditions cause multple pathcy areas of sensory loss in different limbs

A

vasculitis or RA

154
Q

low frequency unilateral resting tremor, rigidity, bradykinesia and postural instability typify what disorder

A

parkinsons

155
Q

what is an essential tremor

A

high frewuency, bilateral upper extremity tremor that occurs with movement and at sustained posture and susbsides when limb is at rest

156
Q

what is anisocoria

A

differnent sized pupils

157
Q

pronator drift indicates a lesion in what area

A

corticospinal tract in the opposite side

158
Q

what is ataxia

A

loss of control of coordinated movements

159
Q

what would cause nustagmus, dysarthria, hypotonia and ataxia

A

cerebellar disease

160
Q

what is dysdiadochokinesis and when is it seen

A

slow, irregular and clumsy rapid alternating movements seen in cerebellar disease

161
Q

what is an intention tremor

A

rhythmic oscillitory tremor during an intentional movement like trying heel to shin movement

162
Q

how would you describe an ataxic gait

A

wide base, uncoordinated with reeling and instability

163
Q

what would you see in cerebellar ataxia

A

difficulty standing with feet together whether eyes open or closed

163
Q

what is a positive romberg sign

A

patient stands well with eyes open but loses balance with eyes closed

164
Q

wat is stereognosis

A

ability ot percieve an object by touch

165
Q

what is a positive brudzinski sign and what does it indicate

A

flexion of both hips and knees when neck is flexed, meningities

166
Q

kernig sign, and what does it indicate

A

pain and increased resistant to knee extension when flexing leg at hip and knee and then trying to extend leg, meningitis

167
Q

what is a jolt accentuation of headache and what does a positive indicate

A

rotating head side to side quickly worsens headache, indicates meningitis

168
Q

what is asterixis

A

flapping tremorf

169
Q

what is dysarthia

A

defective articulation

170
Q

what is dysphonia

A

impaired volume, quality or pitch of voice

171
Q

what are the two common kinds of aphasia

A

expressive (broca) and receptive (wenicke)

172
Q

what is seen in expressive (broca) aphasia

A

preserved comprehencion but slow non fluent speech

173
Q

what is seen in Receptive or wericke aphasia

A

impaired comprehension with fluent speech

174
Q

are fine crackles heard in inspiration or expiratoion

A

inspiration

175
Q

fine or coarse crackles start in early inspiration and last throughout expiration

A

coarse

NURS 518 (15 decks)

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