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respiratory and cardiac > respiratory > Flashcards

respiratory Flashcards

1
Q

what does decreased tactile fremitus indicate

A 
Decreased or absent fremitus may be caused by excess air in the lungs or may indicate emphysema,
 pleural thickening 
or effusion, 
massive pulmonary edema,
 or bronchial obstruction.
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2
Q

What does increased tactile fremitus indicate?

A

Increased tactile fremitus (often coarser or rougher in feel) occurs in the presence of fluids or a solid mass within the lungs and may be caused by lung consolidation, heavy but nonobstructive bronchial secretions, compressed lung, or tumor.

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3
Q

Percussion tone indicators for lungs (resonance, hyperresonance, dullness)

A

resonance– normal
hyperresonance– may be normal in thin patients but may indicate hyperinflation
dullness– abnormal, found in solid or fluid filled structures (pneumonia who get symmetry of sounds)

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4
Q

bronchitis physical exam findings

A

INSPECTION: occasional tachypnea, shallow breathing, often no deviation from expected findings. PALPATION: tactile fremitus Undiminished. PERCUSSION: resonance. AUSCULTATION: breath sounds may be prolonged; occasional crackles, expiratory wheezes, and rhonchi.

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5
Q

pneumonia physical exam findings

A

INSPECTION: tachypnea, shallow breathing, flaring of alae nasi, occasional cyanosis, limited movement at times on involved side, splinting.
PALPATION: increased fremitus in presence of consolidation; decreased fremitus in presence of a concomitant empyema or pleural effusion.
PERCUSSION: dullness if consolidation is great. AUSCULTATION: a variety of crackles with lobar and occasional rhonchi; bronchial breath sounds, egophony, bronchophony, whispered pectoriloquy

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6
Q

pneumothorax physical exam findings

A

INSPECTION: tachycardia, cyanosis, respiratory distress, bulging intercostal spaces, respiratory lag on affected side, tracheal deviation with tension pneumothorax.
PALPATION: diminished to absent tactile fremitus; subcutaneous crepitance from air leaking.
PERCUSSION: Hyperresonance.
AUSCULTATION: diminished to absent breath sounds, Hamman sign if air underlies that area; diminished to absent whispered voice sounds.

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7
Q

asthma physical exam findings

A

INSPECTION: tachypnea, nasal flaring, intercostal retractions.
PALPATION: tachycardia, diminished fremitus. PERCUSSION: occasional hyperresonance, limited diaphragmatic descent; lower diaphragmatic level. AUSCULTATION: prolonged expiration, wheezes, diminished lung sounds

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8
Q

atelectasis physical exam findings

A

INSPECTION: delayed &/or diminished chest wall movement (respiratory lag), narrowed intercostal spaces on affected side, tachypnea.
PALPATION: diminished fremitus, apical cardiac impulse deviated ipsilaterally, trachea deviated ipsilaterally. PERCUSSION: dullness over affected lung. AUSCULTATION: upper lobe: bronchial breathing, egophony, whispered pectoriloquy; lower lobe: diminished or absent breath sounds, wheezes, rhonchi, and crackles in varying amounts

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9
Q

Bronchiectasis physical exam findings

A

INSPECTION: tachypnea, respiratory distress, hyperinflation, clubbing (esp. cystic fibrosis).
PALPATION & PERCUSSION: few, if any consistent findings. AUSCULTATION: variety of crackles, usually coarse, and rhonchi, sometimes disappearing after cough

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10
Q

COPD physical exam findings

A

INSPECTION: respiratory distress, audible wheezing, cyanosis, distention of neck veins, peripheral edema (in presence of right-sided heart failure); nail clubbing. PALPATION: somewhat limited mobility of diaphragm and diminished vocal fremitus.
PERCUSSION: occasional hyperresonance. AUSCULTATION: postpertussive rhonchi (sonorous wheezes), sibilant wheezing, inspirational crackles

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11
Q

emphysema physical exam findings

A

INSPECTION: tachypnea, deep breathing, pursed lips, barrel chest, thin/underweight.
PALPATION: apical impulse may not be felt; liver edge displaced downward; diminished fremitus.
PERCUSSION: hyperresonance, limited descent of diaphragm on inspiration; upper border of liver dullness pushed downward.
AUSCULTATION: diminished breath and voice sounds with occassional prolonged expiration; diminished audibility of heart sounds; only occasional adventitious lung sounds

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12
Q

Stridor

A

a harsh, high-pitched, crowing, piercing inspiratory sound, such as the sound often heard in acute laryngeal (upper airway) obstruction; may sound like crowing and be audible without a stethoscope. This is always an abnormal finding at any age.

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13
Q

RALES

A

An abnormal sound heard on auscultation of the chest, produced by passage of air through bronchi that contain secretion or exudate or that are constricted by spasm or a thickening of their walls, also known as crackle.

