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Advanced Health Assessment > Test 2: Heart & lungs > Flashcards

Test 2: Heart & lungs Flashcards

1
Q

hyperresonance of lungs can be heard in

A

asthma and COPD

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2
Q

soft and low pitched; inspiratory sounds that last longer than expiratory sounds without pause

A

vesicular breath sounds

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3
Q

inspiratory and expiratory sounds are about equal; heard often in the 1st and 2nd interspaces and b/t scapula

A

bronchovesicular breath sounds

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4
Q

loud expiratory sounds last longer than inspiratory sound with a short silence between.

A

bronchial breath sounds

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5
Q

discontinuous breath sounds

A

crackles or rales

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6
Q

continuous breath sounds

A

wheezes or rhonchi

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7
Q

discontinous, soft, high-pitched, and very brief breath sounds. Popping that sounds like wood in fireplace.

A

fine crackles

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8
Q

discontinuous, brief, popping breath sounds. Most common during inspiration.

A

coarse crackles

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9
Q

relatively high-pitched with hissing or shrill quality. mostly heard on expiration

A

wheezes

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10
Q

when “ee” sounds like “a” that suggest pneumonia

A

egophony

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11
Q

longer forced expiratory time is seen with

A

COPD

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12
Q

creaking or grating sounds that have been described as being similar to walking on fresh snow

A

pleural rub

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13
Q

continuous, low pitched sounds with a gurgling, snoring or rattle-like quality. More common during expiration.

A

rhonchi

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14
Q

an S3 gallop indicates

A

a change in ventricular compliance

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15
Q

mitral valve opens and rapid ventricular filling as blood flows early in diastole from atria into ventricle.

A

S3

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16
Q

S4 relates to a

A

stiff ventricle and atrial contraction

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17
Q

Stage I hypertension is

A

140-159/90-99mmHg

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18
Q

Stage II hypertension is

A

> 160/100

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19
Q

Prehypertension

A

129-139/80-89 mmHg

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20
Q

the carotid upstroke always occurs

A

in systole after S1

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21
Q

sounds or murmur coinciding with the carotid upstroke are

A

systolic

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22
Q

sounds or murmurs coinciding after the carotid upstroke are

A

diastolic

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23
Q

how to detect mitral stenosis

A

patient in left lateral decubitus and listen to apical pulse with bell of stethescope.

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24
Q

how to detect aortic murmurs

A

ask the patient to lean forward, exhale, and hold breath. listen with diaphragm from left sternal border to apex.

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25
Q

aortic regurgitation is heard at

A

2nd - 4th left interspaces

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26
Q

timing of aortic regurgitation

A

early diastolic

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27
Q

quality of aortic regurgitation

A

descrescendo, blowing, high pitched

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28
Q

aortic regurgitation can cause

A

left ventricular hypertrophy

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29
Q

heard in the right 2nd interspace that radiates to the carotids

A

aortic stenosis

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30
Q

timing of aortic stenosis

A

mid systolic murmur

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31
Q

quality of aortic stenosis

A

harsh sounding, crescendo-decrescendo heard higher at apex

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32
Q

aortic stenosis murmur is heard best when

A

patient is leaning forward

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33
Q

aortic stenosis is heard mostly in

A

elderly patients

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34
Q

tricuspid regurgitation is best heard over

A

lower left sternal border over xiphoid

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35
Q

timing of tricuspid regurgitation

A

holosystolic

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36
Q

quality of tricuspid regurgitation

A

blowing, increases intensity during inspiration,

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37
Q

tricuspid stenosis is best heard at

A

4th-5th ICS left of sternal border

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38
Q

timing of tricuspid stenosis

A

diastolic

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39
Q

quality of tricuspid stenosis

A

descrescendo, soft, and low-pitched

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40
Q

murmur usually associated with rheumatic fever

A

mitral and tricuspid stenosis

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41
Q

tricuspid stenosis increases in intensity by

A

exercise, inspiration, sitting forward

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42
Q

consider atbx prophylaxis prior to dentist appts for pateints with

A

tricuspid stenosis

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43
Q

group most associated with tricuspid stenosis

A

children, pregnancy

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44
Q

pulmonic valve regurgitation is heard best at

A

2nd ICS at left sternal border and radiates to apex

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45
Q

timing of pulmonic valve regurgitation

A

diastolic

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46
Q

quality of pulmonic valve regurgitation

A

High-pitched decrescendo murmur

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47
Q

most common causes of pulmonic valve regurgitation

A

pulmonary HTN or tetrology of fallot

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48
Q

pulmonic valve regurgitation is usually

A

asymptomatic

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49
Q

pulmonic valve stenosis is best heard at

A

2nd and 3rd left ICS

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50
Q

timing of pulmonic valve stenosis

A

midsystolic to late systolic

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51
Q

quality of pulmonic valve stenosis

A

harsh, crescendo-decrescendo

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52
Q

pulmonic valve stenosis usually found in

A

children-congenital

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53
Q

VSD is heard best at

A

4th left ICS

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54
Q

timing of VSD

A

holosystolic (throughout s1 and s2)

