202 Exam 2 Flashcards
1
Q
tension headache
(onset/duration?)
A
mild to moderate less disabling form of migraine
location: usually on both sides across frontal, temporal or occipital region
band-like tightness (nonthrobbing)
gradual onset
diffuse dull aching pain
2
Q
migrane headache
(onset/duration?)
A
HA of genetically transmitted vascular and trigeminal nerve origin (2-3 times more common in women)
commonly one-sided, pain often behind eyes, temporal or frontal region
throbbing, pulsating
rapid onset (can last up to 72 hrs or more)
3
Q
cluster headache
(onset/duration?)
A
intermittent , excruciating, unilateral with autonomic signs
location: on one side, often behind or around the eye
abrupt onset (45-90 mins)
can occur multiple times a day in “clusters”
4
Q
cancerous lumps feel like
A
hard, fixed, not tender
5
Q
parkinsons disease
A
a deficiency of the neurotransmitter dopamine, and degeneration of the substantia nigra of the basal ganglia in the brain
6
Q
Cushing’s syndrome
A
excessive secretion of adrenocorticotropic hormone (ACTH), person develops round moon-like face
7
Q
Bell’s palsy
A
a lower motor neuron lesion producing rapid onset of cranial nerve VII paralysis of facial muscles (unilateral)
8
Q
brain attack or CVA
A
a upper motor neuron lesion (central). caused by a blood clot of a cerebral vessel as in atherosclerosis (ischemic stroke) or a rupture in a cerebral vessel (hemorrhagic stroke)
9
Q
four functions of respiratory system
A
changing chest size during respiration
inspiration
expiration
control of respiration
10
Q
Clear sputum
A
bronchitis, viral infection, cold
11
Q
Yellow or green sputum
A
respiratory infection or bacterial infection
12
Q
pulmonary edema sputum color
A
pink and frothy (very concerning)
13
Q
anteroposterior-transverse diameter ratio
A
1:2
14
Q
tactile fremitus pg 439
A
15
Q
solid viscera organs/glands
A
liver
pancreas
spleen
adrenal glands
kidneys
ovaries
uterus
16
Q
hollow viscera organs/glands
A
stomach
gallbladder
small intestine
colon
bladder
17
Q
solid vs hollow viscera
A
solid: retains shape, solid in mass
hollow: shape depends on content (changes shape), organ is hollow
18
Q
proper assessment order for abdomen
A
IAPP: inspect, auscultate, percussion, palpation
19
Q
what is significant about kidney placement
A
the left kidney is slightly higher than the right. important for physical examination
20
Q
dysphagia
A
difficulty swallowing
21
Q
you may see abdominal pulsations in which people
A
newborns, children, skinny adults, HTN, a triple A, peristalsis
22
Q
normal bowel sounds characteristics
A
high-pitched, gurgling, cascading (normally 5-30 times per min)
23
Q
hyperactive bowel sounds
A
high-pitched, rushing, tinkling, signal increased motility
“borborygmi”
Colitis
24
Q
hypoactive bowel sounds
A
most commonly follow abdominal surgery or with inflammation of the peritoneum, late bowel obstruction, NPO
25
two tests to confirm ascites
fluid wave
shifting dullness
26
arteries in the abdomen
aortic
renal
iliac
27
what is a bruit
A bruit is an audible vascular sound associated with turbulent blood flow
28
rebound tenderness (blumbergs sign)
hold hand at 90 degrees, palpate slowly and deeply, then lift up quickly
perform test at end of exam because it can cause pain and muscle rigidity
29
inspiratory arrest test (Murphy's sign)
murphy's sign is elicited in pts with acute cholecystitis by asking patient to take in a hold a deep breath while palpating the right subcostal (below the ribs)
if pain occurs when the inflamed gallbladder comes into contact with the examiners hand, murphy's sign is positive
signifies acute cholecystis
30
3 types of hernias
umbilical hernia
epigastric hernia
incisional hernia
31
umbilical hernia
the protrusion of the momentum or intestine through a weakness or incomplete closure in the umbilical ring
32
epigastric hernia
protrusion of abdominal structures presents as a small fatty nodule at epigastrium in midline, through the Linea alba
33
incisional hernia
a bulge near an old operative scar that may not show when person is supine but is apparent when the person increases intra-abdominal pressure by a sit-up or standing
34
percussion of healthy lungs produces
resonance
35
which lung sound dominates
vesicular
36
decreased fremitus
asthma, collapsed lung, obstructed bronchus, pneumothorax, and emphysema
pleural effusion- fluid build up in the pleural cavity surrounding the lungs so it absorbs the vibrations from the visceral lung tissue (blocks the sound)
37
increased fremitus
increased density of lung tissue = increase vibrations example- pneumonia
38
enlarged thyroid gland is called a
Goiter
39
lymph node locations (10)
1. preauricular
2. posterior auricular
3. occipital
4. jugulodigastric
5. superficial cervical
6. posterior cervical
7. supraclavicular
8. deep cervical chain
9. submandibular
10. submental
40
lymph nodes characteristics and assessment
characteristics: <1cm, freely moveable, enlarged/inflamed = could indicate acute infection or illness
assessment: bimanual palpation, circular motion
41
anterior landmarks on thoracic cage
suprasternal notch
sternum
manubriosternal angle
costal angle
42
posterior landmarks on thoracic cage
vertebra prominens
spinous processes
inferior border of scapula
twelfth rib
43
number of lobes on each lung
2 lobes on the left
3 lobes on the right
44
listen to lower lobes (posteriorly or anteriorly?)