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14
Q

rhonchi

A

oud, low, coarse sounds like a snore most often heard continuously during inspiration or expiration; coughing may clear sound (usually means mucus accumulation in trachea or large bronchi)

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15
Q

fine crackles

A

high-pitched, discrete, discontinuous crackling sounds heard during the end of inspiration; NOT cleared by a cough

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16
Q

Coarse crackles (Coarse rales)

A

Loud, low-pitched, bubbling and gurgling sounds that start in early inspiration and may be present in expiration. Sounds like opening a velcro fastener.

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17
Q

Pleural Friction Rub

A

A coarse grating or crunching sound.
Caused by inflamed surgace of the visceral and parietal pleura rubbing together.
May be associated with pleurisy, TB, pneumonia, pulmonary infarction, cancer, etc.
Steroids and antibiotics may be incicated.

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18
Q

Wheeze

A

Continuous, high-pitched, musical squeak or whistling sound occurring on expiration and sometimes on inspiration when air moves through a narrowed or partially obstructed airway.

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19
Q

bronchophony

A

9 heard louder and clearer even at a distance from larynx - usually muffled normally - shows signs of fluid or solid tissue in alveoli–> pneumonia, atelectasis, tumor

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20
Q

whisper pectoriloquy

A

whisper “1, 2, 3” the transmission of sounds should be faint and muffled. it may be inaudible.
IF clearly audible → Indicative of consolidation

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21
Q

Egophony

A

The patient is instructed to say “E” and it sounds like “A”. This would indicate consolidation of the lung tissue as with a pneumonia-like condition.

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22
Q

Stethoscope diaphragm

A

its flat edge is best for high-pitched sounds such as:
breath
bowel
normal heart sounds
Hold the diaphragm firmly against the person’s skin – firm enough to leave a slight ring afterward

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23
Q

bell of stethoscope

A

good for listening to low pitched sounds; apply lightly to chest (weight of stethoscope); make sure entire circumference is in contact with the skin

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24
Q

How should paradoxical breathing in a newborn be treated?

A

No intervention is needed. Paradoxical breathing in a newborn is common, especially during sleep. Newborns rely primarily on the diaphragm for their respiratory effort, only gradually adding the intercostal muscles. Infants quite commonly also use the abdominal muscles.

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25
Q

mitral regurge

A

5ICS and MCL

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26
Q

Mitral Stenosis

A

5th ICS

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27
Q

Aortic insuffencency

A

2nd ICS RSB diastole

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28
Q

aortic stenosis

A

2nd ICS RSB systole

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29
Q

s1

A

lubb” - marks the beginning of SYSTOLE

closure of tricuspid and mitral valves dull quality and low pitch onset of ventricular systole (contraction)

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30
Q

S2

A

Aortic and pulmonic valve closure “dub” - marks the beginning of DIASTOLE

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31
Q

What patient position is best for auscultating high-pitched cardiac murmurs?

A

siting up and leaning slightly forward during expiration (with the stethoscope DIAPHRAGM)

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32
Q

What patient position is best for auscultating low-pitched cardiac filling sounds during diastole?

A

left lateral recumbent position (with BELL of stethoscope)

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33
Q

pulsus alternans

A

a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.

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34
Q

Hear S1and S2

A

with the Diaphragm

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35
Q

Hear S3 and S4

A

with the bell

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36
Q

Aortic is heard at

A

2nd ICS R

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37
Q

Pulmonic

A

2nd ICS L

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38
Q

Tricuspid

A

5th ICS L

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39
Q

Mitral

A

5th ICS L MCL

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40
Q

S3 seen with

A

CHF, wet,

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41
Q

S3 is herd at the Apex why

A

ventricular gallop

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42
Q

s4 is herd at the base why

A

atrial gallop

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43
Q

intensity grades of murmurs

A 
1= faint only herd if the practitioner is aware
2= quite but herd immediately
3= moderately loud 
4= loud with palpable thrill
5= very loud hear with stethoscope partly off chest
6= herd with out stethoscope
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44
Q

Non modifiable risk for CVD

A

Age, Gender, Genetics

45
Q

Modifiable risk for CVD

A

HTN, HLD, DM

46
Q

CHADS model is

A

congestive, heart, age, diabetes, stroke

47
Q

CHADs model stand for

A

score helps to predict how high the is of not using anticoagulation.

48
Q

Xanthomas

A

high blood lipids,

49
Q

A 52 yr old female with known CHF reports dyspnea with minimal exertion (walking from room to room). In what NYHA functional class is she?

A

Class III

50
Q

whisper pectoriloquy

A

whisper “1, 2, 3” the transmission of sounds should be faint and muffled. it may be inaudible.
IF clearly audible → Indicative of consolidation

51
Q

aortic stenosis sound like

A

harsh systolic murmur

52
Q

Cardiac cycle systole is

A

ventricular contraction

53
Q

disastolye is

A

ventricular relaxation

54
Q

S1 is when

A

closing of the mitral/tricuspid valve

55
Q

S2 is when

A

closing of the aortic/ pulmonic valves.

