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Health Assessment > test 2 > Flashcards

test 2 Flashcards

1
Q

cough less than 3 weeks

A

acute

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2
Q

cough 3-8 weeks

A

subacute

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3
Q

cough greater than 8 weeks

A

chronic

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4
Q

if a toddler has a cough - what’s on your differential

A

FB aspiration
pneumonia
vaccinated? pertussis?
URI

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5
Q

geriatric with cough

A

Pulmonary embolism
COPD
from medication? ACE
aspiration

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6
Q

cough with seasonal allergies

A

allergic disease with increased pollen count

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7
Q

cough with asthma

A

from bronchospasm

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8
Q

wheezing or lack of air movement, hypoxia, hypercapnia, acidosis

A

Asthma

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9
Q

flushing, pruritis, anxiety, faintness, sneezing, vomiting

A

anaphylaxis

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10
Q

difficulty breathing after a trauma

A

think pneumo

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11
Q

tall, lanky adolescence with acute SOB

A

spontaneous pneumo

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12
Q

risk factors for pulmonary embolism

A 
age older than 60yr 
Pulmonary HTN
CHF
chronic lung disease
ischemic heart disease
stroke
cancer
surgery
fracture 
family history of clotting disorders
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13
Q

SOB that worsens with increasing activity and improves by rest

A

pulmonary or cardiac

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14
Q

risk factors for pulmonary embolism

A 
age older than 60yr 
Pulmonary HTN
CHF
chronic lung disease
ischemic heart disease
stroke
cancer
surgery
fracture 
family history of clotting disorders
Exogenous estrogen
malignancy within 6 mos
history of DVT/PE
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15
Q

not ever vaccinated with shortness off breath - what needs to be ruled out

A

poliomyelitis

tetanus

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16
Q

what do you think in a child younger than 1 who has new onset resp distress with vomiting and diarrhea. started eating honey this morning

A

Clostridium botulinum source of contamination by honey cause resp distress

incubation is only a few hours. symptoms include cranial nerve involvement, diplopia, weak suck, facial weakness and absent gag. hypotonia and weakness => resp failure

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17
Q

not ever vaccinated with shortness off breath - what needs to be ruled out

A 
poliomyelitis
tetanus
pertussis
influenza
covid
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18
Q

what do you think in a child younger than 1 who has new onset resp distress with vomiting and diarrhea. started eating and trying new foods

A

Honey - botulism
Clostridium botulinum source of contamination by honey cause resp distress

incubation is only a few hours. symptoms include cranial nerve involvement, diplopia, weak suck, facial weakness and absent gag. hypotonia and weakness => resp failure

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19
Q

Asymmetrical chest movement

A

lobar pneumonia

pleural effusions

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20
Q

involvement of the supraglottic area, proximal to vocal cords, muffled voice

A

tonsillitis

epiglottitis

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21
Q

normal voice with stridor

A

subglottic

tracheal lesion

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22
Q

common anomalies that predispose infants to upper airway obstruction

A

infants younger than 6 mos

anomalous vascular rings
laryngeal webs
laryngomalacia
tracheomalacia

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23
Q

tracheal shift

A

pneumothorax

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24
Q

JVD

A

heart failure

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25
Q

pallor of sclera or nail beds

A

severe anemia

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26
Q

clubbing

A

chronic hypoxia

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27
Q

rapid new onset clubbing

A

infective endocarditis

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28
Q

edema of lower extremeties

A

think increased r heart filling -> primary lung disease or Left ventricular failure

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29
Q

in young infants edema appears as

A

hepatomegaly and periorbital or flank edema

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30
Q

crepitus

A

chest injury
pneumothorax
cutaneous emphysema

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31
Q

tactile fremitus is diminished in

A

pneumothorax
asthma
emphysema
other conditions that trap air in the lung

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32
Q

can cause a spontaneous pneumo from rupture of subpleural blebs located at the apex of the upper lobe or in the superior seg of the lower lobe