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55
Q

quality of VSD

A

harsh and loud with thrill

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56
Q

venous hum is due to the rush of blood from the _____ to the ____

A

jugular veins, superior vena cava

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57
Q

in venous hum, this is louder

A

diastole

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58
Q

location of venous hum

A

under the medial third of right clavicle

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59
Q

continuous murmur without a silent interval

A

venous hum

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60
Q

Described as a humming, roaring, low-pitched sound best heard with the bell.

A

venous hum

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61
Q

age group most affected by venous hum

A

children

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62
Q

innocent murmur caused by low-frequency vibrations generated by normal pulmonary valve leaflets during systole or periodic vibrations generated by a left ventricular false tendon.

A

stills murmur

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63
Q

stills murmur heard best at

A

2nd to 4th left ICS

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64
Q

timing of stills murmur

A

early and mid systolic

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65
Q

quality of stills murmur

A

musical

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66
Q

linked with a remarkably rapid ejection of blood from the left ventricle during systole

A

hypertrophic obstructive cardiomyopathy (HOCM)

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67
Q

HOCM best heard at

A

lower left sternal border

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68
Q

timing of HOCM

A

late systolic

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69
Q

Typically develops during a puberty growth spurt as an adolescent

A

HOCM

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70
Q

timing of coarctation of aorta

A

continous

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71
Q

congenital narrowing of aorta

A

coarctation of aorta

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72
Q

Patent ductus arteriosis is caused by

A

failure of closure of hole that connects pulmonary artery and aorta

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73
Q

assessment of PDA reveals

A

bounding pulses

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74
Q

timing of PDA

A

continuous

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75
Q

higher risk of PDA with

A

premature infants

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76
Q

grade of murmur that is loud with thrill

A

Grade 4

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77
Q

grade of murmur where it is audible without a stethoscope and thrill is palpable

A

grade 6

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78
Q

risk factors for PE

A

age > 60, pulmonary HTN, CHF, lung disease, stroke, cancer, trauma, DVT, oral contraceptives

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79
Q

s/s of PE

A

pleuritic chest pain, hemoptysis, dyspnea, pleural friction rub, fever

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80
Q

virchow’s triad with DVT

A

venous stasis, hypercoagulability, endothelial injury.

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81
Q

sharp tearing chest pain with pain radiating to ipsilateral shoulder,

A

pneumothorax

82
Q

pneumothorax will have ___ tactile fremitus and _____ of lungs

A

decreased; hyperresonance

83
Q

tracheal shift seen in

A

pneumothorax, pleural effusion, atelectasis

84
Q

in pneumothorax, the trachea is deviated toward the _____ during exhalation and toward the _____ during inhalation.

A

opposite side; the side of pneumothroax

85
Q

s/s of croup

A

barking cough, stridor, hoarseness

86
Q

cause of croup

A

parainfluenza type 1

87
Q

AP radiograph reveals this with croup

A

steeple or thumb sign

88
Q

in COPD there is ____ tactile fremitus and _____ lungs

A

decreased; hyperresonance

89
Q

s/s of COPD

A

cough worse in morning, increased sputum, barrel chest, fatigue

90
Q

asthma is characterized as

A

reversible airway obstruction, inflammation, and airway hyperresonsiveness.

