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Clinical Methods > Midterm A > Flashcards

Midterm A Flashcards

1
Q

How often should a patient’s registration form be updated?

A

Every year

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2
Q

What information does a patient’s medication summary include?

A
  • Dosage
  • Route
  • Frequency
  • Whether the patient has received the dose at a particular time
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3
Q

What is a consultation note?

A

Input from a consulting subspecialty physician

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4
Q

What is the SOAP format for physician’s progress notes?

A
  • Subjective (what the patient tells you
  • Objective (what you find in the physical exam)
  • Assessment (problem list)
  • Plan (management)
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5
Q

What is the range for normal blood pressure values in the average healthy adult at rest?

A

90/60-120/80

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6
Q

What is the range for normal heart rates in the average healthy adult at rest?

A

60-100 BPM

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7
Q

What is the range for normal respiratory rates in the average healthy adult at rest?

A

12-20 breaths per minute

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8
Q

What is the range for normal body temperatures in the average healthy adult at rest?

A

97.8-99.1 degrees Fahrenheit

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9
Q

What is the range for normal pulse ox values in the average healthy adult at rest?

A

95-100%

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10
Q

What is systolic blood pressure?

A

The pressure exerted on the wall of the arteries during heart contraction (systole)

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11
Q

What is diastolic blood pressure?

A

The pressure exerted on the wall of the arteries during heart relaxation (diastole)

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12
Q

What range of systolic blood pressures classifies a patient as having Stage 1 hypertension

A

140-159mmHg

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13
Q

What range of diastolic blood pressures classifies a patient as having Stage 1 hypertension

A

90-99 mmHg

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14
Q

What range of systolic blood pressures classifies a patient as having Stage 2 hypertension

A

Greater than or equal to 160mmHg

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15
Q

What range of diastolic blood pressures classifies a patient as having Stage 2 hypertension

A

Greater than or equal to 100mmHg

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16
Q

What are Cheyne-Stokes respirations?

A

Apnea alternating with tachypnea (fast breathing >20bpm)

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17
Q

What is Kussmaul’s breathing?

A

Deep labored hyperventilation associated with metabolic acidosis

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18
Q

Patients with what comorbidity would exhibit Kussmaul’s breathing?

A

Diabetes

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19
Q

What is orthopnea?

A

Shortness of breath while laying flat

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20
Q

How much lower are axillary temperatures in relation to oral temperatures?

A

Axillary temps are 1 degree Celsius lower than oral temps

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21
Q

How much higher are rectal temperatures in relation to oral temperatures?

A

Rectal temps are 0.4-0.5C higher than oral temps

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22
Q

What are the sources of obtaining core temperature?

A

PA > esophagus > bladder > nasopharyngeal > rectal

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23
Q

What is the first step in the sequence of a patient interview?

A

Greeting the patient and establishing a rapport

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24
Q

What are the questions included in the CAGE questionnaire?

A
  • Have you ever felt the need to CUT DOWN on your 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?
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25
Q

What are the 5 stages of the Kubler-Ross theory of response to death?

A

1) Denial/isolation
2) Anger
3) Bargaining
4) Depression/sadness
5) Acceptance

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26
Q

What is the definition of nonmaleficence regarding professional ethics?

A

“First, Do No Harm”

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27
Q

What is subjective data?

A

What the patient tells you

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28
Q

What is objective data?

A

What you detect during the exam

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29
Q

What are the seven attributes of symptoms of present illness (CHLORIDE)?

A
  • CHaracter or quality
  • Location
  • Onset
  • Radiation
  • Intensity
  • Duration
  • Exacerbating or alleviating factors
  • Associated manifestations
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30
Q

What are the 4 cardinal techniques of physical examination?

A

1) Inspection
2) Palpation
3) Percussion
4) Auscultation

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31
Q

What electrolyte value is used to monitor salt/water balance and evaluate fluid and electrolyte balance?

A

Sodium

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32
Q

What are the normal adult lab values for sodium?

A

136-145mEq/L

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33
Q

What electrolyte value is important to assess cardiac function?

A

Potassium

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34
Q

What are the normal adult lab values for potassium?

A

3.5-5.0mEq/L

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35
Q

What electrolyte value is used to investigate acid/base balance and proper balance of body fluids?

A

Chloride

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36
Q

What are the normal adult lab values for chloride?

