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PCM 2 > Semester 3 Final > Flashcards

Semester 3 Final Flashcards

1
Q

Levels of consciousness

A

Alert: responds fully and appropriately

Lethargic: requires loud voice for response

Obtunded: Need to shake patient gently for response

Stupor: Need painful stimulus for response

Coma: Unarousable even with painful stimuli

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2
Q

Normal respiratory rate

A

14-20 per minute in adults up to 44 per minute in infants

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3
Q

What is tachypnea?

A

Rapid shallow breathing

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4
Q

What is Cheyne-Stokes Breathing?

A

Oscillatory breathing with periods of deep breathing alternating with periods of apnea

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5
Q

Describe breathing pattern of obstructive breathing

A

Prolonged expiration because of increased resistance to air flow (asthma, chronic bronchitis, COPD)

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6
Q

Normal heart rate

A

60-100 bpm

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7
Q

What is sinus arrhythmia?

A

Heart rate varies cyclically with breathing. Speeds up with inspiration and slows down with expiration.

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8
Q

Name the following regions of the ear

A
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9
Q

What is wrong with this ear?

A

Acute Otitis Media

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10
Q

What is wrong with this ear?

A

Serous Otitis Media

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11
Q

What is wrong with this ear?

A

Hemotympanum

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12
Q

What is wrong with this ear?

A

Pressure equalizer (PE) tube

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13
Q

What is wrong with this ear?

A

Tympanic membrane perforation

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14
Q

What is wrong with this ear?

A

Otitis Externa

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15
Q

Identify the structure below

A

Nasal polyp

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16
Q

Identify the structure below

A

Middle turbinate adhesions

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17
Q

What condition does this patient have?

A

Allergic rhinitis

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18
Q

What condition does this patient have?

A

Nasal septal perforation

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19
Q

What does this patient have?

A

Patient had tonsils removed

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20
Q

What is this structure called?

A

Bifid uvula

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21
Q

Differential diagnosis for neck masses

A

Branchial cleft cyst

Goiter

Infected cyst

Submental cyst

Lymph node metastasis

Submandibular abscess

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22
Q

Describe diffuse enlargement of the thyroid

A

No palpable nodules

Caused by: Grave’s disease, Hashimoto’s thyroiditis and endemic goiter

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23
Q

What could cause a single nodule of the thyroid

A

Could be cyst, benign tumor, or malignancy

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24
Q

What could cause a multinodular goiter?

A

Metabolic disorder

Check family history

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25
Q

Symptoms of hyperthyroidism

A

Nervousness

Weight loss even with increased appetite

Excessive sweating, heat intolerance

Palpitations

Frequent bowel movements

Tremor and proximal muscle weakness

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26
Q

Signs of hyperthyroidism

A

Warm, smooth, moist skin

Graves: eye signs

Increased systolic and diastolic blood pressures

Tachycardia or Afib

Hyperdynamic cardiac pulsations with accentuated S1 tremor, proximal muscle weakness

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27
Q

Symptoms of hypothyroidism

A

Fatigue, lethargy

Modest weight gain with anorexia

Dry course skin, cold intolerance

Swelling of face, hands, legs

Constipation

Weakness, muscle cramps, arthralgias, paresthesias, impaired memory and hearing

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28
Q

Signs of hypothyroidism

A

Dry coarse skin, yellowish, nonpitting edema, hair loss

Periorbital puffiness

Decreased systolic and diastolic BP

Bradycardia

Decreased heart sounds

Impaired memory, hearing loss, somnolence

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29
Q

Location of branchial cleft cyst vs. thyroglossal duct cyst

A

Branchial cleft cysts are anterior to the midportion of the sternocleidomastoid muscle.

Thyroglossal duct cysts are at midline of neck just above thyroid cartilage.

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30
Q

Steps of the eye exam

A

Visual acuity and visual fields

Pupils

External eye exam

Extraocular muscles

Fundus exam

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31
Q

Patient is completely blind in the right eye, where is the defect?

A

Right optic nerve

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32
Q

Patient has bitemporal hemianopsia, where is the defect?

A

Optic chiasm

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33
Q

Patient has left homonymous hemianopsia, where is the defect?

A

Right optic tract or right optic radiation

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34
Q

What is Horner’s syndrome?

A

Ptosis, miosis, and anhydrosis of one side.

Affected pupil is small, reacts briskly to light and near effort. Eyelid is droopy, with loss of sweating on forehead.

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35
Q

What is ptosis?

A

Drooping of the upper eye lid

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36
Q

What is exophthalmos?

A

Wide eyed stare with retracted eyelids seen in hyperthyroidism

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37
Q

Describe the innervation and actions of the extraocular muscles

A

LR6, SO4, 3

IO, UO; SO, DO

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38
Q

What is ectropion?

