Midterm Flashcards
Midterm sample questions
what is HIPAA and when was it started?
Health Insurance Portability and Accountability Act - 1996
Designed to provide privacy standards for patients.
Created by the dept. of health and human resources
What CANNOT be included in a case presentation?
any identifiers:
Names
Numbers of any sort (DOB, phone, MRN, SS, etc)
Identifying Photos
what happens if you do not safeguard the patients information?
you get kicked out
What is on the identification sheet (aka registration form)?
demographics
employment
insurance
emergency contact
what is included in the patient’s history?
Date & Time Identifying Data Chief Complaint History of Present Illness incl. medications, allergies, habits Past History: both medical and surgical Family History: narrative or diagram Personal/Social History: Review of Systems (ROS)
what is included in the physical exam?
Vital Signs: Blood Pressure, Heart rate, Respiration rate, Temp(C), O2 Saturation (SpO2)
Exam of all systems:
Skin, HEENT(incl. thyroid and lymph nodes), Thorax/lungs, breasts/axillae, musculoskeletal, cardiovascular, abdomen, peripheral vascular/nervous system & genital/rectal exam
what are the components of a consent form?
Patient Name & Date
Name and Description of Surgery
Indication for Surgery
Risks & Benefits of Procedure
Alternatives to Procedure
Patient’s Signature, printed name, date, and time/Surgeon’s signature
*Patient must be competent to make medical decisions
what is the SOAP format?
Subjective: what the patient tells you
Objective: found as part of your physical exam
Assessment: Problem list
Plan: Management
what are the normal ranges for vital signs for a patient at rest?
Blood Pressure: 90/60- 120/80
Heart Rate: 60-100 beats per minute (BPM)
Respiratory Rate: 12-20 breaths per minute
Temperature: 97.8-99.1 F (ave. 98.6)
Pulse Oximetry: 95-100%
what is the difference between systolic and diastolic pressure?
Systolic BP (SP): the pressure exerted on the walls of the arteries during heart contraction (systole) (top number) Diastolic BP (DP): the pressure exerted on the walls of the arteries during heart relaxation (diastole) (bottom number)
what is MAP and how does it effect perfusion?
Mean Arterial Pressure (MAP): aka perfusion pressure
MAP= DP+ 1/3 PP (pulse pressure= SP-DP)
MAP > 60 mmHg to perfuse organs
MAP > 70 mmHg to perfuse organs in hypertensive patient.
what are the classifications of HTN?
Normal: Systolic:119 or lower Diastolic: 79 or lower
Prehypertension: Systolic: 120-139 Diastolic 80-89
Stage 1 Hypertension: Systolic: 140-159 Diastolic: 90-99
Stage 2 Hypertension: Systolic: 160 or higher Diastolic: 100 or higher.
are body temperatures uniform wherever they are taken?
No,
Axillary temperatures - 1 C lower than oral
Rectal temperatures + 1 C higher than oral
what is pulse oximetry?
Non-invasive means of measuring the saturation of hemoglobin
What is the CAGE questionnaire and what is it used for?
CAGE Questionnaire
Have you ever felt the need to CUT DOWN on drinking?
Have you ever felt ANNOYED by criticism of your drinking?
Have you ever felt GUILTY about drinking?
Have you ever had an EYE-OPENER to steady your nerves or get rid of a hangover?
what are the stages of the kubler-ross response?
Kubler-Ross: 5 stages in a person’s response to death.
Denial & Isolation Anger Bargaining Depression or Sadness Acceptance
what is the difference between subjective and objective data?
Subjective Data: What the patient tells you.
Objective Data: What you detect during the exam.
what is the chief complaint?
The reason the patient is here to see you.
Make every attempt to use the patient’s own words.
If the patient has NO complaints, report their GOALS instead.
what are the seven attributes of a symptom?
Seven Attributes of a Symptoms (Chloride)
Character or Quality Location Onset Radiation Intensity Duration Exacerbating or Alleviating factors
what is included in the past medical history?
General health and strength of the patient Adult illnesses Childhood illnesses Past surgeries or hospitalizations Recent tests Immunizations
what is the review of systems?