A

cystic fibrosis

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33
Q

most common cause of persistent stridor in infancy

A

bronchomalacia

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34
Q

brassy cough and difficulty swallowing in infants with inspiratory stridor and expiratory wheeze

A

vascular ring

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35
Q

cough that is paroxysmal and young child or infant not vaccinated

A

pertussis “whooping cough”

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36
Q

Persistent nocturnal paroxysmal coughing

A

asthma

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37
Q

coughing at night usually between midnight and 2 am

A

Asthma hallmark

caused by the low level of cortisol (glucocorticoid) in the body at that time

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38
Q

a severe cough in the early morning indicates

A

postnasal drip, CF or bronchiectasis

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39
Q

Cough that is worse at night

A

croup
postnasal drip
lower resp tract infection
allergic reaction

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40
Q

a cough that disappears with sleep

A

habit cough

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41
Q

dry brassy cough indicates

A

pharyngeal or tracheal irritation, allergy or habit

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42
Q

paroxysmal cough

A

asthma
pertussis
CF
foreign body aspiration

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43
Q

sudden short burst of cough in infants (Staccato cough)

A

C. trachomatis

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44
Q

a harsh dry cough caused by airway compression from enlarged nodes in the perihilar or paratracheal regions seem to occur with

A

TB

fungal infection

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45
Q

sudden short burst of cough in infants (Staccato cough)

A

C. trachomatis (chlamydial pneumonia)

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46
Q

causes cough through direct sim of cough receptors by gastric acid

A

GERD

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47
Q

cobblestone appearance of the posterior pharynx

A

caused by lymphoid hyperplasia secondary to chronic stimulation of postnasal drip

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48
Q

Barrel chest

A

AP diameter is 1/3 -1/2 of Lateral diameter

COPD

also children with chronic cough secondary to CF or severe asthma

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49
Q

diagnostic for CF

A

sweat test

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50
Q

eosinophilia

A

bronchial asthma
allergic rhinitis
atopic dermatitis

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51
Q

greenish or rusty colored sputum

A

Bacterial pnemonia

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52
Q

most common cause of infection in the lower resp tract in children and young adults

A

mycoplasma pneumoniae

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53
Q

infant (3-11 wks)with fine rales, no wheezing. chest x ray shows hyperinflated lungs with diffuse interstitial or alveolar infiltrates

A

chlamydial pneumonia (C. Trachomatis)

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54
Q 
child younger than 2
fever
rhinorrhea
cough
wheezing
tachypnea
tachycardia
resp distress
nasal flaring

x ray shows hyperinflation with mild interstitial infiltrates

A

bronchiolitis (RSV)

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55
Q

steeple sign

A

croup

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56
Q

high risk for gerd

A

cigarette smokers
overweight
overuse alcohol

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57
Q

when does it become chronic bronchitis

A

at least 3 consecutive months

for more than 2 years

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58
Q 
rasping, hacking cough
resonant to dull chest
possible barrel chest
prolonged expiration
possible wheezes
A

chronic bronchitis

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59
Q

weight loss
hemoptysis
SOB

A

bronchogenic carcinoma

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60
Q

FTT
productive cough
poor weight gain
initially dry and hacking then goes to loose and produces purulent material
scattered or localized coarse rales and rhonchi audible

A

CF

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61
Q

allergic shiners
allergic salute
eczema
rhinorrhea with clear watery drainage

A

allergic rhinitis

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62
Q

chronic cough worse at night
persistent coldlike symptoms
noisy breathing or snoring at night

A

chronic sinusitis

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63
Q

Brassy cough is the most common symptom

A

TB

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64
Q

chronic cough worse at night
persistent cold like symptoms
noisy breathing or snoring at night

A

chronic sinusitis

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65
Q

child or adult with dry cough, headache malaise, sore throat, fever, rales and rhonchi