A

Lower eye lid is turned outward exposing the pulpebral conjunctiva

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39
Q

What are the components of the retina visible on fundoscopic exam?

A
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40
Q

What is wrong with this optic disc?

A

Nothing. This is a normal optic disc.

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41
Q

What is wrong with this optic disc?

A

Papilledema due to increased intracranial pressure. There are no clear margins of the optic disc.

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42
Q

What is wrong with this optic disc?

A

Glaucoma

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43
Q

What is wrong with this eye?

A

Hypertensive retinopathy

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44
Q

What is wrong with this eye?

A

Retinal emboli

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45
Q

What is wrong with this eye?

A

Age related macular degeneration

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46
Q

What is wrong with this eye?

A

Diabetic Retinopathy

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47
Q

What are the two processes that cause the majority of vascular disease in the US?

A

Atherosclerosis and Thrombophlebitis

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48
Q

What are the risk factors for atherosclerosis?

A

Diabetes mellitus

Hyperlipidemia

Hypertension

Smoking

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49
Q

What are the risk factors for thrombosis?

A

Stasis

Hypercoagulable state

Endothelial injury

(“Virchow’s triad”)

50
Q

Describe the Allen’s test

A

Test for patent ulnar artery by having patient elevate hand and make fist for 30 seconds. Doctor compresses radial and ulnar arteries and patient opens hand. With pressure on the radial artery, doctor releases ulnar artery. All 5 fingers should turn pink within 7 sec if ulnar artery is patent.

51
Q

What is the grading system for pulses?

A

0= nonpalpable

1+ = weak pulse

2+ = normal

3+ = increased

4+ = bounding/ aneurysmal

52
Q

What is the difference between a thrill and a bruit?

A

Thrills are palbable vibrations wheras bruits are audible sounds. Both indicate turbulent flow.

53
Q

What is Buerger’s test?

A

Tests for arterial insufficiency in the lower extremity. Elevate patient leg to 45 degrees for 1 minute and observe pallor. Allow patient to sit with foot dangling and observe rubor.

54
Q

What are some signs of arterial insufficiency?

A

Shiny skin

Hair loss

Thickened toenails

Gangrene

Foot ulceration (especially diabetics)

Color changes indicating vasospasm (Raynaud’s)

55
Q

What are the signs of acute venous insufficiency caused by a DVT?

A

Edema

Skin discoloration (redness)

Congested foot veins

Homan’s sign: calf pain w/ passive dorsiflexion

56
Q

What are the signs of chronic venous insufficiency?

A

Edema

Hyperpigmentation

Ulceration

Pitting edema

**Caused by venous valve damage**

57
Q

How does the location of commonly found ulcers differ between arterial and venous insufficiency?

A

In arterial insufficiency, ulcers are typically found on the toes and feet. Venous insufficiency usually causes ulcers over the medial malleolus

58
Q

What is the shape of the normal doppler ultrasound waveform of a peripheral artery? What causes changes to this?

A

Triphasic

Calcifications: biphasic

Poor arterial flow: monophasic

59
Q

What is the ABI?

A

Ankle-brachial index

= systolic pressure at ankle / systolic pressure in arm

**Normal is 1

Change of .15 is considered significant

60
Q

What are the physiologic changes to vital signs that occur with aging?

A

Height and weight: malnutrition, osteoporosis, increased fat/decreased muscle mass

Blood pressure: Systolic rises with age, diastolic rises until age 60, atherosclerosis, orthostatic hypotension

HR and rhythm: resting HR may decrease, loss of SA pacemaking increases arhythmia risk

Temperature regulation decreases

61
Q

How do the eyes change with aging?

A

Loss of periorbital fat: entropion/ectropion

Rigid iris

Loss of lens elasticity and ciliary muscle atrophy: loss of depth perception, ability to distinguish details, and night vision

Decreased lacrimal secretions

Near vision declines dramatically (presbyopia) by 5th decade

62
Q

How do the ears change with aging?

A

Lose ability to hear high pitched sounds

Presbycusis: gradual loss of hearing beginning around 50 yo

63
Q

What does the CV system change with aging?

A

Tortuous neck vessels

Loss of LV complience

Decreased early diastolic filling, atrial kick contributes more

Increased left atrial size, audible S4

Aortic scleoris, audible systolic murmur

Increased PR interval

64
Q

What are the activities of daily living (ADL)?

A

Elements of basic self care including: bathing, dressing, toileting, transfers, continence, feeding

65
Q

What are the instrumental activities of daily living?

A

Activities requiring a higher level of function than ADLs, including: food preperation, shopping, laundry, housework, telephone, medication, finance and transportation

66
Q

What are the “generalizations” of the pediatric assessment?