Series of questions from “head to toe” in a system based approach
(General, skin, HEENT, Neck, Breasts, Resp. Cardio, GI, Urinary, Genitals, Perif. Vasc., MS, Neuro, Hematologic, Endocrine, Psych)
what are the cardinal techniques of examination?
Inspection, Palpation, Percussion, Ascultation
what are the BMI ranges and how is it calculated?
Weight (kg)/height (meters squared)
25 overweight
>30 is obese
what are the 5 segments when doing a neuro exam?
mental status cranial nerves motor function sensory system reflexes
what are some normal hematology lab values?
White Blood Cell Count (WBC)(cells/ml): 4,500-10,000
Red Blood Cell Count (RBC)(x 10 6): 4.0-5.5
Hemoglobin (Hgb)(g/dl): 12.0-16.5
Hematocrit (Hct)(%): 36-50
Mean Corpuscular Volume (MCV): 80-100
Platelet Count (plt): 100,000-450,000
what are some normal values for a complete metabolic panel?
Sodium (Na)( mEq/L): 135-147 Potassium (K)(mEq/L): 3.5-5.2 Chloride (Cl)(mEq/L): 95-107 Bicarbonate (HCO3) (mEq/L) 23-29 BUN (Blood Urea Nitrogen)(mg/dl): 7-20 Creatinine (Cr)(mg/dl): 0.5-1.4 Glucose (Glu) (mg/dl): 60-110
what are normal bilirubin and alkaline phospatase values and what do they indicate?
Total Bilirubin (TB) (mg/dl): 0.1-1.2
Alkaline Phosphatase (Alk phos)(IU/L:) 33-153 liver function: bile duct or gallbladder issue
what are some normal values for coagulation studies?
Protime (PT)(Extrinsic pathway): 10-14 seconds
Partial Prothrombin Time (PTT)(Intrinsic pathway): 25-39 sec
International Normalized Ratio (INR): 0.8-1.2
INR= PT test/PT normal
whatis the purpose of the lacrimal gland?
produces tears. Tears protect the cornea from drying out, inhibits microbial growth, and gives a smooth optical surface to the cornea
what is the fundus of the eye?
Fundus (posterior part of the eye) contains the retina, choroid, fovea, macula, optic disc, and retinal vessels
what are the two phases of hearing?
Conductive Phase
From external ear through the middle ear
Sensorineural Phase
Involves the cochlea and vestibulocochlear nerve (CN VIII)
what is the function of the nasal turbinates and meatuses?
Principal functions: cleansing, humidification, and temperature control of inspired air.
which sinuses are accessible to exam?
Only the frontal and maxillary sinuses are accessible to exam.
what is the snellen eye chart used for?
visual acuity NOT peripheral vision
what is Nystagmus?
Nystagmus (fine rhythmic oscillation of the eyes)
what is the difference between the Weber and Rinne tests?
hearing tests
Weber test: lateralization
Rinne test: compares air conduction and bone conduction
where are some of the places where lymph nodes can be identified?
Preauricular: front of ear
Posterior auricular: superficial to mastoid process
Occipital: at base of skull posteriorly
Tonsillar: at angle of mandible
Submandibular: midway btwn the angle and tip of the mandible
Submental: few centimeters behind tip of mandible
Superficial cervical: superficial to sternomastoid
Posterior cervical: along anterior edge of the trapezius
Deep cervical chain: deep to sternomastoid (often inaccessible to exam)
Supraclavicular: deep in the angle formed by the clavicle and the sternomastoid
The parts of the history and ROS that will be especially pertinent to the airway exam include:
Previous surgeries
Previous prolonged intubations
Previous tracheostomy
Previous laryngectomy
Previous traumas to the airway, neck, etc.
Social history including smoking, drug and alcohol dependence
what are some clues to a difficult intubation?