posteriorly
45
During a health history interview with patient what question should you ask? (thorax and lungs)
do you have to sleep with a lot of pillows at night? (orthopnea)
46
bronchial (trachea) breath sound characteristics
pitch: high
amplitude: loud
duration: inspiration < expiration
quality: harsh, hollow, tubular
location: trachea, larynx
47
Bronchiovesicular breath sound characteristics
pitch: moderate
amplitude: moderate
duration: inspiration = expiration
quality: mixed
location: over major bronchi where fewer alveoli are located
48
Vesicular breath sound characteristics
pitch: low
amplitude: soft
duration: inspiration > expiration
quality: rustling
location: over peripheral lung fields where air flows through smaller bronchioles and alveoli
49
adventitious lung sounds: Crackles
discontinuous popping sounds heard over inspiration
mechanisms: inhaled air collides with previously deflated airways, airways suddenly pop open
example- (late)- pneumonia, heart failure, interstitial fibrosis. (early)- chronic bronchitis, asthma, emphysema
50
adventitious lung sounds: wheezes
continuous musical sounds heard mainly over expiration
mechanisms: air compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors
example- acute asthma, or chronic emphysema, COPD
51
percussion sound that predominates over abdomen
tympany
52
measurement of pulmonary function status
forced expiratory time
pulse oximeter
6-minute walk
53
Barrel chest
AP-T 1:1
chronic emphysema and asthma as a result of hyperinflation of lungs
54
scoliosis
a lateral s-shaped curvature ofd the thoracic and lumbar spine usually involved in vertebrae rotation
most common in adolescent aged girls
55
kyphosis
exaggerated posterior curvature of the thoracic spine that cause significant back pain and limited mobility (humpback)
56
pectus excavatum
sunken sternum and adjacent cartilages (also called funnel breast). depression at 2nd ICS
57
pectus carinatum
a forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions long costpchondral junctions (pigeon breast)
58
cheyne-stokes respiration
a cycle in which respirations gradually wax and wane in a regular pattern, increasing rate and depth then decreasing.
most common in heart failure, in some cases renal failure, meningitis, drug overdose, increase intracranial pressure
59
biot respirations
similar to cheyne stokes however pattern is irregular. series of normal respirations (3-4 breaths) followed by period of apnea
60
chronic obstructive breathing
normal inspiration and prolonged expiration to overcome airway resistance
61
rhonchal fremitus
vibrations felt when inhaled air passes through thick secretions in the larger bronchi (may decrease by coughing)
62
pleural friction fremitus (palpable friction rub)
produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid
the opposing surface makes a coarse grating sound when rubbed together during breathing
63
discontinuous lung sounds
crackles- fine
crackles - coarse
atelectatic crackles
pleural friction rub
64
continuous lung sounds
wheeze- sibilant
wheeze- sonorous rhonchi
stridor (r/t anaphylaxis)
65
Stridor lung sound
originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissue, or lodged foreign body
croup and acute epiglottis, ANAPHYLAXIS
66
percussion (of the lungs) is helpful in identifying ___
surface alterations of lung tissue
67
layers of the heart (outer to inner)
pericardium
myocardium
endocardium
68
precordium
the area on the anterior chest directly overlying the heart and great vessels
69
S1 sound occurs with __
closure of the Atrioventricular (AV) valves (tricuspid and mitral)
beginning of systole
70
S2 sound occurs with __
closure of the semilunar valves (pulmonic and aortic) and signals the end of systole
71
effect of respiration on amount of blood in heart
moRe to the Right heart
Less to the Left
72
extra heart sounds
S3 - occurs immediately after S2 (may hear in pts with CHF, Acute MI, coronary artery disease, late pregnancy)
S4- occurs immediately before S1 (athletes, elderly pt, chronic hypertension, aortic stenosis, cardio myopathy)
73
S1 is louder at ___ and coincides with ____ pulse
the apex, carotid artery pulse
74
S2 is louder at
the base
75
jugular veins give information about the __ side of the heart
right
(JVD shows more in right jugular vein)
76
jugular vein distention can indicate
Right side heart failure
Right heart pressure
venous congestion
77
cultural consideration- prevalence of heart disease and stroke is higher among ___
black adults
78
cyanosis is r/t ____
