Cardio/Resp Flashcards
(178 cards)
1
Q
Vertical Axis
A
Counting down ribs and intercostal spaces
2
Q
Circumference of the Chest Measurment
A
series of vertical lines as landmarks
3
Q
Anterior Circumference of Chest Measurements
A
4
Q
Posterior Circumference of Chest Lines
A
5
Q
Lateral Circumference of Chest Lines
A
6
Q
Supraclavicular
A
Above the Clavicles
7
Q
Infraclavicular
A
Below the Clavicle
8
Q
Interscapular
A
Between the scapulae
9
Q
Infrascapular
A
Below the scapulae
10
Q
Which lung has 3 lobes
A
Right Lung
11
Q
Anterior lung fields
A
12
Q
Anterior Respiratory Ausculation Points
A
13
Q
Right Lateral Lung Fields
A
14
Q
Left Lateral Lung Fields
A
15
Q
Posterior Lung Fields
A
16
Q
Posterior Respiratory Auscultation Points
A
17
Q
Accessory Muscles of the Neck
A
Sternomastoid Muscle
18
Q
Accessory Muscles of the Chest
A
Intercostal Muscles
19
Q
Gestures:
Clenched fist over sternum
A
suggests angina pectoris
20
Q
Gestures:
Finger pointing to tender area
A
Suggests muscoloskeletal pain
21
Q
Gestures:
hand moving from neck to epigastric area
A
Suggests heartburn
22
Q
7 attributes of symptom complaint
A
Location
Quality
Severity
Timing
Setting in which it occurs
Alleviating/Aggrevating factors
Accompanying symptoms
23
Q
Most frequent cause of chest pain in children
A
Anxiety
24
Q
How should you rate shortness of breath
A
In relation to daily activities
25
Breathing difficulty in Anxiety Patients
"can't get enough air"
tingling aroung lips/extremities (paresthesia)
26
Cardiac related cough
sign of left sided heart failure
27
Acute cough duration
Less than 3 weeks
28
Subacute cough duration
3-8 weeks
29
Chronic cough duration
More than 8 weeks
30
Most common cause of acute cough
Viral Upper Respiratory Infections
31
Mucoid Sputum
Translucent, white, or gray
32
Purulent Sputum
Yellow or Green
33
Foul smelling sputum
Present in anaerobc lung abcess
34
Patient position for examining posterior thorax
Sitting with arms crossed over chest and hands resting on opposite shoulders
35
Patient position for examining anterior thorax
Supine
36
Thorax assessment techniques
Inspect
Palpate
Percuss
Auscultate
37
Normal repiratory rate for healthy adult
14-20
38
Stridor
High-pitched wheeze
Sign of upper airway obstruction
39
Lateral displacement of trachea
Occurs in pneumothorax, plueral effusions, or atelectasis
40
AP diameter
Shape of chest from front to back
41
Observed assymetric chest expansion
Pleural effusion
42
Observed retraction
Severe asthma
COPD
Upper airway obstruction
43
Posterior Palpation for chest expansion
Raise a small skin fold between your fingers, ask patient to take deep breath, and watch for equal expansion of hands
44
Fremitus
Vibrations felt in thorax when patient is speaking
45
Technique for detecting tactile fremitus
Use the ball of your palm
Have patient repeat "99"
Feel for symmetry of both sides
46
Anterior palpation points for tactile fremitus
47
Posterior palpation points for tactile fremitus
48
Typical findings:
Tactile Fremitus
More prominent interscapularly than in lower lung fields
disapears below diaphragm
Often more prominent on right than left
49
Findings:
Asymetric decreased fremitus
Unilateral pleural effusion
pneumothorax
Neoplasm
Decreased transmission of low frequency sounds
50
Findings:
Asymetric increased fremitus
Unilateral pneumonia
## Footnote
increased transmission through consolidated tissue
51
What does percussion determine
If tissues are air-filled, fluid-filled, or solid
52
Percussion technique
Place top joint of middle finger on surface and tap it quickly with the tip of your other middle finger. Movement comes from wrist, not fingers
 
53
Percussion sounds:
Flat
Intensity: Soft
Pitch: High
Duration: short
Location example: thigh
54
Percussion sounds:
Dull
Intensity: Medium
Pitch: Medium
Duration: Medium
Location Example: Liver
55
Percussion Sounds:
Resonant
Intensity: Loud
Pitch: Low
Duration: Long
Location examply: Healthy lung
56
Percussion Sound:
Hyperresonant
Intensity: Very loud
Pitch: Lower
Durantion: Longer
Location example: Shouldn't be one
57
Percusiion sound:
Tympanitic
Intesity: Loud
Pitch: High
Duration: Longer
Location example: Gastric air bubble or puffed out cheek
58
Percussion points of posterior thorax
59
Percussion with consolidation or fluid
Dullness rather than resonance
60
Lobar pneumonia
Alveoli are filled with fluid and blood
Dull percussion
61
Pleural effusion
Pleural accumulations of serous fluid
Dull percussion sounds
62
Hemothorax
Pleural accumulation of blood
Dull percussion
63
Empyema
Pleural accumulation of pus
Dull percussion
64
Percussion in presence of fibrous tissue or tumor
Dull percussion
65
Oserved generalized hyperresonance
Hyperinflated lungs of COPD or asthma