A

Mycoplasma pneumoniae

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66
Q

dry cough
sore throat
frequent throat clearing
mucoid secretions posterior pharynx with cobblestone appearance, sinuses tender

A

UACS (upper airway cough syndrome)

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67
Q

mimics croup, high fever, copious amounts of purulent sputum

follows infection of S. Aureus or H Influenzae

A

bacterial tracheitis

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68
Q

Risk factors ACS

A 
older than 65
>=3 risk factors CAD
-hypercholesterolemia
-htn
-DM
-smoker
-family history
-obesity

CAD
Family history of sudden death
Cocaine/tox use

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69
Q

Symptoms of ACS

A 
Chest pain
pain that radiates to shoulder, arm, neck, jaw and to epigastrium
N/V
Diaphoresis
ischemic pain
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70
Q

Clinical signs ACS

A

Hypotension
pain >60 min
Acute decompensated HF signs
ischemic changes on ECG

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71
Q

Tearing or ripping pain
sudden onset
pain radiates to back
HTN

A

thoracic aortic dissection

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72
Q

what is stable angina

A

anginal symptoms present for at least 3 months

does not occur at rest

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73
Q

where are the locations for typical anginal pain

A

substernal chest
jaw
shoulder
arms

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74
Q

exacerbating factors for angina

A

exertion
emotional stress
heavy meal
cold

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75
Q

quality of pain for angina

A

pressure
tight
heavy
similar to prior angina

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76
Q

timing for angina

A

lasting 15 seconds to 15 min

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77
Q

relief for angina

A

rest

sublingual nitro

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78
Q

chest pain after GI procedure or retching

A

evaluate for esophageal rupture

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79
Q

Chest pain with history of Sickle cell disease

A

evaluate for acute chest

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80
Q

chest pain with skin tenderness or rash

A

evaluate for herpes zoster

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81
Q

chest pain with prominent cough and fever

A

eval for pneumonia

82
Q

Due to its high sensitivity, a negative d dimer assay is sufficient to r/o a PE in most patients with chest pain

true or false

A

false

83
Q

Pleuritic pain relieved by sitting forward

friction rub
viral prodrome
abrupt onset
sinus tachycardia
low grade fever
A

Pericarditis

84
Q

what does EKG look like for Acute pericarditis vs MI

A

Diffuse ST elevation
PR depression

MI 
localized ST elevation
T wave inversion
Q waves 
hyper-acute T waves
No PR depression
85
Q 
Chest pain
mild dyspnea
anywhere from fatigue to cardiogenic shock
Orthopnea
edema
JVD
Viral prodrome is common
ischemic pattern on ECG
A

Myocarditis

86
Q

burning epigastric or substernal pain
usually in relation to sleep, eating or when laying supine
acid taste
chronic cough

A

GERD
Gastritis
PUD

87
Q

risk factors for acute aortic syndrome

A 
aortic disease
bicuspid aortic valve
inherited connective tissue dz
  -Marfan syndrome
   - Ehlers Danlos
Vasculitis
Family hx of  aortic disease or sudden death
88
Q

Pulse deficit
SBP differential >20mmHg
HTN DBP >100mgHg
focal neurologic deficit

A

Acute aortic syndrome

89
Q

what do you use diaphragm

A

higher frequency sounds

S1, S2

90
Q

when do you use bell

A

lower frequency
S3, S4
Murmurs grade I-III

91
Q

Atrioventricular valves include

A

Tricuspid and Mitral

92
Q

acute hoarseness

A

less than 2 weeks

93
Q

Hoarseness > 2 weeks

A

refer out to an ENT for possible to r/o neoplasm

94
Q

what cranial nerve is involved in hoarseness and voice change

A

CN X - vagus nerve

95
Q

damage to CN X can be

A

hormone imbalance
bacterial infection
tumor
transgender voice surgery

96
Q

what upper resp infections can cause vocal cord inflammation

A

Acute laryngitis
epiglottitis
Acute laryngotracheobronchitis (Croup)

