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Part 4 Boards > Vital Signs > Flashcards

Vital Signs Flashcards

1
Q

Normal oral temp

A

98.6 deg Farenheit

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2
Q

Normal adult pulse

A

60-100 bpm

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3
Q

Normal adult respiratory rate

A

14-18 breaths per minute

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4
Q

Where are the peripheral pulses located? (9)

A 
Temporal artery 
Facial artery 
Carotid artery
Brachial artery 
Radial artery 
Femoral artery 
Popliteal artery
Posterior tibial artery
Dorsalis pedis artery
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5
Q

Normal adult blood pressure

A

90-120/60-80

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6
Q

What blood pressure indicates hypertension?

A

over 140/90

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7
Q

What blood pressure indicates hypotension?

A

under 90/60

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8
Q

What condition consists contains vesicles that are elevated with serous activity .5 cm and follows a thoracic dermatome?

A

Herpes Zoster

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9
Q

What condition presents with silver scales on the exterior surface?

A

Psoriasis

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10
Q

What condition contains a “butterfly rash”?

A

Systemic Lupus Erythymtosis

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11
Q

What two tests, test for vertebrobasilar artery insufficiency?

A

!. Dekleyn’s

2. Vertebrobasilar Artery Functional Maneuver

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12
Q

Explain how to perform vertebrobasilar artery maneuver.

A

Patient seated.
Auscultate (Bell) and palpate subclavian AND cartoid arteries
If NO BRUITS, pt rotates and hyper-extends head to each side.

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13
Q

When do you know if a vertebrobasilar artery maneuver test is positive?

A

Positive test produces:

vertigo, blurred vision, nausea, syncope, nystagmus

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14
Q

What disease is indicated by bilateral ptosis?

A

Myasthenia Gravis

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15
Q

What disease is indicated by unilateral ptosis?

A

Horner’s Syndrome (loss of cervical sympathetics, ptosis, miosis, and anhydrosis) OR CN III Lesion.

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16
Q

What eye conditions are observed in the early stages of AS?

A

Iritis/Uveitis

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17
Q

What eye condition is an indication of increased intracranial pressure?

A

Papilledema

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18
Q

What (3) eye conditions are indicative of arteriosclerosis?

A

AV nicking, silver wire arterioles, widened light reflex

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19
Q

What (3) eye conditions are indicative of hypertension?

A

Flame hemorrhages, cotton wool spots, and narrow light reflex

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20
Q

What (4) eye conditions are indicative of diabetes mellitus?

A

Yellow, hard, waxy, exudates, neovascularization, microaneurysms, absent red light reflex

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21
Q

What two conditions occur in the external ear?

A
  1. Otitis externa

2. Air conduction loss

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22
Q

What three conditions occur in the middle ear?

A
  1. Otitis media
  2. Otosclerosis
  3. Meniere’s disease
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23
Q

What 5 conditions occur in the inner ear?

A
  1. Meniere’s disease
  2. Labyrinthitis
  3. Vertigo
  4. Acoustic Neuroma
  5. Ototoxicity
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24
Q

How do you interpret findings during the Weber and Rinne Test?

A

If patient does not hear the sound equally on both sides it is called LATERALIZATION. If they hear louder in one ear it can mean that there is air conduction on the louder side or a nerve deficit on the other side.

Rinne:
This test is used to determine either air conduction or sensorineural problem. 1st check the side that is louder to check for air conduction loss by placing the tuning fork on the mastoid process and asking the patient to verbalize when they can no longer hear it. Then place the tuning form in from on EAM. Normal hearing= EAM for 2X as long as on the mastoid. If not 2X as long, consider air conduction. If normal… consider nerve on the opposite side.

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25
Q

Tenderness of sinuses= ___________.

A

Sinusitis

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26
Q

Where is the upper lobe of the right lung located?

A

above the clavicle to the 4th rib

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27
Q

Where is the middle lobe of the right lung located?