91
Q

GERD can be a risk factor for

A

asthma, acute bronchitis

92
Q

hallmark of asthma is

A

coughing at night

93
Q

children with asthma have respirations that are

A

slow and deep

94
Q

bacterial causes of PNA

A

Mycoplasma, Streptococcus, Haemophilus influenza

95
Q

incubation period for Mycoplasma pneumonia

A

21 days

96
Q

s/s of PNA in adults

A

pleuritic chest pain, dyspnea, green sputum, fever, chills

97
Q

this is usually absent in elderly with PNA

A

fever

98
Q

these conditions increase tactile fremitus

A

PNA, HF, and tumors

99
Q

trx for outpatient with bacterial PNA

A

macrolide (azithromycin or clarithromycin)

100
Q

PNA in children is mostly caused by

A

RSV, adenovirus, parainfluenza

101
Q

3 clinical findings with acute COPD exacerbation

A

worsening dyspnea, increased sputum purulence, and increased sputum production

102
Q

causes of acute bronchitis

A

adenovirus, rhinovirus, influenza A&B, parainfluenza

103
Q

s/s of acute bronchitis

A

rhonchi on expiration, hacking cough, low-grade fever, burning chest

104
Q

in acute bronchitis, the chest xray is

A

normal

105
Q

avoid this with bronchitis

A

antihistamines and decongestants

106
Q

typical trx for acute bronchitis

A

cough suppressants

107
Q

chronic bronchitis is the production of sputum for at least

A

3 months for 2 years

108
Q

chronic bronchitis is usually

A

irreversible and progressive

109
Q

secondary polycythemia is seen with

A

chronic bronchitis

110
Q

In chronic bronchitis, the FEV1/FVC ratio is

A

< 70%

111
Q

bronchiolitis is an infection of lower respiratory tract caused by

A

RSV

112
Q

risk factor for bronchiolitis

A

daycare centers

113
Q

This commonly accompanies bronchiolitis

A

otitis media

114
Q

S/S of bronchiolitis

A

URI for 1-3 days, fever, cough, crackles, purulent rhinorrhea

115
Q

s/s of TB

A

night sweats, hemoptysis, brassy cough

116
Q

PPD can cause a false negative with

A

steroid use

117
Q

positive PPD test for a regular person is induration greater than

A

15 mm

118
Q

positive PPD test for immigrant, healthcare worker, or drug user is when induration is greater than

A

10 mm

119
Q

in sputum smear, this suggests TB

A

acid-fast bacilli (AFB)

120
Q

monitoring this when on TB meds

A

LFTs

121
Q

in adults, a URI is viral when there is a

A

temp less than 101, small amounts of clear-yellow sputum, nasal congesiton, malaise

122
Q

In adults, a URI is bacterial when there is

A

temp greater than 101, chest pain, purulent sputum

123
Q

in children, a bacterial URI is when there is

A

fever, loss of appetite

124
Q

often people with GERD are

A

smokers, overuse alcohol, and are overweight

125
Q

inflammation of the pleural lining of the lung after a URI

A

pleurisy

126
Q

pain with pleurisy is lessened when

A

lying on the affected side

127
Q

pericarditis pain is described as

A

sharp, stabbing pain that radiates to left shoulder

128
Q

in pericarditis, pain is worse when

A

supine or sitting, better when sitting forward

129
Q

labs indicative of pericarditis

A

elevated WBC and ESR and ST elevation

130
Q

s/s of aortic aneurysm

A

diaphoresis, hypotension, asymmetrial pulses & BP

131
Q

size of aortic aneurysm

A

aortic diameter > 3 mm

132
Q

meds that can cause syncope

A

antidepressants, antiarrhythmics, beta blockers, diuretics

133
Q

diagnostic tests for syncope

A

carotid ascultation, Holter monitor, stress test, ECG, tilt table test

134
Q

normal ABI

A

0.90-1.30

135
Q

severe PAD

A

< 0.39

136
Q

s/s of PAD

A

claudication, no hair on legs, thick toenails, cool extremities

137
Q

in PAD, the legs feel better when ____ and feel worse when _____

A

dependent; elevated

138
Q

gold standard for diagnosing PAD

A

contrast angiography

139
Q

varicose veins are when veins are

A

incompetent and allow reverse blood flow.