97
Q

what kind of breathing can lead to morning hoarseness

A

nasal congestion can lead to mouth breathing

98
Q

Carnett sign

A

lifting head up and lifting legs up - if the pain worsens, it is a positive Carnett sign meaning that it is an intra abdominal cause (visceral) of pain

99
Q

LLQ

A

colon
ureter
bladder
uterus

100
Q

diverticulitis

A

CT with contrast

Bloody diarrhea means one of the diverticula may have ruptured. Go to the ER otherwise it can be managed outpatient
ABX
f/u in a week

101
Q

Kehrs sign

A

occurence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity

102
Q

Kehr sign

A

pressure on the LUQ eliciting left shoulder pain - due to diaphragmatic irritation by the ruptured spleen and strongly suggests splenic injury. CT would be used to identify and grade the splenic injury

103
Q

Murphy sign

A

pain on inspiration when hand placed over gallbladder (cholecystitis)

104
Q

Rovsings sign

A

Pain in the RLQ with palpation pressure in the LLQ - positive is a sign of acute appendicitis

105
Q

(Hepato-Jugular Reflex)

A

Pt supine with upper body elevated to 30-45 degrees. Have pt turn head to L and to R
Looking at the IJ - Push on RUQ (Hepato-Jugular Reflex) - Elevated CVP - measure from angle of Louis - normal 7-9 cm

106
Q

where is the apical pulse found in infants and young children younger than 7

A

fourth intercostal space, left mid clavicular line

107
Q

where is the apical pulse found in adults and children older than 7

A

5th intercostal space, left midclavicular line

108
Q

if the apical pulse is felt lower, what could it mean

A

could indicate cardiac enlargement

109
Q

colonoscopy recommendations (no risk factors)

A

starting at 45, then every 10 years until 75 then physician/health dependent till 85. No colonoscopies after 85

110
Q

murmur

very soft, heard in quiet room with cooperative pt

A

Grade I

111
Q

murmur loud with thrill, audible with stethoscope off of chest 1 cm

A

Grade VI

112
Q

Easily heard murmur, not loud

A

Grade II

113
Q

Loud murmur with thrill, audible with stethoscope at 45 degree angle

A

Grade V

114
Q

Murmur loud with palpable thrill

A

Grade IV

115
Q

Murmur loud but n thrill

A

Grade III

116
Q

waking up with headaches in mornings for the past 2-3 weeks

A

neoplasm

117
Q

headache with bilat tight squeezing

A

tension headache

118
Q

recent surgery, anxious and sob

A

think pulmonary embolism

119
Q

a thrill felt in the suprasternal notch

A

Aortic stenosis
pulmonary stenosis
PDA
COA

120
Q

Thrill ULSB

A

originates from pulmonary valve or artery
pulmonary stenosis
PA stenosis
PDA (rare)

121
Q

Thrill URSB

A

aortic origin

Aortic stenosis

122
Q

Thrill LLSB

A

VSD

123
Q

why would you listen to heart in the axillaries on the back

A

listening for pulmonary stenosis

124
Q

new onset fever and diarrhea x 4 days

A

shigella

125
Q

fever and diarrhea

A

Campylobacter

126
Q

Issues with dizziness and vertigo what CN

A

VIII (8)

127
Q

what is S1 and where is it best heard

A

closure of mitral and tricuspid

Apex or Lower left sternal border

128
Q

wide splitting can be due to

A

Ebstein’s anomaly (displaced tricuspid valves down towards the apex)

129
Q

GERD symptoms

A 
Vomiting
Food refusal
Feeding aversion
Unexplained crying
Sleep disturbances
Abd pain
Choking
Coughing
Gagging
Older children and adolescents
Epigastric pain
Heartburn
Pain in relation to sleep, eating or when lying supine
Acid taste
Chronic cough
130
Q

S2 what is it

A

closure of aortic and pulmonic valves

131
Q

A2

A

closure of Aortic

132
Q

P2

A

closure of pulmonic

133
Q

Unstable angina vs. stable angina

A

Unstable- does not improve with rest/ medication
Last greater than 15 minutes
Chest pain occurs with very little activity

134
Q

Male vs. female cardiovascular disease

A

Men generally develop CVD at a younger age and have a higher risk of coronary heart disease than women. Women in contrast, are at a higher risk of stroke, which often occurs at an older age.