A

90-110mEq/L

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37
Q

What is the normal range for CO2 lab values in adult patients?

A

23-29mEq/L

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38
Q

What lab value reveals important information about how well the kidneys and liver are working?

A

Blood Urea Nitrogen (BUN)

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39
Q

What are the normal adult lab values for BUN?

A

10-20mg/dl

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40
Q

What are creatinine lab values used to diagnose?

A

Impaired renal function

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41
Q

If kidney function is impaired, how will the creatinine levels change?

A

The Cr levels will be elevated in the blood

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42
Q

What are normal creatinine levels in males?

A

0.6-1.2 mg/dl

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43
Q

What are normal creatinine levels in females?

A

0.5-1.1mg/dl

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44
Q

What lab value is used to diagnose or monitor diabetes?

A

Glucose

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45
Q

What are the normal lab values for glucose?

A

70-100mg/dL

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46
Q

What is the normal WBC range?

A

4,300-10,800

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47
Q

What is the normal Hgb range in females?

A

12-16

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48
Q

What is the normal Hgb range in males?

A

13-18

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49
Q

What is the normal range for hematocrit in men?

A

45-52%

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50
Q

What is the normal range of hematocrit in women?

A

37-48%

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51
Q

What is Mean Corpuscular Volume?

A

The average volume of a red cell

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52
Q

What is the normal range of mean corpuscular volume?

A

86-98 femtoliters

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53
Q

What is the normal range for platelet count?

A

150,000-400,000

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54
Q

What is CBC with diff?

A

Complete blood count with differential - a machine generated percentage of the different types of white blood cells

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55
Q

What does a PT test measure?

A

Extrinsic pathway to assess clotting ability of blood

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56
Q

What is a normal prothrombin time?

A

11-15 seconds

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57
Q

What is INR?

A

International normalized ratio - allows for standardization of the value no matter where the test is done

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58
Q

What are normal INR values?

A

1.0-1.5

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59
Q

What does PTT measure?

A

The efficacy of the intrinsic and common coagulation pathways.

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60
Q

What test is used to monitor the treatment effects with heparin?

A

PTT

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61
Q

What is the normal range of PTT?

A

30-50 seconds

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62
Q

How do cardiac myocytes maintain polarity?

A

Membrane pumps control distribution of ions to keep the inside of the cells electronegative

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63
Q

Which pump maintains the electrical polarity of the myocyte membranes?

A

The sodium/potassium pump

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64
Q

How does the sodium/potassium pump work? What form of energy does it use?

A

Pumps 3 Na+ OUT of the cell for every 2 K+ that come IN the cell. It uses ATP to keep the cell polarized.

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65
Q

Which cardiac cells are the power source of the heart?

A

Pacemaker cells

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66
Q

Which cardiac cells depolarize spontaneously?

A

Pacemaker cells

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67
Q

What is the dominant pacemaker of the heart?

A

Sino-atrial node in the right atrium

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68
Q

What is the intrinsic rate of the SA node?

A

60-100bpm

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69
Q

What is the intrinsic rate of the atrial foci?

A

60-75bpm

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70
Q

What is the intrinsic rate of the AV node (junctional foci)?

A

40-60bpm

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71
Q

What is the intrinsic rate of the HIS bundle/purkinje system (ventricular foci)?

A

30-40bpm

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72
Q

Which cardiac cells serve as the hard wiring of the heart and carry current throughout the heart?

A

Electrical conducting cells

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73
Q

What are the electrical conducting cells of the ventricles?

A

Purkinje system

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74
Q

What are the electrical conducting cells of the atria?

A

Bachman’s bundle

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75
Q

Which cardiac cells constitute the largest part of the heart tissue and are responsible for the labor of contracting and relaxing?

A

Myocardial cells

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76
Q

The waves of an EKG reflect the electrical activity of which cardiac cell types?

A

Myocardial cells

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77
Q

What is the voltage of one small square on an EKG paper? One large square?

A

Small square: 0.1mv

Large square: 0.5mv

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78
Q

What is the length of time indicated by one small square on an EKG paper? One large square?

A

Small square: 0.04sec

Large square: 0.2sec

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79
Q

What electrical activity of the heart is occurring during the P wave?

A

Atrial depolarization

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80
Q

What does the 1st portion of the P wave represent?