A

from the 4th to the 6th rib medially

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28
Q

Where is the lower lobe of the right lung located?

A

from the 6th to the 8th rib laterally

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29
Q

Where is the upper lobe of the left lung located?

A

above the clavicle to the 6th rib

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30
Q

Where is the lower lobe of the left lung located?

A

from the 6th to the 8th rib laterally

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31
Q

Where are the upper and lower lobes locates on the posterior?

A

above T3 toward the axilla is the upper lobes

below to T10 is the lower lobes

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32
Q

What does dullness indicate during percussive chest sounds?

A

Pneumonia, atelectasis, and pleurisy

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33
Q

What does resonance indicate during percussive chest sounds?

A

Normal and bronchitis

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34
Q

What does hyperresonance indicate during percussive chest sounds?

A

Emphysema and Pneumothorax

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35
Q

Where are tracheal breath sounds heard?

A

Over the trachea

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36
Q

Where are bronchial breath sounds heard?

A

Over the manubrium

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37
Q

Where are bronchovesicular breath sounds heard?

A

Between the 1st-2nd ribs anteriorly and between the scapulae posteriorly

38
Q

Where are vesicular breath sounds heard?

A

The remaining lung field

39
Q

Explain what you hear with bronchophony.

A

Clear, distinct sounds are heard as the patient says “99”, consolidation is present

40
Q

Explain what you hear with egophony.

A

You hear “aaaa” as the patient says “eeeee”, consolidation is present

41
Q

Explain what you hear with whispered pectoriloquy.

A

“99” is heard clearly and distinctly, consolidation is present

42
Q

Features of lobar pneumonia.

A 
Percussion is dull (over the fluid) 
Rales aka crackles heard 
Increased tactile fremitus 
Productive cough at 10 days 
Rusty brown sputum 
Possible fever
43
Q

Features of tuberculosis.

A 
Caused my mycobacterium tuberculosis 
Low grade fever 
Night sweats 
Productive cough 
Yellow/green sputum 
Starts in apices of the lung 
Crackles in upper lobe 
Tine test/Mantoux test 
Positive purified protein derivative 
MOST definitive test for dx= sputum culture
44
Q

Features of pleurisy.

A 
Inflammation of pleura 
Usually produces exudative pleural effusion and stabbing chest pain worsened by respiration and cough 
Dull on percussion
Dry/non-productive cough
Decreased respiratory excursion 
Decreased tactile fremitus 
Friction rub present 
Decreased breath sounds 
\+ Schepelman's Test
45
Q

Features of pneumothorax.

A

Ruptured lung causing air to become trapped in the pleural space
Decreased chest expansion
Decreased tactile fremitus
Hyper-resonant
Decreased breath sounds
Can occur in young, previously healthy, tall, thin runners
Unilateral darkening of the chest due to collapse of the lung; tracheal shift away from the lesion

46
Q

Features of atelectasis.

A

Collapse of the lung that is usually the result of bronchial obstruction due to a mucous plug
Presents with decreased tactile fremitus
Dull on percussion
Decreased chest expansion
Decreased or absent breath sounds
On x-ray the collapsed lung will display increased density and mediastinal shift to the same side

47
Q

Features of emphysema.

A

Destruction of the elastic pulmonary connective tissue results in permanent dilation of the alveoli air sacs

Presents with decreased tactile fremitus, hyperresonant percussion, decreased breath sounds, and prolonged expiration with an expiratory wheeze and 20-30 years of smoking likely.

Fluid will accumulate first in the costophrenic recesses

Bilaterally darkened lung fields; narrowed compressed heart; horizontal ribs; flattening of the diaphragmatic domes

48
Q

Features of bronchogenic carcinoma.

A

Primary malignant lung tumor that starts in the area of the bronchus.

Long term history of smoking (20-30 years)

Coughing (non-productive) more than 30 days

Afebrile, dyspnea, weight loss, and clubbing of the fingernails

49
Q

Features of costochondritis.