135
Q

cranial nerves 2, 4, 6

A

2- optic nerve
IV- Trochlear nerve
VI- Abducens nerve
all control eyes

136
Q

what can cause a wide S2 split

A

ASD
Pulmonary stenosis
Right Bundle branch block
Mitral regurgitation

137
Q

What can cause a narrow S2 split

A

pulmonary HTN

Aortic Stenosis

138
Q

Patient can’t taste or smell

what cranial nerves

A

Facial nerve (CN VII)
glossopharyngeal (CN IX)
Vagus nerve (CN X)
Olefactory (CNI)

139
Q

holosystolic is most commonly heard in

A

VSD

140
Q

Midsystolic murmurs

A

Aortic Stenosis or Pulmonary stenosis

141
Q

Lat systolic murmurs

A

mitral valve prolapse

142
Q

Most common innocent murmur

A

Stills
worsens with fever, infection, anxiety
ages 3-7
LLSB

143
Q

What neuro disease causes demyelination in the 3rd and 4th decade of life?

A

Multiple sclerosis

144
Q

recent surgery than gets anxious and short of breath

A

PE

145
Q

Newborn with systolic murmur

A

Don’t worry, normal finding

146
Q

dizzy when stands up

A

hypovolemic

147
Q

morning headaches

A

neoplasm

148
Q

headache with bilat tight squeezing

A

Tension headache

149
Q

CN

A 
1- olefactory
II - Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens
VII Facial
VIII Vestibulocochlear
IX Glossopharyngeal
X Vagus
XI Accessory
XII Hypoglossal
150
Q

self limited means

A

it goes away on its own

151
Q

CN can you smell your coffee

A

I olefactory

152
Q

what CN controls muscle function and pupil response

A

Oculomotor III

153
Q

early diastolic murmur caused by a

A

incompetent aortic or pulmonary valve

154
Q

Mid diastolic begins with ____ and is caused by ___- usually from ___

A

Begins with S3

Caused by turbulence from the mitral or tricuspid valves usually from stenosis

155
Q

Late diastolic caused by active

A

atrial contraction into the ventricle

156
Q

CN responsible for downward, outward and inward eye movements

A

Trochlear (IV)

157
Q

When do you refer murmurs

A 
greater than III/VI
Loudest at the LUSB
Harsh quality
Pansystolic (holosystolic)
Systolic click
Abnormal second heart sound
158
Q

largest of your cranial nerves

opthalmic - sends sensory info from your upper part of face

maxillary - sensory form middle part of face

mandibular - sensory infor from ears, lower lip, and chin

controls muscles of jaw and ear

A

CN V

Trigeminal

159
Q

CN thats associated with eye movement (lateral rectus muscle)

A

CN VI Abducens

160
Q

CN for making facial expressions

taste for most of your tongue

salivary glands

tear producing glands

communicating sensations from outer parts of ear

A

VII facial

161
Q

CN

think ear
cochlear - detect vibrations from sound based off of the sounds loudness and pitch This generates nerve impulses that are transmitted to cochlear nerve

Vestibular - adjust balance and equilibrium

A

CN VIII - Vestibulocochlear

162
Q

CN
sensory from sinuses, back of throat, inner ear and back of your tongue

providing a sense of taste for back part of your tongue

stimulating voluntary movement of a muscle in back of throat called the stylopharyngeus

