PDX Flashcards
do no harm, never want to give a patient information that you dont is true, dont avoid relevant topics
Nonmaleficence
Your actions need to be motivated by what is in the patients best interest
Beneficence
Korotkoff Sounds
Normally patients blood flow through an artery produces no audible sounds
When a pressure cuff is applied and inflated above the systolic pressure in the artery the collapse stops flow and also produces no audible sounds
as the pressure in the cuff is reduced, the external pressure surrounding the artery becomes less than systolic allowing blood to rush into the artery and produce korotkoff sounds
Blood pressure ranges
Normal: <120 / <80
Prehypertension: 120-139/ 80-89
Hypertension 1: 140-159 / 90-99
Hypertension 2: >=160 / >=100
A fall in systolic pressure of 20mmHg or more after standing, especially when accompanied by symptoms and tachycardia
Diastolic fall of > 10
Orthostatic hypotension
Causes of Orthostatic Hypotension
Drugs, moderare or severe blood loss
prolonged bed rest
diseases of the ANS
Technique for orthostatic hypotension
Measure BP/HR with patient supine after patient is resting up to ten min, wait 3 min
Repeat measurements with patient standing
Do you use the bell or diaphragm to measure ausculatory pressure
BELL
inflate 30 above
White coat hypertension
> 140/90
Pyrexia Fever temp
greater than 98.6
Hyperpyrexia fever temp
> 106 F
Hypothermia Fever Temp
< 95 F
slowed breathing, caused by diabetic coma, drugs, and increased intracranial pressure
BRADYPNEA
breathing with freq. sighs caused by hyperventilation syndrome
Sighing respiration
rapid shallow breathing caused by restrictive lung disease, pleuritic chest pain, and elevated diaphragm
Tachypnea
periods of deep breathing (hyperpnea) followed by periods of apnea (no breathing), may be in children and elederly while sleeping, alo caused by heart failure, uremia, drugs and brain damage
Cheyne-Stokes breathing
prolonged expiration b/c narrowed airways, increased resistance to airflow, caused by asthma, chronic bronchitis and COPD
Obstructive breathing
hyperventilation = rapid deep breathing, caused by exercise, anxiety, and metabolic acidosis
Hyperpnea
= always deep breathing, but can be fast, normal or sloq
Kussmaul breathing
(biots breating) = unpredicatble irregularity – may be shallow or deep and stop for short periods, caused by respiratory depression and brain damage
Ataxic breathing
= pain is linked to tissue damage to the skin, musculoskeltal system or viscera but the sensory system is intact
Nociceptive Pain (somatic)
= is a direct consequence of a lesion or disease affecting the esomatosensory system
Neuropathic Pain
= there is alteration of central nervous system processing of sensation, leading to amplification of pain signals
Central sensitization pain
This pigment is golden yellow in subcutaneous fat and heavily keratinzed areas (palms/soles)
Carotene
Short, fine, nonpigmented hair
Vellus
Coarser, thicker, conspicous, usually pigmented hair
Terminal
White free edge of nail plate
Lanula
Seal between proximal nail fold and nail plate
Cuticle
this type of sweat gland is everywhere and regulates body temp
ECCRINE
This type of sweat gland is found in the axillary and genital areas, stress stench comes from bacterial decomposition
Apocrine
Sebaceous glands produce their fatty substance through
Hair follicles everywhere but palms and soles
red, swollen, and tender nail folds
Paronochia
enlarged nail free edge
Oncholysis
ground glass appearance, distal band of reddish brown, obliteration of lunula (nails)
Terrys Nails
white spots on nails
Leukoychia
Traverse white bands on nails
Mees Lines
Transverse linear depressions on nails
Beaus Lines
bulbous swelling of the soft tissue at the nail base, with loss of the normal angle between the nail and proximal nail fold
vasodilation
congenital heart disease
Nail Clubbing
Difference between plaque and papule
Both are elevated superficial lesions
Plaque = 1cm or larger
Papule = 1cm or lesss
Difference between vesicle and bulla
Both are fluid filled cavities
Vesicle is 1cm or less
Bulla is 1cm or more
AKA hives, a raised, itchy wheal that is usually a sign of an allergic reaction
URTICARIA
somewhat irregular, relatively transient, superficial area of localized skin edema
Wheal
red or purple disclorations on the skin that do not blanch on applying pressure
Purpura