A

Growth and development colors history taking and physical exam

Children do not exist in a vacuum, need 3rd party input

Children are NOT small adults, or aliens

67
Q

What is unique to the pediatric cardiac exam?

A

Murmurs are present in over 50% of children

Benign/Innocent

Characteristics: systolic, I-III/VI, musical, @LSB, Non-radiating, unassoicated with other cardiac findings

68
Q

What are the definitions for overweight and obese in pediatric patients?

A

Overweight: BMI 85-95%ile

Obese: BMI>95%ile

69
Q

Describe the changes seen in pediatric vital signs with age

A

Temperature taken rectally until 3yo

Pulse and respiratory rate decrease with age

BP increases with age

70
Q

Approach to child 1-4 yo

A

Challenges: physical struggle, crying child, distraught parents, stranger anxiety

Perform least distressing procedures first, work to more distressing

71
Q

What is one of the most important indicators of infant health?

A

Somatic growth as assessed by growth charts

These look at length, weight and head circumference

72
Q

Mnemonic for adolescent history?

A

“HEADS”

Home: environment, relationships

Education: academic performance, grade level, career aspirations

Eating: nutrition, attitudes

Activities: intersts, work, participation

Affect/Anxiety

Drugs: smoking, drinking, drugs

Sexuality: behavior, orientation, attitudes

Safety: driving behavior, violence, abuse

73
Q

What are the visible signs of breast cancer?

A

Retraction

Abnormal contours

Skin dimpling

Nipple retraction and deviation

Edema of skin

Paget’s disease

74
Q

What are common breast masses?

A

Fibroadenoma

Cysts

Cancer

75
Q

Describe the lymphatic drainage of the breast

A

The pectoral, subscapular, and lateral nodes drain breast tissue into the central nodes (deep in axilla), which drain into the infraclavicular and supraclavicular nodes

The pectoral node drains the majority of the breast

76
Q

What are the modifiable risk factors for breast cancer?

A

Post menopausal obesity

Hormone replacement therapy

Alcohol ingestion

Physical inactivity

Breast feeding choices

Type of contraception

77
Q

What are the non-modifiable risk factors for breast cancer?

A

Age

Family history

Breast tissue density

Proliferative lesions with atypia on biopsy

Duration of estrogen exposure

History of radiation

78
Q

What are the causes of non-physiologic nipple discharge?

A

Papillomas

Duct ectasia

Non-lactational infections

Fibrocystic breast changes

Ductal carcinoma in-situ/invasive carcinoma

79
Q

Physical exam findings of anemia

A

Scleral icterus

Spoon nails and pica

Paresthesias and diarrhea

Smooth tongue/glossitis

80
Q

Physical exam findings of coagulation disorders

A

Petechiae

Ecchymoses, hematomas, hemarthroses

Purpura

81
Q

How does lymphatic drainage from males and females genetalia differ?

A

Male genetalia drain to the horizontal inguinal lymph nodes

Exterior female genetalia drain to the horizontal inguinal nodes, internal genetalia drain to pelvic and abdominal nodes which are not palpable.

82
Q

What does the P wave represent?

A

Depolarization of the atria

Duration < 0.12sec

Amplitude <0.25 mV

83
Q

What does the PR interval represent?

A

AV nodal conduction (also includes atrial depolarization time and conduction through bundle of His)

Normal length: 0.12- 0.2 sec

84
Q

What does the QRS complex represent?

A

Depolarization of the ventricles

Normal length = 0.06 - 0.1 sec

Q= first deflection, downward, representing depolarization of septum

R = first upward deflection, negative in aVR, progression in precordials

S = first downward deflection after R wave

85
Q

What does the ST segment represent?

A

The time between ventricular depolarization and repolarization

Normally isoelectric

86
Q

What does the T wave represent?

A

Repolarization of the ventricles

Opposite direction from depolarization (epi to endo)

87
Q

What does the QT interval represent?

A

The duration of all ventricular electrical events in one cardiac cycle

Depends on HR

Normally 0.2-0.4

Corrected QT = QT/sqrt(RR)

88
Q

Which are the anterior leads of an EKG?

A

V1, V2, V3, V4

89
Q

Which are the inferior leads of an EKG?

A

II, III, and avF

90
Q

Which are the left lateral leads of an EKG?

A

I, aVL, V5 and V6

91
Q

Which are the right leads of an EKG?

A

aVR and V1

92
Q

What is the normal paper speed and calibration of an EKG?

A

Paper speed = 25 mm/s

Calibration = 10.0 mm/mV

93
Q

What are the characteristics of sinus rhythm?

A

Normal identical P wave before every QRS

Narrow QRS

Normal rhythm (60 - 100 bpm)

94
Q

What are the EKG characteristics of atrial flutter?

