Vital Signs

Question 1

Auscultatory Gap

Answer 1

Silent period between systolic and diastolic sounds that leads to the physician thinking BP is lower than it actually is.

Underestimation of diastolic BP

Question 2

JNC-VII BP classifications

Answer 2

Normal: 160/>100

Always take the higher reading

Question 3

Orthostatic hypotension

Answer 3

Drop of >20 systolic or >10 diastolic

HR increase of >15 bpm or tachycardic

Question 4

Normal HR

Answer 4

60-100 bpm

Question 5

Normal RR

Answer 5

14-20 bpm

Question 6

SpO2 levels

Answer 6

> 92 is OK, normal is 97-99

<89=hospitalization

Question 7

Temperature

Answer 7

98.6 F (37 C) is normal

oral is gold standard

Question 8

Sputum

Answer 8

substance produced by lungs by coughing
- note color, consistency, blood etc

Infection, inflammation (asthma), COPD, pulmonary edema

Question 9

Hemoptysis

Answer 9

coughing up blood from lungs
Clots, cancer, pulmo HTN, PE
Smoking, Infection (most common cause)

Question 10

Dyspnea

Answer 10

subjective SOB
objective=tachypnea
Paroxysmal nocturnal dyspnea, orthopnea

Question 11

Wheezing

Answer 11

high pitched sound from partially obstructed airway.
Bronchospasm, edema, foregin body, CHF, tumor,

All that wheezes is not asthma

Question 12

Cyanosis

Answer 12

blue discoloration of skin due to decreased O2

central (problem at lungs) vs peripheral (problem at tissues

Question 13

Pleuritic pain

Answer 13

chest wall pain associated with breathing, inflammation of pleuras

Question 14

Examination of respiratory system

Answer 14

Inspection, palpation, percussion, auscultation

Question 15

Percussion sounds

Answer 15

Dull: solid organ, think liver
Resonant: air-containing organ, think lungs
Tympanic: hollow organ, think stomach
Flat: large muscle mass

Question 16

Tracheal lung sounds

Answer 16

very loud, very high pitched

1:1 IE ration
harsh
heard over trachea on neck

Question 17

Bronchial lung louds

Answer 17

loud, high pitched 1:3 IE
over manubrium
(larger airways)

Question 18

Bronchovesicular

Answer 18

moderate or intermediate pitch and volume
1:1
Head over primary bronchi b.w. scapulae

Question 19

Vesicular

Answer 19

soft, low pitch
3:1 I:E ratio
heard over most lung fields anteriorly/post/lat
this is the one to listen for

Question 20

Rales/crackles

Answer 20

opening and closing alveoli that are filled with fluid

PE

Question 21

Wheezes

Answer 21

high pitched sound caused by turbulent airflow in partially obstructed small airways, ex asthma

Question 22

Ronchi

Answer 22

low pitched sound that arise from partially obstructed large airways (bronchitis)

often filled with mucus

Question 23

PMI

Answer 23

located in 5ICS at MCL
displaced PMI indicates pathology (cardiac hypertrophy)

Thrills: check for vibration=mumur
Heave: impulse or displacement of sternum or precodium

Question 24

heart auscultation

Answer 24

R2ICS=aortic area 
L2ICS=pulmonic area
L3ICS=Erbs point 
L4ICS= tricuspid area
L5ICS= mitral area

Question 25

S1

Answer 25

first heart sound (lub) | closure of tricuspid and mitral valves

Question 26

S2

Answer 26

Second heart sound (dub) | closure of aortic and pulmonic valves

Question 27

Physiologic splitting

Answer 27

during second heart sound, heard over the pulmonic valve | due to more blood entering heart during inspiration (normal)

Question 28

PE of abdomen

Answer 28

``` Inspect auscultate percuss palpate rectal ```

Question 29

Borborygmi

Answer 29

hyperactive bowl sounds, low pitched rumbling | hyperperistalsis

Question 30

Bruits

Answer 30

soft sound made by disrupted arterial flow thru a narrowed artery listen midline

Question 31

Bicep DTR

Answer 31

C5-6

Question 32

Tricep DTR

Answer 32

C6-7

Question 33

Knee DTR

Answer 33

L2-4

Question 34

Ankle DTR

Answer 34

S1