Sectional 2- Lab Info Flashcards
Signs and symptoms of pericarditis include: _ of _, increased _, and decreased _ _. Easing factors are _ _, _ on all _, and sitting _.
Signs and symptoms:
- SHORTNESS of BREATH
- increased HR
- decreased STROKE VOLUME
Easing factor: BENDING FORWARD, KNEELING on all FOURS, and sitting UPRIGHT
If someone has had a previous MI, if it happens again the symptoms will be _ _. If symptoms are _ than it is probably _ _.
If someone has had a previous MI, if it happens again the symptoms will be THE SAME
If the symptoms are DIFFERENT than it is probably SOMETHING ELSE
Muscle movements associated with deep breathing, left side bending of the trunk, bilateral trunk rotation and a supine position are all?
Are all AGGRAVATING FACTORS for pericarditis
How do you differentiate b/w pericarditis and an MI: pericarditis will be _ dependent and will have a _ _ rub. Where is it best heard?
Pericarditis will be POSITION dependent and will have a PERICARDIAL FRICTION rub
PMI (point of maximal impulse)
-left 5th intercostal space mid clavicular line
A _ _ _ will sound loud, grating, creaking or squeaking and will resemble snoring. A _ _ _ will sound hard, grating, scratching or crunching.
PLEURAL FRICTION RUB- loud, grating, creaking, squeaking, snoring
PERICARDIAL FRICTION RUB- hard, grating, scratching, or crunching
The pleural friction rub is best heard over the _ _ or the _, _ or _ _ of the lung
Best heard over the LOW AXILLA or the ANTERIOR, LATERAL, or POSTERIOR BASE of the lung
The pleural friction rub occurs in late _ and early _, but will cease when a patients _ _ _. To auscultate have the patient _ _ and _ _.
Occurs in late INSPIRATION and early EXPIRATION, but will cease when the patient HOLDS THEIR BREATH
To auscultate have the patient LEAN FORWARD and STOP BREATHING
The pericardial friction rub occurs in relation to the _, and is most noticeable during _ _ and continues even when _ _ _ _.
Occurs in relation to the HEARTBEAT, and is most noticeable during DEEP INHALATION and continues even when PATIENTS HOLDS THEIR BREATH
_ of the aorta is a narrowing that occurs after the subclavian artery. Can _ _ in the arms and head, and _ _ in the legs and seriously _ the _. How do you test?
COARCTATION of the aorta is a narrowing .. . .
Can INCREASE BP in the arms and head, and DECREASE PRESSURE in the legs and seriously STRAIN the HEART
Test by comparing the femoral and radial pulses (should beat at same time or with the femoral pulse preceding the radial pulse)
The most common sign of coarctation of the aorta is _ _ as measured in the _
Is HIGH BLOOD PRESSURE as measured in the ARM
When comparing the femoral and radial pulses to assess for coarctation the therapist wants to be on the _ _ side. Suspicion should be raised if there is any delay in the _ _. If so you should?
Therapist wants to be on the PATIENTS LEFT side
Suspicion should be raised if there is a delay in the FEMORAL PULSE
If so you should REPORT FINDINGS TO PHYSICIAN
When measuring ABI you should you take the _ _ from the dorsalis/ tibial pedis pulses and the L/R arm. When should you be concerned?
Take the HIGHEST NUMBER from the . . .
Should be concerned if it’s greater than 1.2 (dr. Garcia)/ 1.5 (handout) or less than .8-.9
_ are abnormal swishing sounds heard on auscultation of narrowed or obstructed arteries. Should be assessed if patients history includes: age over _, _, _ in the neck/ back/ abdomen/ flank, associated signs of _ and _ episodes.
BRUITS are abnormal swishing sounds heard on auscultation . .
Should be assessed if pt HX includes:
- age over 65
- CAD
- PAIN in the neck/ back/ abdomen/ flank
- associated signs of PVD
- SYNCOPAL episodes
You can cause a false bruit by?
Pushing down too hard with the stethoscope
What arteries do should you check for BRUITS
County FAIR
- carotid artery
- femoral artery
- Abdominal aorta
- iliac artery
- renal artery
When auscultating for BRUITS you should _ _ _ on abdomen
You should JUST REST DIAPHRAGM on abdomen
If aorta is narrowed it will cause a _ in _ after narrowing and a _ in _ before. Can cause _ bleeds, _, _, and _ feet. In a child they will have a _ _ _ and/or _ easily.