56
Q

Sinus node is the

A

pacer 60 /min

57
Q

AV node is at the

A

atrial septum

58
Q

Bundle of His

A

to the ventricles

59
Q

End of conduction is at the

A

Perkinje fibers

60
Q

Blood flows from the SVC to

A

RA, Tricuspid valve, RV, Pulmonic valve.

61
Q

Pulmonic valve to the

A

Pulmary artery , LA, LV, Aortic valve, aorta

62
Q

P wave is

A

atrial depolarization

63
Q

P-R interval is

A

filling of the ventricles

64
Q

QRS

A

impulse throug the budle of hiss to the L perkinje fibers

65
Q

t wave is

A

repolarization of ventricles

66
Q

Histroy cues for cardiac assessment

A

sob with excertion
chest pain
Main complain is Fatigue

67
Q

child cardiac history clues

A

working at breathing, pallor, limited activity

68
Q

cardiac lifestyle risk factors

A

smoking, seditary lifestyle, obesity, hostility( type A)

69
Q

emerging risk factors

A

chlamydia pnemonia, elevated homocystinemia, CRP

70
Q

Most common presenting symtoms

A

fatigue/ activity intolerance

71
Q

stable angina is

A

predictable pattern

72
Q 
NY heart association ( NYHA) for SOB in heart failure 
class 1=
A

No symptoms and no limita>on in ordinary physical activity,

73
Q

NYHA class2=

A

No symptoms and no limitation in ordinary physical activity,

74
Q

NYHA class 3=

A

Marked limitation in activity due to symptoms, even during less-than- ordinary activity walking shortt distance < 100m

75
Q

NYHA class 4=

A

Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.

76
Q

CHADS scorehelps to predict how high the risk is of not using

A

anticoagulation

77
Q

CHADs score of 2 or above indicates

A

need for anticogulation coumadin

78
Q

CHADS score of 1 indicates

A

nedd for ASA or coumadin

79
Q

Osler’s nodes

A

painful erythematous nodules Associated w/infective carditis

80
Q

Janeway lesion

A

seen in acute bacterial Endocardid>s..flat..painless

81
Q

Xanthomas

A

people with high blood lipids

82
Q

Arcus senilis

A

high lipids

83
Q

ABI is for

A

Predict severity of peripheral arterial disease

84
Q

ABI normal is

A

1.0or >

85
Q

ABI at 0.9 is

A

at risk

86
Q

ABI at ,0.6-0.8 is

A

borderline ischemia

87
Q

ABI at < 0.5 is

A

severe ischemia

88
Q

edema 1+ is

A

mild pitting 0-1/4”

89
Q

edema 2+ is

A

1/4-1/2” moderate pitting

90
Q

edema 3+ is

A

1⁄2 - 1” piting (severe)

91
Q

edema 4+ is

A

> 1” (severe)

92
Q

JVP of >4cm is

A

Right-sided Heart Failure (most common)

• Increased right atrial pressure

93
Q

S1 is loudest at

A

Loudest at apex- mitral & tricuspid areas

94
Q

S2 is the loudest at

A

Loudest at base-aortic & pulmonic areas

95
Q

Mitral heat sound at the

A

5th ICS L, MCL, >S1

96
Q

Aortic heart sound at the

A

2nd ICS R, >S2,

97
Q

S3 is heard with

A

Pathological seen in CHF, sign of being “wet”, ventricular gallop

98
Q

S4 is heard with

A

Atrial gallop,Always pathological

99
Q

Murmurs sound like

A

blowing, harsh, rumbling, musical

100
Q

Mitral regurge haer at

A

5ICS MCL

101
Q

Pericardial friction rub sounds like

A

a high-pitched or squeaking sound; it may be systolic, diastolic and systolic

102
Q

murmur grade 1=

A

faint heard only if know 1/6

103
Q

murmur grade 2=

A

quiet but heard immediately 2/6

104
Q

murmur grade 3=

A

moderately loud 3/6

105
Q

murmur grade 4=

A

loud 4/6 w/palpable thrill

106
Q

murmur grade 5=

A

very loud heard w/stethoscope partly off chest wall 5/6

107
Q

murmur grade 6=

A

heard w/stethoscope totally off the chest wall

108
Q

What makes the first heart sound (S1)?

A

Closure of the mitral valve

109
Q

a history of chronic congestive heart failure with an enlarged heart, but his condition is well controlled by medication. You perform a cardiac examination. With the patient in the leu lateral decubitus position, what is your most likely finding when palpating for his apical impulse?

A

A diffuse apical impulse greater than 3.0 cm that occupies more than one interspace

respiratory and cardiac (3 decks)

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