A

Inflammation of the cartilage connection between the ribs and the sternum. It develops as a consequence of physical activity and is worse with exercise.

Pain increased while taking a deep breath.

Palpable tenderness at the 3rd, 4th, or 5th costosternal articulation

50
Q

Features of Tietze Syndrome.

A

Inflammation of the costal cartilage at one articulation. This pain can radiate and be chronic in nature.

51
Q

Features of Herpes Zoster aka Shingles.

A

Painful rash following the course of a dermatome usually a single nerve.

Primarily involves the dorsal root ganglion but when it does involve CN it is most commonly CN V.

52
Q

Features of sarcoidosis.

A

A disease in which abnormal collections of inflammatory cells (granulomas) form as nodules.

Most often appear in the lungs or lymph nodes.

Most commonly seen in people of African American descent

X-ray: bilateral hilar lymphadenopathy

53
Q

Features of Hodgkin’s

A

Cancer of the lymphatic system

Most commonly seen in young Caucasian males

Present with fever, night sweats, weight loss, intense pruritis (release of IgE) and enlarged spleen

Best diagnosed from biopsy looking for Reed Sternberg cells

X-ray: unilateral hilar lymphadenopathy

54
Q

Where do you percuss for the heart?

A

From the midaxillary line to the right side of the sternum in the 3rd, 4th, and 5th intercostal spaces for cardiomegaly

55
Q

What do you look for when palpating around the heart?

A

abnormal pulsations and thrills

56
Q

What do you listen for when auscultating the heart?

A

detection of high pitched sounds with the diaphragm or low pitched murmurs with the bell

57
Q

Where is the aortic valve located?

A

right sternal border at the 2nd intercostal space

58
Q

Where is the pulmonic valve located?

A

left sternal border at the 2nd intercostal space

59
Q

Where is the tricuspid valve located?

A

left sternal border at the 4th or 5th intercostal space

60
Q

Where is the mitral valve located?

A

mid-clavicular line at the 5th intercostal space

61
Q

Features of right sided heart failure.

A

Cardiomegaly jugular venous pulsations/distension

Bilateral leg swelling- pitting edema

Difficulty breathing

62
Q

What are the common causes of right sided heart failure?

A

Left sided heart failure and cor pulmonale

63
Q

Features of angina pectoris- coronary vasospasm

A

Comes on with exertion

Printzmetal angina comes on with rest (atypical)

Relieved by vasodilators under the tongue (usually nitroglycerin)

64
Q

Features of myocardial infarction.

A

Acute heart failure

Comes on with rest

Severe substernal chest pain

Referral to the left arm

Labored breathing caused by atherosclerosis

CPK is elevated

Increased SGOT

Increased LDH

65
Q

What tests are performed for heart conditions?

A

Electrocardiogram

Echocardiogram (valves)

Refer to cardiologist!!

66
Q

Where does gallbladder refer pain?

A

Right shoulder or tip of the right scapula- VISCEROSOMATIC

67
Q

What are features of cholecystitis?

A

MC seen in overweight females over 40 years of age

Most common cause is cholelithiasis

Severe right upper quadrant pain, nausea, vomiting and precipitated by eating a large fatty meal

68
Q

What are the tests for cholecystitis?

A

Diagnostic ultrasound

Oral Cholecystogram

69
Q

What sign confirms cholecystitis?

A

Murphy’s sign- inspiratory arrest sign

70
Q

What are features of pancreatitis?

A

Epigastric pain going straight through the T10-T12 area like a knife- Viscerosomatic

Chronic is seen with alcoholism

Acute= 911 emergency

71
Q

What sign confirms pancreatitis?

A

Grey Turner Sign- bleeding into the flank

Cullen’s sign- Periumbilical ecchymosis

72
Q

What do you find on positive lab tests for pancreatitis?

A

Increased amylase and lipase

73
Q

What is diabetes mellitus?