It will cause a DECREASE in PRESSURE- after narrowing
It will cause an INCREASE IN PRESSURE- before narrowing
Can cause NOSE bleeds, HTN, HEADACHES, and COLD feet
In a child they will have POOR EXERCISE TOLERANCE/ FATIGUE easily
The _ _ and _ _ are the 2 most common sites for a peripheral arterial anuerysm, occurs almost exclusively in _, and is most often caused by _.
The POPLITEAL SPACE and FEMORAL TRIANGLE are the 2 most common sites for peripheral arterial aneurysm, occur almost exclusively in MEN, and is most often caused by ATHEROSCLEROSIS
A peripheral arterial aneurysm will present as a _ _ that is _ _ or _ in diameter and will cause _ _ in the LE
Will present as a PULSATING MASS that is 2 cm or MORE in diameter and will cause ISCHEMIC SYMPTOMS in the LE (intermittent claudication, resting pain, thrombosis)
A right ABI equals ratio of _ of the right pressures (posterior tibialis or dorsal pedis) divided by _ arm pressure in? Left ABI?
Right ABI= HIGHER of the right foot pulses/ HIGHER arm pressure in RIGHT OR LEFT
Left ABI= HIGHER of the left foot pulses/ HIGHER of the arm (left or right)
ABI is taken using a _ and BP cuff on the LE pulses and a _ and BP cuff on the UE
LE pulses use DOPPLER and BP cuff
UE pulse use STETHOSCOPE and BP cuff
_ _ _ is the filling of the jugular vein with excessive fluid, such that it becomes visibly bulging. Often due to?
JUGULAR VEIN DISTENTION is the filling of the . . .
Often due to RIGHT SIDED HEART FAILURE
With _ _ you are palpating for vibrations that can be felt when an individual is speaking. It is evaluated at _ _ starting above the scapula and ending just below.
With TACTILE FREMITUS you are palpating for vibration . . .
It is evaluated a 6 LOCATIONS starting above the scapula and ending just below
Changes in tactile fremitus: increase could indicate _ or decreased bilaterally could mean _.
Increase- PNEUMONIA
Decrease bilaterally- COPD
Differentiating sound: _ sounds dull; _ sounds resonant/ lower pitched; _ sounds tympanic/ hollow quality; _ _ sounds flat/ high pitched
LIVER sounds dull
LUNGS sound resonant/ lower pitched
STOMACH sounds tympanic
THIGH MUSCLE sounds flat
What is the range of normo-active bowel sounds when auscultating abdomen?
Norma-active is 5-34 clicks/ gurgles per minute
When using the blue/ green filaments you should apply _ _, if using the red apply _ _.
When using the blue/ green filaments you should apply 3 TIMES if using the red apply ONLY ONCE
What is the monofilament size that is used to decipher if patient is at risk for ulceration? How much pressure should you apply with the filament?
5.07
Apply enough pressure to Bend the monofilament (approx. 10 grams)
_ of _ _ means that the patient will be unable to detect discomfort from ulcerations, cuts, blisters, puncture wounds or pressure necrosis from poorly fitted shoes.
LOSS OF PROTECTIVE SENSATION
Disease progression with diabetes: decrease in _ _ followed by decrease in _ _ (_) and then a decrease in _. Sensory symptoms such as numbness, prickling and pain will start will coincide with?
Decrease in VIBRATORY SENSE followed by a decrease in PRESSURE SENSATION (MONOFILAMENT) and then a decrease in REFLEXES.
Sensory symptoms . . . Will coincide with VIBRATORY LOSS
Vibrational sense if often the first sense to be lost in _ _. What instrument is used to test? Also used to test?
Is often first sense to be lost in PERIPHERAL NEUROPATHY
Tuning fork is used to test, also used to test hearing loss
A tuning fork can also be used to detect _ along with a . Test is known as the _ _ test (). (2)Using an activated _ Hz tuning fork on the distal point if you _ _ the vibration through the stethoscope or if _ _ _ it is indicative of a fracture _ _
Tuning fork can be used to detect FRACTURES along with a STETHOSCOPE
Test is known as the AUSCULTATORY PERCUSSION TEST (APT) or the SEGMENTAL BRADFORD test
Using an activated 128 Hz tuning fork on a distal point if you DON’T HEAR the vibration through the stethoscope of if the patients experiences pain it is indicative of a fracture IN BETWEEN
Tibial or fibular fractures can also be tested for by?