A

Right atrial depolarization

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81
Q

What does the 2nd portion of the P wave represent?

A

Left atrial depolarization

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82
Q

What is the purpose of the AV node delay?

A

It slows conduction from the atria to the ventricles to allow the atria to finish contracting before the ventricles begin to contract. Allows the atria to completely empty their volume into the ventricles.

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83
Q

What are the 3 parts of ventricular conduction?

A

1) Bundle of His
2) Bundle branches
3) Terminal purkinje fibers

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84
Q

What electrical activity of the heart is occurring during the QRS complex?

A

The beginning of ventricular depolarization and contraction

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85
Q

What is represented by R/R’ waves?

A

Bundle branch blocks

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86
Q

What electrical activity of the heart is occurring during the T wave?

A

Ventricular repolarization

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87
Q

Where is the PR interval?

A

Start of the P wave to the beginning of the QRS complex

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88
Q

Where is the ST segment?

A

The end of the QRS complex to the beginning of the T wave

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89
Q

Where is the QT interval?

A

Includes the QRS complex, ST segment, and T wave

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90
Q

What is indicated by a positive deflection on an EKG?

A

A wave of depolarization towards a positive electrode

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91
Q

What is indicated by a negative deflection on an EKG?

A

A wave of depolarization away from a positive electrode

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92
Q

What is indicated by a biphasic wave on an EKG?

A

Depolarizing wave moving perpendicular to a positive electrode

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93
Q

What direction is a wave of repolarization moving as indicated by a negative deflection?

A

Towards a positive electrode

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94
Q

What direction is a wave of repolarization moving as indicated by a positive deflection?

A

Away from a positive electrode

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95
Q

What leads make up a 12 lead EKG?

A

6 limb leads (3 standard leads, 3 augmented leads) and 6 precordial leads

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96
Q

How many electrodes are needed for a 12 lead EKG?

A

10

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97
Q

What view of the heart is seen with standard limb leads?

A

The frontal plane. It views electrical forces moving up, down, left and right throughout the circle.

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98
Q

What are the negative and positive electrodes in Lead 1?

A

Right arm negative, left arm positive. 0 degree orientation.

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99
Q

What are the negative and positive electrodes in Lead 2?

A

Right arm negative, left leg positive. 60 degree angle of orientation.

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100
Q

What are the negative and positive electrodes in Lead 3?

A

Left arm negative, left leg positive. 120 degree angle of orientation.

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101
Q

What view of the heart is seen with the precordial leads?

A

The horizontal plane, view electrical forces moving anteriorly and posteriorly

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102
Q

Which electrodes are positive and negative in the precordial lead system?

A

All precordial electrodes are positive with a negative central terminal that’s made by connecting all 3 limb leads

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103
Q

Which leads provide an anterior view of the heart?

A

V2, V3, V4

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104
Q

Which leads provide a left lateral view of the heart?

A

I, aVL, v5, v6

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105
Q

Which leads provide an inferior view of the heart?

A

II, III, aVF

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106
Q

Which leads provide a view of the right ventricle?

A

aVR, V1

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107
Q

Any lead in the 12 lead EKG that views the wave of atrial depolarization (P wave) as moving towards it will record a _______ deflection on the EKG.

A

Positive

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108
Q

Which leads in the 12 lead EKG show a positive P wave?

A

Left lateral leads and inferior leads - I, aVL, v5, v6, II, aVF

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109
Q

Which leads on a 12 lead EKG produce a biphasic wave during atrial depolarization (P wave)?

A

III and v1 because they lie perpendicular to the wave of atrial depolarization

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110
Q

Which lead in the frontal plane shows a negative P wave on a 12 lead EKG?

A

aVR because the current is going away from it

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111
Q

Which lead shows the most positive P wave amplitude?

A

Lead II

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112
Q

Which lead shows the most negative P wave amplitude?

A

aVR

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113
Q

How long is the PR interval?

A

0.12-0.2 seconds (3-5mm)

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114
Q

What electrical activity of the heart is represented by septal Q waves?

A

Depolarization of the interventricular septum

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115
Q

Q waves are seen as tiny negative deflections in which leads?

A

Left lateral leads - I, aVL, V5, V6

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116
Q

What is the normal amplitude of Q waves?

A

Less than or equal to 0.1mV

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117
Q

What pathology is denoted by a large negative Q wave in the inferior leads (II, III, aVF)?