visible and palpable leathery induration and thickening of the epidermis , often from chronic rubbing
lichenification
blanchable lesions
erythema
spider angioma
spider vein
cherry angioma
non blanchable lesions
petechia/purpura
ecchymosis
Which side of the chest wall is best to hear all the lobes of the lungs
LATERAL SIDE
Tracheal Position
the trachea bifurcates into its mainstem bronchi at the levels of:
sternal angle anteriorly and T4 spinous process posteriorly
funnel chest is characterized by a depression in the lower portion of the sternum, compression of the heart and great vessels may cause murmurs
Pectus Excavatum
this chest has an increased anteroposterior diameter
This shape is normal during infancy and often accompanies normal aging and COPD
Barrel Chest
nonpainful uncomfortable awareness of breathing that is inappropriate to the level of exertion (SOB)
Dyspnea
May show this breathing pattern while sleeping
Cheyne-Stokes Breathing
diphragmatic excursion length usually
5-6cm
Causes of when FREMITUS is decreased or absent:
Very thick chest wall
Obstructed bronchus
COPD
seperation of the pleural surfaces by fluid (pleural effusion)
neoplasms
What increases fremitus
UNILATERAL pnemonia
Abnormally high level for diphragmatic excursion is indicative of
Pleural effusion
high diaphragm from atelectasis
diaphragmatic paralysis
Positive tests of egophony, whispered pectoriloquy, bronchophony indicate
pleural effisions and pneumonia
discontinous, intermittent brief, like dots in time
CRACKLES
Late Inspiratory Crackles
Interstital lung disease, early CHF
Early Inspiratory Crackles
Chronic bronchitis, asthma
Midinspiratory and expiratory crackles
Bronchiectasis
precordial crackles synchronous with heartbeat, not respiration
Best heard in left lateral position due to mediastinal emphysema
Mediastinal Crunch
Hammans Sign
Continous, relatively high-pitched with hissing or shrill quality
Musical, often audible at mouth and through chest wall
Narrow airways, astma, COPD, chronic bronchitis, CHF
WHEEZES
airway is narrowed so much that wheezing cant be produced
Silent Chest
found in severe obstructive pulmonary
Wheeze is entirely or predominantly inspiratory
Partial obstruction of larynx or trachea
Stridor
Continous, musical, low-pitched with snoring quality
Secretions in large airways
Rhonchi
During diastole there is contraction of
and during systole there is contraction of
ATRIA
Ventricles – systole
What valves are open during DIASTOLE
TRICUSPID and MITRAL valves
(aortic and pulmonic are closed = S2)
During SYSTOLE what valbes are closed
TRICUSPID and MITRAL = S1 sound lub
The systolic murmur occurs between what
S1 and S2
ASsociated with ventricular ejection
Diastolic murmurs occur between
S2 and S1
associated with ventricular relaxing and filling
What sound is the atrial sound or atrial gallop
S4
JVP reflects pressue in what part
RIGHT ATRIUM
elevated JVP – right side CHF
Positive Rovsings Palpation of the LLQ increases the pain felt in the RLQ
APPENDICITIS
Positive murphys sign indicates
Patient places hand below right anterior costal margin midclavicular and the patient is told to inspire
Cholecytitis
sloshing sound when patient moves from side to side
Succussion Splash
this can be heard in patients with high blood pressure
BRUITS
if heard in systolic/diastole – arterial occulusion/insufficency
Rebound tenderness suggests
Peritoneal inflammation that can come with appendicitis
Positive iliopsoas and obturator test indicate what diagnostically
APPENDICTIS
during bowel movements, an intense urge with straining but little or no result
TENESMUS
red blood in the stool
Hematochoezia
black tarry stools
Melena
Smooth large tender liver suggests
Inflammation
if NONtender = cirrhosis
Kidney enlargement indicates
hydronephrosis, cysts and tumors
Bilateral enlargements – polycystic kidney disease
Pyelonephritis is an infection of what
Kidney and ureters
indicators of oropharyngeal dysphagia include
Drooling, naopharyngeal regurgitation and cough
Odynophagia = pain on swallowing
Consider what
esophageal ulceration from radiation
an increased hydrostatic pressure in cirrhosis can cause
ASCITES
a periumblical or upper abdominal mass with expansile pulsations that are 3cm or more wide would suggest
Abdominal Aortic aneurysm
pain may signal a rupture
T5-9 Left
Stomach
T7-T9 Left
Spleen/Pancreas
T6/7-T9
Liver/Gallbladder
T9-10
Small Intestine
T10-L1
Kidney
T10-T11 Right
Right Colon
T12-L2 Left
Left Colon
