Test 2: Heart & lungs Flashcards
hyperresonance of lungs can be heard in
asthma and COPD
soft and low pitched; inspiratory sounds that last longer than expiratory sounds without pause
vesicular breath sounds
inspiratory and expiratory sounds are about equal; heard often in the 1st and 2nd interspaces and b/t scapula
bronchovesicular breath sounds
loud expiratory sounds last longer than inspiratory sound with a short silence between.
bronchial breath sounds
discontinuous breath sounds
crackles or rales
continuous breath sounds
wheezes or rhonchi
discontinous, soft, high-pitched, and very brief breath sounds. Popping that sounds like wood in fireplace.
fine crackles
discontinuous, brief, popping breath sounds. Most common during inspiration.
coarse crackles
relatively high-pitched with hissing or shrill quality. mostly heard on expiration
wheezes
when “ee” sounds like “a” that suggest pneumonia
egophony
longer forced expiratory time is seen with
COPD
creaking or grating sounds that have been described as being similar to walking on fresh snow
pleural rub
continuous, low pitched sounds with a gurgling, snoring or rattle-like quality. More common during expiration.
rhonchi
an S3 gallop indicates
a change in ventricular compliance
mitral valve opens and rapid ventricular filling as blood flows early in diastole from atria into ventricle.
S3
S4 relates to a
stiff ventricle and atrial contraction
Stage I hypertension is
140-159/90-99mmHg
Stage II hypertension is
> 160/100
Prehypertension
129-139/80-89 mmHg
the carotid upstroke always occurs
in systole after S1
sounds or murmur coinciding with the carotid upstroke are
systolic
sounds or murmurs coinciding after the carotid upstroke are
diastolic
how to detect mitral stenosis
patient in left lateral decubitus and listen to apical pulse with bell of stethescope.
how to detect aortic murmurs
ask the patient to lean forward, exhale, and hold breath. listen with diaphragm from left sternal border to apex.
aortic regurgitation is heard at
2nd - 4th left interspaces
timing of aortic regurgitation
early diastolic
quality of aortic regurgitation
descrescendo, blowing, high pitched
aortic regurgitation can cause
left ventricular hypertrophy
heard in the right 2nd interspace that radiates to the carotids
aortic stenosis
timing of aortic stenosis
mid systolic murmur
quality of aortic stenosis
harsh sounding, crescendo-decrescendo heard higher at apex
aortic stenosis murmur is heard best when
patient is leaning forward
aortic stenosis is heard mostly in
elderly patients
tricuspid regurgitation is best heard over
lower left sternal border over xiphoid
timing of tricuspid regurgitation
holosystolic
quality of tricuspid regurgitation
blowing, increases intensity during inspiration,
tricuspid stenosis is best heard at
4th-5th ICS left of sternal border
timing of tricuspid stenosis
diastolic
quality of tricuspid stenosis
descrescendo, soft, and low-pitched
murmur usually associated with rheumatic fever
mitral and tricuspid stenosis
tricuspid stenosis increases in intensity by
exercise, inspiration, sitting forward
consider atbx prophylaxis prior to dentist appts for pateints with
tricuspid stenosis
group most associated with tricuspid stenosis
children, pregnancy
pulmonic valve regurgitation is heard best at
2nd ICS at left sternal border and radiates to apex
timing of pulmonic valve regurgitation
diastolic
quality of pulmonic valve regurgitation
High-pitched decrescendo murmur
most common causes of pulmonic valve regurgitation
pulmonary HTN or tetrology of fallot
pulmonic valve regurgitation is usually
asymptomatic
pulmonic valve stenosis is best heard at
2nd and 3rd left ICS
timing of pulmonic valve stenosis
midsystolic to late systolic
quality of pulmonic valve stenosis
harsh, crescendo-decrescendo
pulmonic valve stenosis usually found in
children-congenital
VSD is heard best at
4th left ICS
timing of VSD
holosystolic (throughout s1 and s2)
quality of VSD
harsh and loud with thrill
venous hum is due to the rush of blood from the _____ to the ____
jugular veins, superior vena cava
in venous hum, this is louder
diastole
location of venous hum
under the medial third of right clavicle
continuous murmur without a silent interval
venous hum
Described as a humming, roaring, low-pitched sound best heard with the bell.
venous hum
age group most affected by venous hum
children
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.