A

Inferior MI

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118
Q

Where does the average vector of current swing during ventricular depolarization (QRS complex)?

A

Leftward 0-90 degrees

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119
Q

In which leads is the QRS complex positive?

A

Most of the left lateral and inferior leads

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120
Q

In which lead is the QRS complex negative?

A

aVR

121
Q

Which leads in the frontal plane show a biphasic QRS wave?

A

III and aVL

122
Q

Which leads record deep S waves?

A

V1 and V2

123
Q

Which leads in the horizontal plane show a biphasic QRS?

A

V3 and V4

124
Q

Which lead records the smallest R wave?

A

V1

125
Q

Which lead records the largest R wave?

A

V5

126
Q

What leads show the transition zone of the QRS?

A

V3 and V4

127
Q

How long does a normal QRS last?

A

0.06-0.1seconds

128
Q

Elevation or depression of the ST segment by more than __mm indicates pathologic process

A

1mm

129
Q

It’s typical to find positive T waves in the same leads that have what?

A

Tall positive R waves

130
Q

The duration of the QT interval is proportional to what?

A

Heart rate

131
Q

The QT interval composes __% of the normal cardiac cycle

A

40%

132
Q

What glands present as an airway emergency when they become enlarged?

A

Submandibular glands

133
Q

Which of the paranasal sinuses are accessible during a physical exam?

A

Frontal and maxillary sinuses

134
Q

What questions can you ask to assess thyroid function?

A

Temperature intolerance/sweating? Any new palpitations or change in weight?

135
Q

What is a consensual pupillary reaction?

A

When you test one eye with a pen light there is pupillary constriction in the opposite eye

136
Q

What is tested by the Rinne test?

A

Compares air conduction and bone conduction

137
Q

What is the purpose of the Weber test?

A

To test if there is conductive hearing loss, sensorineural hearing loss, or both

138
Q

What cranial nerve is assessed by asking the patient to stick out their tongue and looking for symmetry?

A

Cranial nerve 12 (hypoglossal)

139
Q

What cranial nerve is assessed by noting the rise of the soft palate when the patient opens their mouth and says “ah”?

A

Cranial nerve 10 (vagus)

140
Q

What could be indicated by a dry cough during an airway exam?

A

Possible tracheobronchial compression

141
Q

What structures are seen in a MAL1 view?

A

Full visibility of tonsils, uvula, and soft palate

142
Q

What structures are seen in a MAL2 view?

A

Visibility of hard and soft palate, upper portion of tonsils and uvula

143
Q

What structures are seen in a MAL3 view?

A

Soft and hard palate, base of uvula

144
Q

What structures are seen in a MAL4 view?

A

Only hard palate

145
Q

What causes angina (chest pain)

A

Rapid arrhythmias that increase the oxygen demands of the myocardium

146
Q

What are the causes of arrhythmias? (HIS DEBS)

A
  • Hypoxia
  • Ischemia/irritability
  • Sympathetic stimulation
  • Drugs
  • Electrolyte disturbances
  • Bradycardia
  • Stretch
147
Q

What lead yields the most information about an arrhythmia?

A

Lead II

148
Q

What are the 5 steps of analyzing an ekg?

A

1) Calculate rate
2) Determine regularity
3) Assess P waves
4) Determine PR interval
5) Determine QRS duration

149
Q

What are the 5 types of arrhythmias?

A

1) Sinus origin - follows the normal pathway, but too fast/slow/irregular
2) Ectopic rhythms - activity originates somewhere other than sinus node
3) Reentrant arrhythmias - activity is trapped within a racetrack
4) Conduction blocks - blocks and delays in conduction pathway
5) Pre-excitation syndromes - activity follows accessory pathways that bypass the normal ones

150
Q

What 3 pathologies is sinus tachycardia normally seen in?

A
  • Congestive heart failure
  • Severe lung disease
  • Hyperthyroidism
151
Q

What pathology is sinus bradycardia normally seen in?

A

Acute myocardial infarction

152
Q

How is sinus arrhythmia defined?

A

Normal EKG but rhythm is slightly irregular, usually reflects variation in heart rate that accompanies inspiration and expiration

153
Q

How does HR change with the respiratory cycle in sinus arrhythmia?

A

Inspiration accelerates HR and expiration decelerates HR

154
Q

What are escape beats?