A

Saw tooth p waves with atrial rate 250-350 bpm

95
Q

What are the EKG characteristics of atrial fibrillation

A

Irregularly irregular

No visible p waves

96
Q

What is the normal axis of the heart?

A

-30 to +90 degrees

LAD is -30 to -90 degrees

RAD is > 90 degrees

97
Q

EKG criteria for RBBB

A

Widened QRS >0.12 sec

RSR’ in V1 and V2 with ST depression and T wave inversion

98
Q

EKG criteria for LBBB

A

Widened QRS

Broad or notched R wave with prolonged upstroke in V5, V6, I, and aVL with ST depression and T wave inversion

99
Q

EKG criteria for left anterior hemiblock

A

LAD with no other cause of LAD (no hypertrophy)

100
Q

EKG criteria for left poserior hemiblock

A

RAD with no other cause for RAD

101
Q

What is a bifasicular block?

A

Either RBBB with left anterior hemiblock

OR

RBBB with left posterior hemiblock

102
Q

EKG criteria for left atrial enlargement

A

Negative portion of p wave > 1 mm in V1 with duration > 0.04 sec

103
Q

EKG criteria for right atrial enlargement (RAE)

A

P wave amplitude > 2.5 mm in leads II, III, and aVF with normal duration

104
Q

EKG criteria for Left ventricular hypertrophy

A

Amplitude of R in V5/V6 + amplitude of S in V1/V2 > 35 mm

Amplitude of R in aVL > 13 mm

LAD > -15 degrees

105
Q

EKG criteria for right ventricular hypertrophy

A

RAD > 100

R > S in V1, S > R in V6

106
Q

What are the characteristics of a murmur that must be described?

A

Timing: systole or diastole

Location: where it is best heard

Shape: crescendo, decrescendo, or holosystolic

Intensity: 1 (barely audible) to 6 (stethoscope off chest), thrill felt at 4/6

Pitch: high or low

Quality: harsh or blowing

Changes: changes with maneuvers like squatting

107
Q

The diaphragm of the stehoscope is used to hear ______ pitches whereas the bell is used to hear ______ pitches

A

The diaphragm of the stehoscope is used to hear HIGH pitches whereas the bell is used to hear LOW pitches

High pitches: S1, S2, midsystolic click, regurgitation

Low pitches: S3/S4, mitral stenosis

108
Q

Heart sound for mitral regurgitation

A

Holosystolic high pitched harsh blowing murmur heard at apex, radiates to left axilla

109
Q

Heart sound for aortic stenosis

A

Harsh, crescendo-decrescendo systolic murmur heard in 2nd right intercostal space, radiates to carotids

110
Q

Heart sound for mitral valve prolapse

A

Late systolic crescendo murmur with midsystolic click

111
Q

Heart sound for mitral stenosis

A

Rumbling diastolic low pitched

112
Q

Describe the physiolocal splitting of S2

A

Splitting of S2 on inspiration due to more negative pleural pressure

Increases on inspiration, decreases on expiration

113
Q

Describe the pathologic splitting of S2

A

Widened splitting: persists throughout respiratory cycle, could be due to pulmonic stenosis, RBBB or mitral stenosis

Fixed splitting: ASD and RV failure

Reverse splitting: split on expiration but absent on inspiration, due to LBBB causing delayed closure of aortic valve

114
Q

What is S3?

A

Extra diastolic sound during rapid ventricular filling

Called “gallop” or “Kentucky” sound

115
Q

What is S4?

A

Increased resistance to ventricular filling, heard just before S1

116
Q

What are the components of the 3 part plan?

A

Diagnostic

Therapeutic

Education

117
Q

Admitting orders contain the following instructions

A

ADC VAAN DISML

Admit to

Diagnosis of patient

Condition of patient

Vital signs

Activity permitted / limitations

Allergies

Nursing orders

Diet

IV fluids

Special orders

Medications

Labs/tests

118
Q

Lung auscultation findings on patient with acute lobar pneumonia

A

Increased bronchial breath sounds because consoldated lung tranmits sound more readily

Vocal fremitis: hear whispered “99” louder than normal, clearer than normal

Egophony: E to A sound

119
Q

Physical exam findings on emphysema patient

A

Hyperresonance on percussion due hyperinflated lungs

Pink puffer appearance

120
Q

Physical exam findings on patient with interstitial lung disease

A

Crackles

Sometimes get clubbing, hypoxemia, desaturation with exercise

121
Q

Physical exam findings of pneumothorax

A

Hyperresonance of affected lung

Decreased breath sounds

On CXR, absent lung markings, trachea shifted away from affected lung

122
Q

Physical exam findings of pleural effusion

A

Dullness to percussion, decreased breath sounds

CXR shows blunding of costodiaphragmatic angle, meniscus sign, complete white out

Trachea shifted away from effusion

PCM 2 (2 decks)

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