decrease cardiac output
79
edema
starts in lower extremities and works its way up
80
nocturia
frequent urination during the night
81
how to palpate carotid arteries
one at a time
grade 1+ 2+ or 3+
82
how to check carotid artery for bruit
ask pt to take a breath in, then out and hold breath and then listen
83
apical pulse location (palpate)
midclavicular line 5th ICS
84
how to calculate pulse deficit
difference between apical pulse rate and radial pulse rate
apical minus radial
85
most common irregular heart rhythm
atrial fibrillation
86
how to listen for extra heart sounds (S3 and S4)
roll pt to their left side and listen with the bell at the apex for presence of diastolic filling sounds (S3 and S4)
87
point of max impulse = apical pulse location
88
auscultatory areas on heart
aortic area (2nd ICS, right sternal border)
pulmonic area (2nd ICS, left sternal border)
Erb's point (3rd ICS, left sternal border)
tricuspid area (5th ICS, left sternal border)
mitral area (5th ICS, left midclavicular line)
89
sound of a murmur
swishing
90
pericardial friction rub
inflammation of the pericardium
sound is high pitched and scratchy
examples: cardio myopathy, pericarditis
91
abnormal pulsations on the precordium
a thrill is heard at the base of the heart in the 2nd and 3rd ICS on the right (indicates severe aortic stenosis, and systemic hypertension) and on the left (indicates pulmonic stenosis and pulmonic hypertension)
92
a lift (heave) occurs with ____
right ventricular hypertrophies
seen in pts with pulmonic valve disease, pulmonic hypertension, and chronic lung disease
93
peripheral vascular system lymph nodes
cervical
axillary
epitrochlear
inguinal
94
intermittent claudication
r/t arterial disease, numbness, tingling or cramps*
95
use doppler for pulse
amplitude
only gets your systolic
96
lack of hair on one foot vs the other indicates
less blood flow and less nutrients
97
water-hammer (corrigan's) pulse
3+ , collapses suddenly
98
peripheral vascular disease in arms
raynauds syndrome
lymphedema- accumulation of protein-rich fluid in the interstitial spaces of the arm following breast surgery or treatment
99
peripheral vascular disease in legs
arteriosclerosis-ischemic ulcer
venous (stasis) ulcer
superficial varicose veins
DVT
100
deep vein thrombosis
requires immediate attention, high risk for PE
101
ascites
free fluid in the peritoneal cavity
102
blood flow through the heart
Superior/inferior vena cava
right atrium
tricuspid valve
right ventricle
pulmonic valve
pulmonary artery --> lungs to exchange CO2 for Oxygen
pulmonary veins
left atrium
mitral valve (bicuspid)
left ventricle
aortic valve
aorta---> oxygenated blood to the rest of the body
103
tests for suspected appendicitis
lliopsoas muscle test
obturator muscle test
104
Chronic arterial symptoms
Deep muscle pain usually in calf
Intermittent claudication- feels like a cramp
Aggravating factors: walking, claudication distance (distance it takes to produce pain), elevation
Relieving factors: rest, dangling
105
Acute arterial symptoms
Distal to occlusion, may involve entire leg
Throbbing
Sudden onset
Six Ps: pain, pallor, pulselessness, Paresthesia, poikilothermia, paralysis
106
Chronic venous symptoms
Calf, lower leg
Aching, tenderness, feeling of fullness
Aggravating factors: Prolonged sitting or standing
Relieving factors: elevation, lying, walking
Associated symptoms: edema, varicosities
At risk: jobs with long time sitting or standing, obesity, prolonged bed rest, varicosities, trauma
107
Acute venous symptoms
Calf
Moderate to intense, sharp, deep, tender
Pain increases with palpating
Helped by pain medication
Symptoms: red, swollen, warm
108
Modified allen test
Used to evaluate the adequacy of collateral circulation before cannulating the radial artery
Occlude both radial and ulnar pulse and then release the ulnar
109
Cervical lymph nodes drain
The head and neck
110
Ancillary lymph nodes drain
The breast and upper arm
111
Epitrochlear lymph nodes drain
The AC fossa and the hand and lower arm
112
Inguinal nodes drain
Most of the lymph of the lower extremity, external genitalia and anterior abdominal wall
113
Artery that supplies the hand
Ulnar
114
+ Blumbergs test indicates
Appendicitis
115
Murphys test indicates
Inflamed gallbladder
116
Hemoptysis
Coughing up blood
117
Manual compression test
Varicose veins
palpate the dilated vein with the fingertips of one hand. With the other hand, firmly compress the vein at a point at least 8″(20.3 cm) higher. Feel for an impulse transmitted to your lower hand