Dry cough -Possible tracheobronchial compression Easy bleeding -Epistaxis risk Gastroesophageal reflux -Aspiration risk Longstanding diabetes mellitus -Limited cervical mobility Loud snoring -Prone to soft-tissue obstruction Major trauma -unstable neck Radiation to the neck -Fibrosis, immobility of larynx Recent temporal craniotomy -Limited mandibular mobility Smoking -Salivation, cough, laryngospasm Undigested food returning to the mouth -Aspiration risk from the pharyngeal pouch
what are the mallampati scores?
Grade 1: Most of glottis visible
Grade 2: Only posterior portion of glottis visible
Grade 3: Epiglottis, but none of glottis visible
Grade 4: No airway structures visualized
trace blood flow to and from the heart
VCs -> RA -> (tricuspid) RV -> (pulmonary) PAs-> Lungs-> PVs-> LA-> (mitral) LV-> (aortic) Aorta-> Body
when do systole and diastole occur?
Diastole:
Pressure in Left Atrium (LA) > pressure in the Left Ventricle (LV) and blood flows from the LA through the open mitral valve and into the LV
Systole:
When the LV starts to contract, and LV pressure > LA pressure the mitral valves shut
LV pressure > aorta and forces the aortic valve open (maximal LV pressure=systolic pressure)
After the LV ejects most of its blood, LV pressure < aorta and the aortic valve shuts
what are the heart sounds and when do they occur?
mitral valves shut (which produces the 1st heart sound S1)
aortic valve shuts (which produces the 2nd heart sound S2)
S3 (a 3rd heart sound): in children and young adults, arises from a rapid deceleration of the column of blood against the ventricular wall. In older adults, an “S3 gallop” usually indicates a pathologic change in ventricular compliance.
S4 (a 4th heart sound) marks atrial contraction and usually happens just before S1. Reflects a pathologic change in ventricular compliance.
what can cause heart murmurs?
Attributed to turbulent blood flow
Stenotic valve: abnormally narrowed valvular orifice that obstructs blood flow and has a very “harsh” characteristic sound Ex. Aortic stenosis
Regurgitant valve: fails to close fully and allows blood to leak backward in a retrograde direction. Ex. Aortic regurgitation/insufficiency.
where do you listen for valve sounds?
Mitral Valve: heard best at the cardiac apex.
Tricuspid Valve: heard best at the lower left sternal border.
Pulmonic Valve: heard best in the 2nd and 3rd left interspaces close to the sternum.
Aortic Valve: heard anywhere from the right 2nd interspace to the apex.
what is the path of conduction in the heart?
SA -> AV -> His -> R and L bundle branches
why is there a delay at the AV node?
allow ventricles to fill
what is a P wave, QRS complex and T wave?
atrial depol.
ventricular depol.
ventricular repol.
define cardiac output and stroke volume
Cardiac Output (CO): the volume of blood ejected from each ventricle in 1 min (product of heart rate (HR) & stroke volume (SV). CO= HR X SV
Stroke Volume: the volume of blood ejected with each heartbeat (depends on: preload, myocardial contraction, and afterload)
what are preload and afterload?
Preload: the load that stretches the cardiac muscle before contraction. The volume of blood in the RV at the end of diastole=preload for the next beat.
Increases: inspiration, increased volume (exercise), CHF
Decreases: exhalation, decreased LV output, and pooling of blood in capillary bed/venous system.
Afterload: refers to the degree of vascular resistance to ventricular contraction (from tone in walls of arterial system).
what is myocardial contractility and how is it affected?
Myocardial Contractility: refers to the ability of the cardiac muscle, when given a load, to shorten.
Increases: when stimulation occurs from the sympathetic ns
Decreases: when blood flow or oxygen delivery to the myocardium is impaired.
what is jugular venous pressure and where is it measured?
Jugular Venous Pressure (JVP): height in the venous column of blood in the internal jugular veins.
Reflects right atrial pressure; important clinical indicator of cardiac function and right heart hemodynamics.
Estimated from the RIGHT internal jugular vein (IJV) b/c right side has a more direct path to the right atrium.
what do the jugular venous pulsations represent?
A wave: reflects the slight rise in atrial pressure that accompanies atrial contraction (just before S1)
C wave: RV contraction causing tricuspid valve to bulge toward RA.