A

A condition in which the pancreas does not produce a sufficient amount of insulin to take the sugar out of the blood and transport it to the tissues of the body. These starved tissues force the breakdown of fats in order to obtain energy.

74
Q

What are the types of diabetes mellitus?

A

Insulin Dependent Type I

non-insulin Dependent Type II

Adult over 40, usually obese

75
Q

What is diabetes insipidus?

A

Condition of the posterior pituitary gland in which there is insufficient ADH. May have polydypsia and polyuria but not polyphagia

76
Q

What is a hiatal hernia?

A

Protrusion of the stomach above the diaphragm. Presents with palpable tenderness in the LUQ, reflux esophagitis, Dyspepsia (indigestion), made worse after eating a large meal or when lying down

77
Q

What is reflux esophagitis?

A

Upward reflux of acid contents of the stomach into the esophagus

Caused by sliding hiatal hernia

worse when lying down, after a big meal, valsalva, or bearing down

Tests: X-ray or upper GI series

78
Q

What is mononucleosis caused by?

A

Epstein Barr Virus

79
Q

What are features of mononucleosis?

A

Seen in young adults (18-25)

Presents with symptoms similar to the flu- fever, headache, fatigue, lymphadenopathy in the cervical region, splenomegaly

Atypical lymphocytes in blood (Downey cells)

Monospot AKA heterophile agglutination AKA paul bunnell test

80
Q

What is regional ileitis AKA crohn’s disease?

A

Nonspecific inflammatory disorder that affects the distal ileum and colon

81
Q

Features of regional ileitis AKA crohn’s disease?

A

Inflammation is patchy with healthy tissue between the patches –> COBBLESTONE appearance

They do NOT absorb B12- which is the problem.

Presents with RLQ pain and chronic diarrhea

Leads to malabsorption syndromes: non-tropical sprue/celiac sprue

Diagnose with sigmoidoscopy

82
Q

Features of ulcerative collitis.

A

Left side of intestines- MC at colon and rectum

presents with bloody diarrhea and fever

Can lead to sacroiliitis (enteropathic arthropathy)

Test= sigmoidscopy

83
Q

Features of irritable bowel syndrome AKA spastic colon

A

Variable degrees of constipation and diarrhea in response to stress.

Seen more commonly in females

Abdominal pain and gas relieved by bowel movements

84
Q

Features of appendicitis

A

Dull periumbilical or epigastric pain that radiates to the lower right quadrant

Presents with fever, nausea, vomiting, and anorexia

Increased WBC (Schilling shift to the left)

Tests: McBurney’s Point, Rebound tenderness-peritonitis, blumberg’s rebound tenderness-peritonitis, rovsing’s signs, psoas sign, obturator sign

Special test= CT

85
Q

Features of Nephrolithiasis

A

Made of calcium- calcium oxalates=MC, calcium urates and calcium phosphates

Back pain radiating into the groin (ureter stone)

Pain=writhing

Murphy’s kidney punch +

Evaluates by increased BUN, uric acid, creatinine clearance, KUB study

UA reveals hematuria (cut ureters so could have infection)

Staghorn calculi- MC cause is hydronephrosis due to kidney stone

86
Q

Features of pyelonephritis

A

E-coli from UTI

WBC casts

87
Q

Features of urethritis

A

MC caused by E. Coli in females and N. Gonorrhea in males

Nitrites in urine

88
Q

Features of cystitis

A

Noninfectious bladder inflammation that causes burning, painful, and frequent urination with incontinence

Patient will also have suprapubic and low back pain

89
Q

What is the 2nd MC cause of CANCER death in women?

A

Breast CA

90
Q

Features of breast cancer.

A

MC in females over 50

MC location= upper/outer quadrant

Presents with nipple retraction, bleeding, orange peel appearance, and dimpling (Paget’s disease of the breast)

Mets to the axilla via the lymphatic system and will most likely be lytic when seen in the bone

Part 4 Boards (1 decks)

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