stills murmur
stills murmur heard best at
2nd to 4th left ICS
timing of stills murmur
early and mid systolic
quality of stills murmur
musical
linked with a remarkably rapid ejection of blood from the left ventricle during systole
hypertrophic obstructive cardiomyopathy (HOCM)
HOCM best heard at
lower left sternal border
timing of HOCM
late systolic
Typically develops during a puberty growth spurt as an adolescent
HOCM
timing of coarctation of aorta
continous
congenital narrowing of aorta
coarctation of aorta
Patent ductus arteriosis is caused by
failure of closure of hole that connects pulmonary artery and aorta
assessment of PDA reveals
bounding pulses
timing of PDA
continuous
higher risk of PDA with
premature infants
grade of murmur that is loud with thrill
Grade 4
grade of murmur where it is audible without a stethoscope and thrill is palpable
grade 6
risk factors for PE
age > 60, pulmonary HTN, CHF, lung disease, stroke, cancer, trauma, DVT, oral contraceptives
s/s of PE
pleuritic chest pain, hemoptysis, dyspnea, pleural friction rub, fever
virchow’s triad with DVT
venous stasis, hypercoagulability, endothelial injury.
sharp tearing chest pain with pain radiating to ipsilateral shoulder,
pneumothorax
pneumothorax will have ___ tactile fremitus and _____ of lungs
decreased; hyperresonance
tracheal shift seen in
pneumothorax, pleural effusion, atelectasis
in pneumothorax, the trachea is deviated toward the _____ during exhalation and toward the _____ during inhalation.
opposite side; the side of pneumothroax
s/s of croup
barking cough, stridor, hoarseness
cause of croup
parainfluenza type 1
AP radiograph reveals this with croup
steeple or thumb sign
in COPD there is ____ tactile fremitus and _____ lungs
decreased; hyperresonance
s/s of COPD
cough worse in morning, increased sputum, barrel chest, fatigue
asthma is characterized as
reversible airway obstruction, inflammation, and airway hyperresonsiveness.
GERD can be a risk factor for
asthma, acute bronchitis
hallmark of asthma is
coughing at night
children with asthma have respirations that are
slow and deep
bacterial causes of PNA
Mycoplasma, Streptococcus, Haemophilus influenza
incubation period for Mycoplasma pneumonia
21 days
s/s of PNA in adults
pleuritic chest pain, dyspnea, green sputum, fever, chills
this is usually absent in elderly with PNA
fever
these conditions increase tactile fremitus
PNA, HF, and tumors
trx for outpatient with bacterial PNA
macrolide (azithromycin or clarithromycin)
PNA in children is mostly caused by
RSV, adenovirus, parainfluenza
3 clinical findings with acute COPD exacerbation
worsening dyspnea, increased sputum purulence, and increased sputum production
causes of acute bronchitis
adenovirus, rhinovirus, influenza A&B, parainfluenza
s/s of acute bronchitis
rhonchi on expiration, hacking cough, low-grade fever, burning chest
in acute bronchitis, the chest xray is
normal
avoid this with bronchitis
antihistamines and decongestants
typical trx for acute bronchitis
cough suppressants
chronic bronchitis is the production of sputum for at least
3 months for 2 years
chronic bronchitis is usually
irreversible and progressive
secondary polycythemia is seen with
chronic bronchitis
In chronic bronchitis, the FEV1/FVC ratio is
< 70%
bronchiolitis is an infection of lower respiratory tract caused by
RSV
risk factor for bronchiolitis
daycare centers
This commonly accompanies bronchiolitis
otitis media
S/S of bronchiolitis
URI for 1-3 days, fever, cough, crackles, purulent rhinorrhea
s/s of TB
night sweats, hemoptysis, brassy cough
PPD can cause a false negative with
steroid use
positive PPD test for a regular person is induration greater than
15 mm
positive PPD test for immigrant, healthcare worker, or drug user is when induration is greater than
10 mm
in sputum smear, this suggests TB
acid-fast bacilli (AFB)
monitoring this when on TB meds
LFTs
in adults, a URI is viral when there is a
temp less than 101, small amounts of clear-yellow sputum, nasal congesiton, malaise
In adults, a URI is bacterial when there is
temp greater than 101, chest pain, purulent sputum
in children, a bacterial URI is when there is
fever, loss of appetite
often people with GERD are
smokers, overuse alcohol, and are overweight
inflammation of the pleural lining of the lung after a URI
pleurisy
pain with pleurisy is lessened when
lying on the affected side
pericarditis pain is described as
sharp, stabbing pain that radiates to left shoulder
in pericarditis, pain is worse when
supine or sitting, better when sitting forward
labs indicative of pericarditis
elevated WBC and ESR and ST elevation
s/s of aortic aneurysm
diaphoresis, hypotension, asymmetrial pulses & BP
size of aortic aneurysm
aortic diameter > 3 mm
meds that can cause syncope
antidepressants, antiarrhythmics, beta blockers, diuretics
diagnostic tests for syncope
carotid ascultation, Holter monitor, stress test, ECG, tilt table test
normal ABI
0.90-1.30
severe PAD
< 0.39
s/s of PAD
claudication, no hair on legs, thick toenails, cool extremities
in PAD, the legs feel better when ____ and feel worse when _____
dependent; elevated
gold standard for diagnosing PAD
contrast angiography
varicose veins are when veins are
incompetent and allow reverse blood flow.