X descent: starts with atrial relaxation, rapid atrial filling due to low pressure.
V wave: tricuspid valve closes & RA fills with blood (after S2)
Y descent: tricuspid valve opens and blood flows from RA passively into RV and right atrial pressure falls.
what is Paroxysmal nocturnal dyspnea (PND)?
Paroxysmal nocturnal dyspnea (PND): episodes of sudden dyspnea or orthopnea that awakens patient from sleep prompting need to go to window for air.
what are some modifiable cardiac risk factors?
Tobacco use Physical Inactivity/Obesity Hypertension Diabetes Hypercholesterolemia Stress/Behavior
what are the steps for measuring JVP or CVP?
1) make patient comfortable. Raise head slightly (pillow) to relax the sternocleidomastoid ms.
2) Raise head of bead (HOB) of exam table to 30 degrees and turn patients head away from side inspected.
3) Examine both sides of neck. Identify external jugular vein (EJ) then find the internal jugular pulsations.
4) Raise or lower the HOB until oscillations of IJV are seen in the lower half of the neck.
5) Focus on the right internal jugular vein. Look for pulsations in the suprasternal notch.
6) Identify the highest point of pulsation in the right IJV. Extend card horizontally and ruler vertically from sternal angle and form a right angle. Distance on ruler in cm=JVP
what are thrills and bruits?
Thrills: humming vibration felt during palpation of the carotid artery.
Bruits: a murmur like sound of vascular rather than cardiac origin. Use the diaphragm of the stethoscope. And ask patient to hold breath then listen with the bell.
what is the PMI?
Apical impulse, point of maximal impulse, or PMI
Represents the brief early pulsation of the LV as it moves anteriorly during contraction and touches the chest wall. Usually at 4th or 5th interspace around midclavicular line
what are some characteristics of heart sounds?
Location – anatomic area Intensity – loudness Duration – length of time Pitch – high vs. low Quality – sharp, dull, booming, snapping, blowing, harsh, musical Timing – systole or diastole
name four systolic murmurs
Aortic stenosis
Mid-systolic ejection murmur, heard best over aortic area, crescendo/decrescendo, radiates to neck
Mitral valve prolapse
Mid-systolic click, heard best over mitral area
Mitral regurgitation
Pansystolic (holosystolic) – valve is unable to contain blood within the ventricle during systole, S1 may be decreased heard best over apex, radiates to left axilla
Tricuspid regurgitation
Pansystolic – valve fails to close completely during systole, heard best over lower left sternal border
name 2 diastolic murmurs
Aortic regurgitation
Leaflets of aortic valve fail to close – volume overload in LV
Heard best in aortic area with patient sitting and leaning forward
Mitral stenosis
Leaflets of valve have become thick, stiff, and distorted because of rheumatic fever
Heard best at apex and using bell
Mainly rheumatic in origin
what are myocytes?
Myocytes (cardiac cells): electrically polarized at rest
name three types of heart cells and their function
Pacemaker cells: electrical power source of the heart
Electrical conducting cells: the hard wiring of the heart
Myocardial cells: the contractile machinery of the heart
what is an action potential?
Action Potential: a record of one electrical cycle of depolarization & repolarization of a single cell.
This one action potential stimulates neighboring cells to depolarize until the entire heart has been depolarized and contracts.
what is automaticity?
Automaticity: all heart cells possess ability to behave as a pacemaker. Suppressed unless SA node fails.
what do the lines and axises represent on EKG paper?
Horizontal axis=time Small square distance=0.04 sec Large square=0.2 sec Vertical axis=voltage Small square=0.1 mV Large square=0.5 mV
how does deflection relate to depolarization?
A wave of depolarization towards a positive electrode=positive deflection.
A wave of depolarization away from a positive electrode=negative deflection.
A depolarizing wave moving perpendicular to a positive electrode=biphasic wave.
what are the three standard leads and the charges associated with them?
Three standard leads
I is with right arm( – ) left arm( +)
II is with right arm( –) legs( +)
III is with left arm (–) legs( +)
electrodes are (positive/negative) with a (positive/negative) terminal
All electrodes are + with a – central terminal
Which leads have an anterior view of the heart?