A

When myocardial cells spring into act and take over pacing when sinus arrest occurs (SA node stops firing)

155
Q

What is the treatment for asystole?

A

CPR and epinephrine IV

156
Q

What is junctional escape rhythm?

A

Depolarization originates near the AV node and there are NO P waves

157
Q

What 2 questions can you ask to determine whether an ectopic arrhythmia is ventricular or supra ventricular?

A
  • Are normal P waves present?

- Is the QRS complex narrow (less than 0.12 secs) or wide (more than 0.12secs)?

158
Q

What are the 2 types of single ectopic supraventricular beats?

A
  • PACs that originate in the atria

- Junctional premature beats that originate in the AV node

159
Q

What is the treatment for single atrial and junctional premature beats?

A

They do not require treatment because they don’t indicate underlying cardiac disease

160
Q

What are the 5 types of sustained supra ventricular arrhythmias?

A

1) Paroxysmal supraventricular tachycardia (PSVT)
2) Atrial flutter
3) Atrial fibrillation
4) Multifocal atrial tachycardia (MAT)
5) Paroxysmal atrial tachycardia (PAT)

161
Q

What is Paroxysmal supra ventricular tachycardia (PSVT)?

A

Sudden tachycardia of 150-250bpm with regular, narrow QRS complexes and retrograde P waves (if visible)

162
Q

What usually initiates Paroxysmal supra ventricular tachycardia (PSVT)?

A

A supraventricular premature beat

163
Q

What helps to diagnose and terminate Paroxysmal supra ventricular tachycardia (PSVT)?

A

Carotid massage, it causes baroreceptors to sense changes in pressure and initiate reflex bradycardia. Allows the rate to slow down so we can visualize P waves and diagnose the tachycardia.

164
Q

What is atrial flutter?

A

Regular rhythm and an atrial rate of 250-350bpm - characterized by saw tooth waves

165
Q

What is atrial fibrillation?

A

“Irregularly irregular” beat without discernible p waves - atrial rate of 350-500BPM and variable ventricular rate.

166
Q

How does a carotid massage affect atrial flutter?

A

May increase the block

167
Q

How does a carotid massage affect atrial fibrillation?

A

May slow ventricular rate

168
Q

What is multifocal atrial tachycardia (MAT)?

A

An irregular rhythm occurring at 100-200BPM. Occurs from random firing of at least 3 different atrial foci

169
Q

What is it called when the EKG has a MAT rhythm but the rate is less than 100bpm?

A

Wandering Atrial Pacemaker

170
Q

How does a carotid massage affect MAT?

A

No effect

171
Q

MAT is common in patients with what comorbidity?

A

Severe lung disease

172
Q

What is Paroxysmal Atrial Tachycardia (PAT)?

A

Regular rhythm with a rate of 100-200bpm. Caused by enhanced automaticity of ectopic atrial focus.

173
Q

What is displayed on the EKG with an automatic type PAT?

A

A warm-up period with an irregular rhythm follow by a cool-down period where the rhythm terminates

174
Q

What is the most common cause of PAT?

A

Digitalis toxicity

175
Q

How do you differentiate PSVT and PAT?

A
  • There is a warm-up and cool down period with PAT

- A carotid massage will help PSVT but not PAT

176
Q

What are the 5 types of ventricular arrhythmias?

A

1) PVCs
2) V tach
3) Torsade de Pointes
4) V fib
5) Accelerated idioventricular rhythm

177
Q

What is the most common ventricular arrhythmia?

A

PVCs

178
Q

What are the EKG characteristics of a PVC?

A

Wide QRS complex and bizarre because ventricular depolarization doesn’t follow normal conduction pathway

179
Q

What is bigeminy?

A

1 normal sinus beat for every 1 PVC

180
Q

What is trigeminy?

A

2 normal sinus beats for every 1 PVC

181
Q

What is the “R-on-T” phenomenon?

A

When PVCs fall on the T wave of the previous beat, can precipitate V tach

182
Q

When should you worry about PVCs?

A
  • If they are frequent
  • If there’s a run of 3 or more
  • If they are multiform (vary in site of origin)
  • If they occur in the setting of an acute MI
183
Q

What is V tach?

A

A run of 3 or more consecutive PVCs at a rate of 120-200bpm, may be slightly irregular

184
Q

What is Torsades De Pointes?