140
Q

venous ulcers appear more on

A

lateral ankle

141
Q

ulcer borders are irregular, flat, and painful

A

venous ulcers

142
Q

arterial ulcers appear more on

A

toes and feet

143
Q

gangrene may be associated with

A

arterial ulcers

144
Q

murmurs that can be best heard with a bell

A

tricuspid and mitral stenosis

145
Q

rumbing sounds are with these murmurs

A

tricuspid and mitral stenosis

146
Q

S3 and S4 are heard when patient has

A

heart failure

147
Q

best to hear S3 and S4 when

A

using bell and patient in left lateral recumbent

148
Q

ways to identify murmurs

A

timing, location, radiation, intensity, pitch, quality

149
Q

timing of mitral valve prolapse

A

late systolic

150
Q

three heart sounds of pericardial friction rub

A

atrial systole, ventricular systole, and ventricular diastole

151
Q

location for pericardial friction rub

A

3rd ICS to left of sternum

152
Q

when you hear a pediatric murmur, next step is to

A

check H&H

153
Q

Class I heart failure

A

physical activity does not cause symptoms

154
Q

class II HF

A

slight limitations with physical activity

155
Q

Class III HF

A

symptoms with less than ordinary activity

156
Q

Class IV HF

A

symptoms at rest

157
Q

GOLD 1

A

FEV1 > 80%

158
Q

GOLD 2

A

FEV1 50-80%

159
Q

GOLD 3

A

FEV1 30-50%

160
Q

GOLD 4

A

FEV1 <30%

161
Q

gold standard for diagnosing COPD

A

spirometry

162
Q

3 measurements of spirometry

A

FVC, FEV1, ratio

163
Q

the amount of air that can be taken into the lungs.

A

forced vital capacity (FVC)

164
Q

reveals how freely the air moves within the lungs.

A

forced expiratory volume in one second (FEV1)

165
Q

when to give pna shots

A

> 65, prevnar 13 then pneumovax 23 6-12 months later

166
Q

components of intermittent asthma

A

symptoms < 2days/week, nighttime awakenings <2x/week

167
Q

components of mild persistent asthma

A

symptoms > 2days/week, nighttime awakenings 3-4x/month, SABA use >2x/week

168
Q

components of moderate persistent asthma

A

symptoms daily, nighttime awakenings >1x/week, SABA use daily

169
Q

components of severe persistent asthma

A

symptoms throughout day, nighttime awakenings 7x/week, SABA use several times/day

170
Q

lung function for severe persistent asthma

A

FEV1 <60%

171
Q

problem with SCDS

A

they prevent but don’t treat existing DVT

172
Q

activity with DVT

A

ambulate ASAP

173
Q

compression stockings with DVT

A

put on before getting out of bed, start after anticoagulation therapy

174
Q

when patient with DVT should be hospitalized

A

high bleeding risk, iliofemoral DVT, renal failure

175
Q

S1 is louder than S2 at the

A

apex

176
Q

S2 is louder than S1 at the

A

base

177
Q

maneuver to listen for HOCM

A

valsalva maneuver increases intensity, squatting decreases intensity

178
Q

helpful acronym to listen for S3

A

kentucky

179
Q

helpful acronym to listen for S4

A

tennessee

180
Q

a stiffening of aortic valve d/t aging

A

aortic sclerosis

181
Q

mitral regurgitation location

A

apex and can radiate to left axilla

182
Q

opening snap occurs in

A

mitral stenosis

183
Q

superficial thrombophlebitis occurs mostly in

A

saphenous vein

184
Q

s/s of renal artery disease

A

HTN < 30, malignant HTN, worsening renal function after use of ACE or ARB

185
Q

trendelenberg test for PVD

A

elevate leg 90 degrees, compress saphenous vein and ask pt to stand up. If blood flow quickly then valves are incompetent.

186
Q

raynaud’s disease

A

episodic spasm of small arteries and arterioles

187
Q

things that aggravate raynaud’s disease

A

cold, emotional upset, smokinG

188
Q

BNP value that indicates HF

A

> 100

189
Q

D-Dimer for DVT is

A

highly sensitive but not specific

190
Q

exercise training for PAD

A

exercise, stop when hurting, then start again when relieved.

191
Q

test that is more sensitive and rapidly responding indicator of ESR.

A

CRP

192
Q

CRP correlates with these levels

A

CKMB

193
Q

failure of CRP to normalize may indicate

A

damage to heart tissue.

194
Q

CRP levels are not elevated in patients with

A

angina

195
Q

CRP may be a stronger predictor of cardiovascular events than

A

LDL

196
Q

preferred study to diagnose PE

A

CT angiography

197
Q

ESR can detect

A

MI and severe anemia

198
Q

In HF, the ECG may show this which indicates loss of viable myocardium

A

Q waves

199
Q

BP goal for those >60 who don’t have diabetes or CKD.

A

150/90

200
Q

BP goal for patients 18 to 59 years of age without major comorbidities, and in patients 60 years of age or older who have diabetes or chronic kidney disease.

A

140/90

201
Q

hypertensive therapy for blacks

A

CCB and thiazide

Advanced Health Assessment (5 decks)

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