V1, V2, V3, V4
Which leads have an left lateral view of the heart?
I, AVL, V5, V6
Which leads have an inferior view of the heart?
II, III, AVF
The AVR is associated with what view?
none
Lead _____: away from current=negative p wave
AVR
Which leads are in the fontal plane and what do their p waves look like?
Lead I & AVL: toward current=positive wave
Lead III: perpendicular to current=biphasic p wave
Lead AVR: away from current=negative p wave
which leads are in the horizontal plane and what do their p waves look like?
Lead V5 & V6: toward current=positive wave
Lead V1: perpendicular to current=biphasic wave
Lead V2-V4: vaiable
What is the PR interval?
Represents the time from the start of atrial depolarization to the start of ventricular depolarization.
Lead _____: smallest R wave
Lead _____: largest R wave
Lead V1: smallest R wave
Lead V5: largest R wave
What is the ST segment?
Represents the time from the end of ventricular depolarization to the start of ventricular repolarization.
What is the QT interval?
Represents the time from the beginning of ventricular depolarization to the end of ventricular repolarization.
Duration of QT interval is proportional to HR
QT interval composes 40% of the normal cardiac cycle (R-R interval)
What do P waves look like in a 12 lead EKG?
P wave: small and usually positive in the left lateral and inferior leads.
Biphasic: III & V1
Positive: II
Negative: AVR
what is an arrythmia?
Refers to any disturbance in the rate, regularity, site of origin, or conduction of the cardiac electrical impulse.
Can be a single aberrant beat (prolonged pause between beats) or a sustained rhythm disturbance
what are some clinical manifestations of arrythmias?
palpations, light-headedness, syncope, CHF, sudden death
what are some causes of arrythmias?
Mnemonic: HIS DEBS H-Hypoxia: I-Ischemia and Irritability: S-Sympathetic stimulation: D-Drugs: E-Electrolyte Disturbances: B-Bradycardia S-Stretch:
what is the difference between a Holter and an event monitor?
A Holter Monitor or ambulatory monitor is a portable EKG machine with a memory.
Patient wears monitor for 24-48 hours and a complete record of the patient heart rhythm is stored and later analyzed for any arrhythmic activity.
An event monitor records 3-5 minutes of a rhythm strip, but is initiated by the patient when he/she experiences symptoms.
EKG recording is sent over phone lines for evaluation.
what are the 5 steps of EKG analysis?
Step 1: Calculate rate. Step 2: Determine regularity. Step 3: Assess the P waves. Step 4: Determine PR interval. Step 5: Determine QRS duration
what is one way to calculate HR from an EKG strip?
Count the # of R waves in a 6 second rhythm strip, then multiply by 10.
What is a normal PR interval?
Normal: 0.12 - 0.20 seconds. (3-5 boxes)
What is a normal QRS interval?
Normal: 0.04 - 0.12 seconds.
(1 - 3 boxes)
name 4 types of arrythmias
- )When electrical activity follows the usual conduction pathways, but are either too fast, too slow, or irregular. These are called arrhythmias of SINUS origin.
- )When the electrical activity originates elsewhere than the sinus node. These are called ECTOPIC rhythms.
3) When the electrical activity originates in the sinus node and follows the usual pathways, but encounters unexpected blocks and delays these are called CONDUCTION BLOCKS.
4) And finally, when the electrical activity follows accessory conduction pathways that bypass the normal ones, providing an electrical shortcut, or short circuit. These arrhythmias are termedPREEXCITATION SYNDROMES.
what is a junctional escape rhythm?
(sinus arrythmia)
Depolarization originates near the AV node and usual pattern of atrial depolarization does not occur, thus NO P waves.
what is Paroxysmal Supraventricular Tachycardia?
ectopic
PSVT is very common and sudden in onset usually initiated by a supraventricular premature beat.
Regular rhythms with a rate of between 150-250 BPM.
You can see retrograde p waves, but usually burried in the QRS complexes.