venous ulcers appear more on
lateral ankle
ulcer borders are irregular, flat, and painful
venous ulcers
arterial ulcers appear more on
toes and feet
gangrene may be associated with
arterial ulcers
murmurs that can be best heard with a bell
tricuspid and mitral stenosis
rumbing sounds are with these murmurs
tricuspid and mitral stenosis
S3 and S4 are heard when patient has
heart failure
best to hear S3 and S4 when
using bell and patient in left lateral recumbent
ways to identify murmurs
timing, location, radiation, intensity, pitch, quality
timing of mitral valve prolapse
late systolic
three heart sounds of pericardial friction rub
atrial systole, ventricular systole, and ventricular diastole
location for pericardial friction rub
3rd ICS to left of sternum
when you hear a pediatric murmur, next step is to
check H&H
Class I heart failure
physical activity does not cause symptoms
class II HF
slight limitations with physical activity
Class III HF
symptoms with less than ordinary activity
Class IV HF
symptoms at rest
GOLD 1
FEV1 > 80%
GOLD 2
FEV1 50-80%
GOLD 3
FEV1 30-50%
GOLD 4
FEV1 <30%
gold standard for diagnosing COPD
spirometry
3 measurements of spirometry
FVC, FEV1, ratio
the amount of air that can be taken into the lungs.
forced vital capacity (FVC)
reveals how freely the air moves within the lungs.
forced expiratory volume in one second (FEV1)
when to give pna shots
> 65, prevnar 13 then pneumovax 23 6-12 months later
components of intermittent asthma
symptoms < 2days/week, nighttime awakenings <2x/week
components of mild persistent asthma
symptoms > 2days/week, nighttime awakenings 3-4x/month, SABA use >2x/week
components of moderate persistent asthma
symptoms daily, nighttime awakenings >1x/week, SABA use daily
components of severe persistent asthma
symptoms throughout day, nighttime awakenings 7x/week, SABA use several times/day
lung function for severe persistent asthma
FEV1 <60%
problem with SCDS
they prevent but don’t treat existing DVT
activity with DVT
ambulate ASAP
compression stockings with DVT
put on before getting out of bed, start after anticoagulation therapy
when patient with DVT should be hospitalized
high bleeding risk, iliofemoral DVT, renal failure
S1 is louder than S2 at the
apex
S2 is louder than S1 at the
base
maneuver to listen for HOCM
valsalva maneuver increases intensity, squatting decreases intensity
helpful acronym to listen for S3
kentucky
helpful acronym to listen for S4
tennessee
a stiffening of aortic valve d/t aging
aortic sclerosis
mitral regurgitation location
apex and can radiate to left axilla
opening snap occurs in
mitral stenosis
superficial thrombophlebitis occurs mostly in
saphenous vein
s/s of renal artery disease
HTN < 30, malignant HTN, worsening renal function after use of ACE or ARB
trendelenberg test for PVD
elevate leg 90 degrees, compress saphenous vein and ask pt to stand up. If blood flow quickly then valves are incompetent.
raynaud’s disease
episodic spasm of small arteries and arterioles
things that aggravate raynaud’s disease
cold, emotional upset, smokinG
BNP value that indicates HF
> 100
D-Dimer for DVT is
highly sensitive but not specific
exercise training for PAD
exercise, stop when hurting, then start again when relieved.
test that is more sensitive and rapidly responding indicator of ESR.
CRP
CRP correlates with these levels
CKMB
failure of CRP to normalize may indicate
damage to heart tissue.
CRP levels are not elevated in patients with
angina
CRP may be a stronger predictor of cardiovascular events than
LDL
preferred study to diagnose PE
CT angiography
ESR can detect
MI and severe anemia
In HF, the ECG may show this which indicates loss of viable myocardium
Q waves
BP goal for those >60 who don’t have diabetes or CKD.
150/90
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.
140/90
hypertensive therapy for blacks
CCB and thiazide