A

“Twisting of the points” - A form of v tach seen in patients with prolonged QT intervals

185
Q

What can cause prolonged QT intervals?

A
  • Electrolyte disturbances (low Ca2+, Mg2+, or K+)
  • Myocardial infarction
  • R-on-T phenomenon
  • Drugs (anti-arrhythmics, tricyclics, phenothiazines, antihistamines when taken with erythromycin, anti-fungals)
186
Q

What is the most frequently encountered arrhythmia in adults who experience sudden death?

A

V fib

187
Q

What is accelerated idioventricular rhythm?

A

Benign, regular rhythm at a rate of 50-100BPM that is seen during an acute MI. It represents a ventricular escape focus that has accelerated to drive the heart.

188
Q

What are the 2 common treatments of arrhythmias?

A

1) Programmed electrical stimulation (ex. catheter ablation)

2) Implantable cardioverter-defibrillators

189
Q

What is left ventricular pressure during diastole?

A

Less than 5mmHg

190
Q

What action produces the first heart sound S1?

A

Closing of the mitral and tricuspid valves (beginning of systole)

191
Q

What action produces the second heart sound S2?

A

Closing of the aortic and pulmonic valves (beginning of diastole)

192
Q

What can cause a 3rd heart sound in children and young adults?

A

The rapid movement of blood against the ventricular wall

193
Q

What is does an S3 gallop indicate in older adults?

A

A pathologic change in ventricular compliance

194
Q

What is indicated by S4 (a 4th heart sound)?

A

It marks atrial contraction and reflects a pathologic decrease in ventricular compliance

195
Q

What is an A2 sound?

A

Aortic valve closer

196
Q

What is a P2 sound?

A

Pulmonic valve closure

197
Q

What causes heart murmurs?

A

Turbulent blood flow caused by a stenotic or regurgitant valve

198
Q

What is a stenotic valve?

A

An abnormally narrowed valvular orifice that obstructs blood flow

199
Q

What is a regurgitant valve?

A

A valve that doesn’t close fully and allows blood to leak backward

200
Q

Where are the sounds of the mitral valve heard best?

A

At the cardiac apex, 4th/5th ICS, midclavicular line

201
Q

Where are the sounds of the tricuspid valve heard best?

A

At the lower left sternal border - 4th intercostal space

202
Q

Where are the sounds of the pulmonic valve heard best?

A

In the 2nd and 3rd left interspaces close to the sternum

203
Q

Where are the sounds of the aortic valve heard best?

A

Anywhere from the right 2nd interspace to the apex

204
Q

What is preload?

A

The load the stretches the cardiac muscle before contraction

205
Q

What increases preload?

A

Inspiration, increased blood volume due to exercise, congestive heart failure

206
Q

What decreases preload?

A

Exhalation, decreased left ventricular output, pooling of blood in the venous system/capillary beds

207
Q

Stimulation from the sympathetic nervous system increases what aspect of the heart?

A

Myocardial contractility

208
Q

What decreases myocardial contractility?

A

Anything that decreases blood flow or oxygen delivery to the myocardium

209
Q

What is after load?

A

The degree of vascular resistance to ventricular contraction

210
Q

What does jugular venous pressure reflect?

A

Pressure in the right atrium

211
Q

What is reflected by the A wave on a CVP waveform?

A

Rise in atrial pressure that accompanies atrial contraction

212
Q

What is reflected by the C wave on a CVP waveform?

A

Right ventricular contraction causing the tricuspid valve to bulge towards the right atrium

213
Q

What is reflected by the X wave on a CVP waveform?

A

Ventricular ejection, atrial relaxation and filling

214
Q

What is reflected by the V wave on a CVP waveform?

A

Tricuspid valve closes and right atrium fills with blood (preload)

215
Q

What is reflected by the Y wave on a CVP waveform?

A

Tricuspid valve opens and blood flows into the right ventricle

216
Q

What is orthopnea quantified by?

A

The number of pillows the patient sleeps with

217
Q

What is paroxysmal nocturnal dyspnea?

A

Episodes of sudden dyspnea or orthopnea that awakens the patient from sleep

218
Q

What is measured by METs?

A

How hard your body is working

219
Q

How much should you inflate the blood pressure cuff when manually measuring a patient’s BP?