QRS complexes are normally narrow
Sinus Arrythmias often vary with what?
Respiration changes HR
Carotid massage is known to diagnose and terminate what?
PSVT - Paroxysmal Supraventricular Tachycardia
Descirbe atrial flutter
Atrial depolarization occurs so rapidly, the baseline rises and falls yielding a saw-toothed pattern or flutter waves.
AV node becomes overwhelmed and therefore not every atrial impulse that goes to AV node results in a QRS complex. AV block
describe atrial fibrillation
In atrial fibrillation, atrial activity is completely chaotic and the AV node may be bombarded with more than 500 impulses per minute.
Multiple reentrant circuits occurring in a totally unpredictable fashion.
No true p waves are seen. Baseline appears flat or undulates slightly. AV node lets occasional impulses pass generating irregularly irregular ventricular rate between 120-180 BPM.
Key: Irregularly irregular without p waves
What is multifocal atrial tachycardia (MAT)?
Multifocal atrial tachycardia (MAT) is an irregular rhythm occurring at a rate of 100-200 BPM.
Results from a random firing of several different atrial foci. When rate < 100 BPM =Wandering atrial pacemaker.
MAT is common in patients with severe lung disease
What is Paroxysmal atrial tachycardia (PAT)?
Paroxysmal atrial tachycardia or PAT is regular rhythm with a rate of 100-200 BPM
Automatic type typically displays a warm-up period (rhythm is irregular) and a cool-down period (terminates)
Seen in otherwise normal hearts
Most common cause: Digitalis Toxicity
How can you differentiate between PSVT and PAT?
How to differentiate PSVT and PAT? Warm up and cool down with PAT and Carotid massage will help PSVT but not PAT.
What is the most common ventricular arrythmia?
PVC
What is a PVC?
QRS complex appears wide and bizarre b/c ventricular depolarization does not follow normal conduction pathways.
Isolated PVCs are common and rarely require treatment. An isolated PVC in the setting of an acute myocardial infarction is more ominous in that it can predispose patient to VT or VF.
What is ventricular Tachycardia?
run of 3 or more consecutive PVCs
What is ventricular fibrillation?
Ventricular fibrillation is a preterminal event, seen almost solely in dying hearts.
Most frequently encountered arrhythmia leading to sudden death.
EKG tracing jerks about spasmodically in course VF and undulates gently in fine VF.
There are no true QRS complexes.
In VF the heart generates no cardiac output and CPR and cardiac defibrillation must be performed at once.
What is Accelerated Idioventricular rhythm?
Accelerated Idioventricular rhythm is a benign rhythm sometimes seen during an acute infarction.
It’s a regular rhythm occurring at 50-100 BPM and represents a ventricular escape focus that has accelerated sufficiently to drive the heart.
Rarely sustained, does not progress to VF and does not require treatment.
What is Torsades De Pointes?
Means “twisting of the points”
Form of VT usually seen in patients with prolonged QT intervals
name two treatments for arrythmias
programmed electrical stimulation or defibrillation
The lower border of the lung crosses the ____ rib at the mid clavicular line and the 8th rib at the _______ line.
6th
midaxillary
Can the lungs experience pain?
No, Lung tissue has no pain fibers: pain in lung conditions such as pneumonia and pulmonary infarction arises from inflammation of the parietal pleura.
What is dyspnea?
Non-painful but uncomfortable awareness of breathing that is inappropriate to the level of exertion.
What are some normal and adventitious breath sounds?
Normal breath sounds are Vesicular, Bronchiovesicular, or Bronchial
adventitious sounds are Rales (crackles), Rhonchi (gurgles), Friction rub, and Wheezes.
What is spirometry?
Literally means “the measuring of breath”
Measures the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled.
What is tidal volume?
The tidal volume (TV), about 500 mL, the amount of air inspired during normal, relaxed breathing.
What is the inspiratory reserve volume?
The inspiratory reserve volume (IRV), about 3,100 mL, the additional air that can be forcibly inhaled after the inspiration of a normal tidal volume
What is the expiratory reserve volume?