By compressing/ squeezing distal and proximal Tib/ fib
What are the 4 main domains that you should look for when examining skin?
Color (any color changes, bruising, jaundice, cyanosis)
Moisture (may be associated with fever, cancer, hyperthyroidism)
Turgor and texture (general state of hydration, pinch skin and look for rebound)
Temperature
What are the ABCDEF of warning signs for malignant melanoma?
A- Asymmetry
B- border irregularity
C- color variation (s/t brown, tan, black, white, red, blue)
D- diameter LARGER THAN 6 mm (tip of pencil eraser)
E- elevation
F- friable (flaky, sloughs skin at site of mole)
What should you do if you find a suspicious mole on your patient?
Ask them if they are aware that it is there
While setting a patient up for cervical traction the PT notices a mole that is brown and black with diffuse edges on the patients neck. The therapist should:
A: discontinue treatment, refer back to MD
B: continue treatment, document skin condition
C: tell patient to have the physician inspect the mole
D: continue with the traction and report the findings to the MD immediately
D (state board question)
What are the normal characteristics of lymph nodes: size- _ than _ cm; consistency- _ and _; tender/ pain- -; mobility- _.
Size- LESS THAN 1 cm
Consistency- SOFT AND SQUISHY
Tender/ Pain- NON- TENDER
Mobility- MOBILE
When observing hair you should pay attention to?
Pay attention to the PATTERN OF DISTRIBUTION
Anemia, heavy metal poisoning, hypopituitarism, and nutritional disease can all cause? Cushing’s disease, tumors of the adrenal glands and gonads can cause?
Anemia, heavy metal . . . - HAIR LOSS
Cushing’s disease, tumors . . . -INCREASE HAIR PATTERNS
_ _ _ are associated with heart disease.
RED NAIL BEDS
_ or _ of the nail surface is associated with psoriasis or inflammatory arthritis
PITTING or RIPPLING of the nail surface . . .
Clubbing is a painless increase in tissue around the ends of the fingers, or inversion of the nail that is associated with?
Associated with LUNG DISEASE
Nail changes are _ the _ _ of serious illness.
Are RARELY THE FIRST CLUE of serious illness
Lymph nodes are usually present in clusters in the _, on either side of the _ and in the _.
In the ARMPITS on either side of the NECK and the GROIN
A patient is being treated for secondary Lymph edema of the right arm as a result of a radical mastectomy and radiation therapy. The resulting edema (stage 1) can best be managed in PT by:
A: intermittent pneumatic compression, extremity elevation, massage
B: kinectics, extremity positioning in elevation and massage
C: AROM and extremity positioning in a functional hand/ arm position
D: isometric exercises, extremity positioning in elevation and compression bandaging
A
If you ask patient if physician is aware of condition, has it remained unchanged since the last time the physician saw you, and they ANSWER NO: what should you ask net? What answer might cause your to suspend your PT treatment pending MD appointment and recommendation
Should ask- When is your next MD visit?
If patient answers GREATER THAN 2 WEEKS- suspend treatment until after MD has assessed condition
A patient was referred for PT following a right breast lumpectomy with axillary lymph node dissection. Scapular control is poor with UE flexion or abduction. PT intervention should focus on:
A: active assistive pulley exercises to assist RC muscles as a result of damage to the subscapular nerve
B: Gravity assisted right UE to promote scapular control following damage to the long thoracic nerve
C:rhomboid strengthening as a result of disuse of scapular stabilizers
B
_ is a biochemical disorder that is caused by back up/ blockage of biochemical a.
FIBROMYALGIA
The _ produces several hormones that help oxygen get into the cells. Making it the _ _ of the _.
The THYROID produces several . . . .
Making it the MASTER GLAND of the METABOLISM
How can you differentiate if chest pain is GI or cardiac in nature? (2)
All GI problems are food related (eating will make it feel better/ worse)
Positioning can affect chest pain if it is GI in nature
Chest pain is _ if it can be reproduced with palpation. Often associated with history of _, _ or _.