A

30mmHg above pressure at which pulse disappears

220
Q

What are thrills?

A

Humming vibrations felt during palpation of the carotid artery

221
Q

What are bruits?

A

Murmur like sounds of vascular rather than cardiac origin.

222
Q

Which artery should be assessed in patients with carotid obstruction?

A

Brachial artery

223
Q

What is represented by the point of maximal impulse (PMI)?

A

The brief early pulsation of the left ventricle as it moves anteriorly during contraction and touches the chest wall.

224
Q

Where on the patient should you assess PMI?

A

Have the patient lie supine and assess the 4th or 5th interspace around the midclavicular line

225
Q

What is the diameter of the PMI?

A

Less than 2.5cm from the midsternal line

226
Q

What is the duration of the PMI?

A

Usually first 2/3rd of systole

227
Q

Which heart sounds do you listen for with the diaphragm of your stethoscope?

A

The high-pitched sounds of S1/S2, murmurs due to aortic and mitral regurgitation, pericardial friction rubs

228
Q

Which heart sounds do you listen for with the bell of your stethoscope?

A

Low-pitched sounds of S3/S4 and mitral stenosis murmurs

229
Q

In what patients might an S3 heart sound be heard?

A

In patients with anemia, fever, pregnancy, or thyrotoxicosis

230
Q

How is the intensity of a heart murmur graded? What are the criteria?

A

On a 6 point scale.
I - very faint
II - quiet but heard immediately
III - moderately loud
IV - loud with a palpable thrill
V - very loud, thrill, heart w/ stethoscope partly off the chest
VI - very loud, thrill, heard with stethoscope entirely off the chest

231
Q

________ murmurs almost always indicate heart disease

A

Diastolic

232
Q

What are 2 types of diastolic murmurs?

A
  • Aortic regurgitation

- Mitral stenosis

233
Q

What is the purpose of taking a review of systems?

A

To gain understanding of overall, general health of the patient

234
Q

What observations do you want to make when evaluating the airway for a DL?

A

MAL score, thyromental distance, mouth opening, cervical flexion/extension, range of motion, masses/scars

235
Q

What is the discharge rate for junctional pacemakers?

A

40-60BPM

236
Q

Where can you measure core body temperature?

A

Pulmonary artery, esophagus, bladder, nasopharynx, rectum

237
Q

What is the normal number of adult teeth?

A

32

238
Q

What is aortic stenosis?

A

Abnormally narrowed valvular orifice that obstructs blood flow and has a harsh sound

239
Q

What causes the S3 heart sound in athletes/children?

A

Ventricular filling and the rapid deceleration of the column of blood against the wall

240
Q

What causes the S3 heard sound in adults?

A

Pathological change in ventricular compliance

241
Q

What is the definition of functional residual capacity?

A

The volume of air left in the lungs after a passive exhalation - 30mL/kg

242
Q

What is the definition of a Grade IV murmur?

A

Loud with palpable thrill

243
Q

Where do tears originate from?

A

Lacrimal gland

244
Q

Where do tears drain into?

A

Lacrimal sac

245
Q

What part of the eye focuses light?

A

Retina

246
Q

What part of the eye controls pupillary size?

A

Iris

247
Q

What part of the eye controls the thickness of the lens and allows the eye to focus?

A

Ciliary body

248
Q

If this part of the eye is not regulated, patients could get increased intraocular pressure or glaucoma

A

Aqueous humor

249
Q

What is the posterior part of the eye that contains the retina, choroid, fovea, macula, optic disc, and vessels?

A

Fundus

250
Q

What is the definition of ventricular tachycardia?

A

Run of 3 or more PVCs are a rate of 120-200BPM

251
Q

An irregularly irregular pulse is associated with which dysrhythmia?

A

Atrial fibrillation

252
Q

What is the normal range for platelet count?

A

150,000-400,000

253
Q

What is a normal thyromental distance?

A

6cm

254
Q

What are the causes of conductive hearing loss?

A

Cerumen (wax), otitis externa, squamous cell carcinoma, osteomas perforation of eardrum, cholesteatoma

255
Q

The Snellen eye chart tests what?

A

Visual acuity

256
Q

Pain in which sinuses are palpable?

A

Maxillary and frontal

257
Q

What does the eustachian tube connect?

A

The middle ear and the nasopharynx

258
Q

What is candidaisis?