A

CN IX glossopharyngeal

163
Q

CN

sensation from ear canal and parts of throat

sensory from organs in chest and trunk such as heart and intestines

motor control of muscles in throat

stim muscles of organs in chest and trunk (to include food through digestive tract - peristalsis)

sense of taste near root of tongue

A

CN X Vagus nerve

164
Q

father died from colon cancer. what do you need to know to find out when to screen pt

A

what age did his father get diagnosed? Back it up 10 years from that point

165
Q

CN controls the muscles in your neck

A

CN XI Accessory

166
Q

CN responsible for movement of tongue

A

XII hypoglossal

167
Q

LLQ

A

colon
ureter
bladder
uterus

168
Q

Pain worse after meals and when laying down, better when stand

A

GERD

169
Q

what sign

push on the left side of the abdomen and the Right side sings

A

RoVsings

appendicitis

170
Q

Psoas sign

A

lift one leg, you apply resistance

appendicitis

171
Q

flex right thigh
rotate knee inward
you do it for them (passive)

A

obturator

Appendicitis

172
Q

Markels sign

A

stand up on the tippy toes and drop down

pain and it hurts

or hit heel of foot

appendicitis
pain = positive

173
Q

murphys sign

A

acute cholecystitis - asking pt to take a deep breath while palpating the r subcostal area - pain with inspiration - positive

174
Q

tests for H pylori

A

Breath in a bag
cant be on PPI for 2 weeks. send to the lab

serum
stool antigen
direct biopsy (if already in)

175
Q

Mallory weiss tear caused from

A

from retching too hard

176
Q

main symptom for pancreatitis

A

severe pain mid epigastric

177
Q

what are you doing for pancreatitis

A

NPO complete bowel rest

watch for a pseudocyst

178
Q

what kind of meds (for what problem) causes pancreatitis

A

diabetic meds

179
Q

what signs are specific for pancreatitis and where is it

A

Grey turners on the flank (bruising)

Cullens - bruising on the (C around umbilicus)

180
Q

what sign?

extend arms, flex hands at wrists, close eyes. push lightly back and watch them flap their hands

A

Asterixis sign

“liver flap”

liver disease

181
Q

McBurney’s point

A

appendicitis

182
Q

skin issue on liver disease

A

Spider nevi

183
Q

Fluid in abdomen

A

aceites

184
Q

Murphys sign

A

instruct pt to let out all breath, you will push in under your R rib area then pt inflate lungs with full breath

if pt sucks back in with pain its a positive murphys sign

gallbladder

185
Q

what 2 big chronic issues have bloody diarrhea

A 
Ulcerative colitis (only cure is to take out colon)
Crohns - colon resections - no cure

only definitive is biopsy to determine which it is

186
Q

gluten intolerance

A

celiac disease

biopsy confirms

187
Q

mesenteric vessels problems

A

DVT of mesenteric veins

Arterial stenosis

188
Q

drugs that can call bowel ischemia

A

vasopressin

189
Q

double vision associated with what CN

A

VI -

190
Q

headache thunderclap or with exertion or sex

A

Subarachnoid hemorrhage

191
Q

headache that wakes them from sleep

A

think increased intracranial pressure

192
Q

which cranial nerve is sweet vs salty

A

CN VII

193
Q 
headache unilateral 
throbbing
nausea
photophobia
exacerbation with activity
A

migraine without aura

194
Q

what criteria is for migraine

A 
POUND criteria 
pulsatile
last between 4-72 hours without meds
unilateral
nausea
debilitating
4/5 migraine diagnosis
195
Q

what headache is not disabling

A

tension

196
Q 
photophobic
paresthesia
numbness
weakness
nausea 
vomiting
A

migraine with aura

197
Q

headache not emergency

A

migraine
tension
cluster

198
Q

headache

throbbing constant pain during waking hours with symptoms of tightness, pressure and muscle contraction

A

mixed headache

199
Q

occurs with movement of head/rolling/turning

A

vertigo

200
Q

falling over, lack of balance

A

Disequilibrium:

Health Assessment (5 decks)

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