Chest pain MUSCULOSKELETAL if it can be reproduced . . .
Often associated with history of TRAUMA, INJURY OR OVERUSE
Diagnosis of _ is made if patient has shoulder disorder, chest pain changes with breathing and the patients discomfort is brought on with light pressure to the Xiphoid process.
Diagnosis of XIPHODYNIA
How can you differentiate an anxiety attack from cardiac event
Anxiety/ panic attack will not be associated with nausea usually
Normal response to activity: SBP will _ _, HR will rise _ to _, and DBP will _ around - _.
SBP will INCREASE STEADILY
HR will rise PROPORTIONAL to WORKLOAD
DBP will INCREASE around 10-15 mmHg
Red flags/ abnormal heart rate response: HR rises _ to _ in workload; _ or _ in HR despite _ in workload
HR rises DISPROPORTIONAL TO INCREASE in workload
MAINTENANCE OR DECREASE in HR despite INCREASE in workload
Red flags/ abnormal response SBP: SBP rises _ to _ in workload; _ or _ in SBP despite _ in workload
SBP rises DISPROPORTIONATELY to INCREASE in workload
MAINTENANCE OR DECREASE in SBP despite INCREASE in workload
Red flag/ abnormal response DBP: resting DBP _ _ _ _ or _ of _ than _ over resting rate causes an ischemic episode that pushed patient _ _.
Resting DBP GREATER THAN 95 mmHG
INCREASE OF GREATER THAN 15 mmHg over resting rate
. . . Causes an ischemic episode that pushed patient INTO FAILURE
_ _ is angina that occurs at a predictable rate and is produced by exercise, exertion or stress. _ _ is angina that occurs at rest or with exertion and has a changed intensity, frequency and/ or duration.
STABLE ANGINA- exercise/ exertion produced, predictable
UNSTABLE ANGINA- unpredictable and varying
_ _ is angina that will wake someone from sleep with the same characteristics of angina from exertion. Can be due to _ or sign of _ _ _.
NOCTURNAL ANGINA . . .
Can be due to DREAM or sign of CONGESTIVE HEART FAILURE
_ _ is angina that occurs while at rest and is secondary to CAD. Can be severe and not readily relieved by _
PRINZMETAL’S ANGINA
Can be severe and not readily relieved by NITROGLYCERIN
MI can manifest differently in _ than in _. Can have _ or _ _ or _ pain, or can have?
MI can manifest differently in WOMEN than in MEN
Can have INTERSCAPULAR or RIGHT BICEPS, or EPIGASTRIC pain, or can have NO CHEST PAIN AT ALL
The likelihood of heart attack increases to 40% on _ _
Increases to 40% on MONDAY MORNING
In older females a _ _ change or _ may be common with an MI
A MENTAL STATUS change or CONFUSION may be common . .
MI in women is often mistaken for?
GERD
Pleuritis can be differentiated from an MI by?
Auscultating the base of the lung, have patient lean forward and stop breathing (if pleural rub stops it’s the lungs that are the issue)
If you see _ _ in the trachea you should report it.
If you see ANY SHIFT in the trachea . . .
The pulse ox cannot determine?
Hemoglobin levels, only looks at O2 saturation- don’t confuse the two
What is the cut-off for O2 sats? PO2? . . . IN ARTERIAL BLOOD
90% or below for O2
55-65 mmHg PO2
Normal O2 sat and PO2 for: arterial blood, venous blood
Normal O2: 97%; Normal PO2: 90-95 mmHg for ARTERIAL
Normal O2: 75%; Normal PO2: 46 mmHg for VENOUS
Dyspnea, Pulmonary edema, Rales (loud, bellowy dry cough- can be exercise induced) and an increased respiratory rate are all signs and symptoms of _ _ _ failure
All signs and symptoms of LEFT SIDED HEART failure
Position dependent edema and jugular vein Distention are both signs and symptoms of?
Both signs and symptoms of RIGHT SIDED HEART FAILURE
Study showed that _ improved prediction of fatal MI in addition to considering conventional _ _.
Showed that ABI in addition to considering conventional RISK FACTORS improves prediction of fatal MI
_% of kids who have had Atelectasis will have HTN
11% of kids . . .