The expiratory reserve volume (ERV), about 1,200 mL, the additional air that can be forcibly exhaled after the expiration of a normal tidal volume.
What is the residual volume?
Residual volume (RV), about 1,200 mL, the volume of air still remaining in the lungs after the expiratory reserve vol. is exhaled
What is the total lung capacity?
The total lung capacity (TLC), about 6,000 mL, is the maximum amount of air that can fill the lungs (TLC = TV + IRV + ERV + RV).
What is the vital capacity?
The vital capacity (VC), about 4,800 mL, is the total amount of air that can be expired after fully inhaling (VC = TV + IRV + ERV = approximately 80 percent TLC). The value varies according to age and body size.
What is the inspiratory capacity?
The inspiratory capacity (IC), about 3,600 mL, is the maximum amount of air that can be inspired (IC = TV + IRV)
What is the functional residual capacity?
The functional residual capacity (FRC), about 2,400 mL, is the amount of air remaining in the lungs after a normal expiration (FRC = RV + ERV).
Normal FEV1/FVC ratio = ?
Normal FEV1/FVC ratio = 80%
The percent of forced vital capacity that is exhaled in the first second
What is obstructive lung disease?
Involves difficulty exhaling all the air from the lungs.
Because of damage to the lungs or narrowing of the airways inside the lungs, exhaled air comes out more slowly than normal.
At the end of a full exhalation, an abnormally high amount of air may still linger in the lungs. FEV1/FVC ratio is < 70%
What is restrictive lung disease?
Results from a condition causing stiffness in the lungs themselves.
In other cases, stiffness of the chest wall, weak muscles, or damaged nerves may cause the restriction in lung expansion.
FEV1. FEV1 > 80%
What are normal ABG ranges for a patient on RA?
pH 7.35-7.45 pCO2 35-45 pO2 80-100 HCO3 22-26 O2 Sat. 95-100%
What are the contraindications for a flexible bronchoscope?
Contraindicated in severe bronchospasm and bleeding
How do you orient yourself when doing a bronchoscope?
When using bronchoscopy for a fiberoptic approach to intubation, your orientation is the tracheal rings are anterior.
When would you use a rigid bronchoscope?
Used in massive bleeding, extraction of large obstructing objects, biopsy of tracheal or main stem bronchus tumors and bronchial carcinoids, facilitation of laser therapy
What is a VQ scan and when is it used?
VQ Scan is a type of medical imaging using scintigraphy and medical isotopes to evaluate the circulation of air and blood within a patient’s lungs in order to determine the ventilation/perfusion ratio.
The ventilation part of the test looks at the ability of air to reach all parts of the lungs, while the perfusion part evaluates how well blood circulates within the lungs.
Commonly done in order to check for the presence of a blood clot or abnormal blood flow inside the lungs (such as a pulmonary embolism (PE)
rank the 4 non sinus pacemakers from lowest to highest bpm
ventricular foci (20-40) junctional foci (AV node- 40-60) Atrial foci (60-75) SA Node (60-100)
tachycardia is seen with a HR of?
> 100 bpm
bradycardia is seen with a HR of?
< 60 bpm
what are palpitations?
unpleasant awareness of the heartbeat described as skipping, racing, fluttering, or pounding.
Mid-systolic ejection murmur, heard best over aortic area, crescendo/decrescendo, radiates to neck
Aortic stenosis
Mid-systolic click, heard best over mitral area
mitral valve prolapse
Pansystolic (holosystolic) – valve is unable to contain blood within the ventricle during systole, S1 may be decreased heard best over apex, radiates to left axilla
mitral regurgitation
Pansystolic – valve fails to close completely during systole, heard best over lower left sternal border,
Tricuspid regurgitation
Leaflets of aortic valve fail to close – volume overload in LV
Heard best in aortic area with patient sitting and leaning forward
May be caused by rheumatic heart disease, congenital bicuspid valves, Marfan’s syndrome, aortic dissection, syphilis
aortic regurgitation
Leaflets of valve have become thick, stiff, and distorted because of rheumatic fever
Heard best at apex and using bell
Mainly rheumatic in origin
mitral stenosis