A

Fungal infection due to yeast - can be found on the tongue and looks like yellow/whitish film

259
Q

What are thrills?

A

Humming vibrations felt during palpation of the carotid artery

260
Q

Where do you listen to hear the mitral valve?

A

Apex of the heart, 4th-5th intercostal space at midclavicular line

261
Q

What is a bruit?

A

Murmur like sound of vascular rather than cardiac origin

262
Q

Where is an aortic stenosis best heard?

A

Over the aortic area - 2nd intercostal space right sternal margin

263
Q

Where is the pulmonic valve auscultated?

A

2nd left intercostal space

264
Q

What part of the stethoscope should you use for high pitched sounds like S1, S2, friction rubs, and regurgitations?

A

Diaphragm

265
Q

What part of the stethoscope should you use to listen to low-pitched sounds like S3, S4, and stenosis?

A

The bell

266
Q

What does ADL stand for?

A

Activities of daily living

267
Q

Which type of hearing loss can be caused by cholesteatoma?

A

Conductive hearing loss

268
Q

Which hearing pathway covers the inner ear?

A

Sensorineural

269
Q

Which hearing pathway covers the middle and outer ear?

A

Conductive

270
Q

Which hearing pathway is damaged by viruses, drugs, noise exposure, and Meniere’s disease?

A

Sensoneurial

271
Q

What cranial nerve is involved in the sensoneurial hearing pathway?

A

8 (vestibulocochlear)

272
Q

What artery passes upward just in front of the ear and is palpable during an examination?

A

Superficial temporal artery

273
Q

Which salivary glands lie superficial to and behind the mandible?

A

Parotid glands

274
Q

What part of the ear do the auricle, ear canal, and eardrum belong to?

A

External ear

275
Q

What part of the ear do the ossicles and eustachian tube belong to?

A

Middle ear

276
Q

What part of the ear do the cochlea and cochlear nerve belong to?

A

Inner ear

277
Q

What is presbyopia/hyperopia?

A

Far-sightedness

278
Q

What is myopia?

A

Near-sightedness

279
Q

What are scotomas?

A

Dark spots surrounded by normal vision

280
Q

What is diplopia?

A

Double vision

281
Q

What causes hoarseness?

A

Diseases of the larynx or extralaryngeal lesions pressing on laryngeal nerves

282
Q

What are nevi?

A

Moles

283
Q

How can longstanding diabetes mellitus lead to a difficult intubation?

A

It can cause limited cervical mobility

284
Q

What is ptosis?

A

Drooping of the upper eye lid

285
Q

What is exophthalmos?

A

Protrusion of the eyeball

286
Q

What part of the eyes are being tested by asking the patient to follow your finger as you sweep through the 6 cardinal directions of gaze?

A

Extraocular muscles

287
Q

What is nystagmus?

A

Fine rhythmic oscillation of the eyes

288
Q

Why can a history of radiation to the neck cause a difficult intubation?

A

It can cause fibrosis and immobility of the larynx

289
Q

Which geographic subdivisions are used as patient identifiers?

A

Any geographic subdivision smaller than a state

290
Q

A MAP greater than __mmHg is needed to perfuse the organs

A

60

291
Q

A MAP greater than __mmHg is needed to perfuse the organs in hypertensive patients

A

70

292
Q

What is an example of nonverbal communication?

A

Offering tissue

293
Q

What fundamental of interviewing involves expressing your desire to work with the patient?

A

Partnering

294
Q

What mental health problem is common yet under-diagnosed and under-treated?

A

Depression

295
Q

What position should the patient be in when you are auscultating with both the diaphragm and the bell? Where on the chest wall should you listen?

A

Patient is reclining, listen to RICS 2, LICS 2-5, and apex

296
Q

What position should the patient be in when you are auscultating with only the bell? Where on the chest wall should you listen?

A

Patient is in left lateral decubitus, listen to the apex

297
Q

What position should the patient be in when you are auscultating with only the diaphragm? Where on the chest wall should you listen?

A

Patient is sitting up and leaning forward while holding their breath, listen to RICS 2, LICS 2-5, and apex

298
Q

What are the 4 types of systolic murmurs?

A

1) Aortic stenosis
2) Mitral valve prolapse
3) Mitral regurgitation
4) Tricuspid regurgitation

Clinical Methods (4 decks)

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