66
Observed unilateral hyperresonance
Suggests large pneumothorax or air filled bulla
67
Technique to identify diaphragmatic location
Percuss the area you expect to be dull then move upward until sound changes from dull to resonant. This is level of diaphragm
68
Noted abnormally high diaphragm level
## Footnote
Suggests pleural effusion, atelectasis, or phrenic nerve paralysis
69
Estimate diaphragmatic excursion
DIstance between level of dullness on full expiration and level of dullness on full inspiration (normal is about 3-5.5 cm)
70
Vesicular breath sounds
Soft, low pitched sound heard over most lung fields. Lasts through entire inhalation and fades about 1/3 of the way into exhilation
71
Broncho-vesicular sounds
Inspiratory ad expiratory sounds are about equal in length, pitch, and intensity
72
Bronchial sounds
Expiratory sounds last longer than inspiratory sounds, louder, harsher, and higher pitched
73
Tracheal sounds
Inspiratory and expiratory sounds are equal, loud, and relatively high
74
Anterior ausculatory areas for normal breath sounds
75
Posterior ausculatory areas for normal breath sounds
76
Bronchovesicular or bronchial sounds noted in abnormal areas
Suspect fluid or consolidation
77
Which side of stethoscope is used to auscultate breath sounds
Diaphragm
78
Crackles
Abnormalities of the lung or airways
Possible pneumonia, fibrosis, early heart failure, bronchitis
79
Wheezes
Narrowed airways
Asthma, COPD, bronchitis
80
Rhonchi
Secretions in large airways
Sounds like snoring
81
Anterior palpation for chest expansion
Push fold of skin up between thumbs and ask patient to take a deep breath. Watch for symmetrical movement of thumbs
82
Pectus Excavatum
## Footnote
(Funnell Chest)
83
Barrell Chest
84
Costovertebral Angle
Palpate for Kidney Tenderness
85
Point of Maximum Impulse (PMI)
Produces The apical pulse and is located in the 5th intercostal space at the midclavicular line
86
Cario Review of Symptoms:
History?
**MI**
**HTN**
**Thrombophlebitis**
**rheumatic fever**
**murmurs**
(Personal and family)
87
Cardio Review of Symptoms:
Labs
Last lipid screening, EKG, stress tests, cardiac cath, echo
88
Cardio review of symptoms:
current complaints
Assess for DOE, nocturnal dyspnea, orthopnea, palpitations, edema, light-headedness
89
Cardiovascular risk factors
Smoking, DM, HTN, cholesterol, sedentary lifestyle, obesity, family history
90
Basic anatomy of coronary circulation
91
Which side of the stethoscope is used to auscultate heart sounds while supine
Diaphragm and Bell
92
Auscultation points for heart sounds
93
Which side of stethoscope is used fro auscultation of left lateral heart sounds
Bell
94
Which side of stethoscope is used for auscultation of heart sounds while patient sits
Diaphragm
95
Heart sounds auscultated when supine
Aortic, pulmonic, erb's point, tricuspid, mitral
96
Heart sounds auscultated left lateral side
Tricuspid, mitral
97
Heart sounds auscultated while patient is sitting and leaning forward
Aortic, pulmonic
98
Review of Heart sounds
99
Stroke volume
Amount of blood ejected with each heartbeat
100
Preload
Volume of blood in the right ventricle at the end of diastole
(volume overload)
101
Myocardial Contractility
Ventricles contract during systole
102
Afterload
the degree of vascular resistance to ventricular contraction
(pressure overload)
103
What does JVP reflect
Right atrial pressure
104
How do you figure cardiac output
Stroke volume x Heart rate
105
Which valves are open during systole
## Footnote
Pulmonic
## Footnote
(Blood pumped into pulmonary arteries)
Aortic
(Blood pumped into aorta)
106
What closes during systole
## Footnote
Mitral and tricuspid valves
107
What valves are open during diastole
## Footnote
Mitral
(Blood flow from left atrium to left ventricle)
Tricuspid
(Blood flow from right atrium to right ventricle)
108
What closes during diastole
Aortic and pumonic valves
109
Murmur Type:
Aortic Stenosis
Systolic murmur
110
MurmurType:
Pulmonic stenosis
Systolic
111
Murmur Type:
Mitral Regurg
Systolic
112
Murmur Type:
Tricuspid Regurg
Systolic
113
Murmur Type:
Aortic Regurg
Diastolic
114
Murmur Type:
Pulmonic Regurg
Diastolic
115
Murmur Type:
Mitral Stenosis
Diastolic
116
Murmur Type:
Tricuspid Stenosis
Diastolic
117
Septal Defects
ASD, VSD
118
Examination Technique:
JVP
* Raise HOB 30 degrees
* Turn patient's head gently to the left
* Find the top point of pulsation
* Place centimeter ruler on sternal angle
* place tongue blade from the top of JVP to ruler (right angle)
* Read distance above sternal angle (3-4cm is normal)
119
Palpation of brisk carotid upflow
Normal
120
Palpation of delayed carotid upstroke
Suggests aortic stenosis
121
Palpation of bounding carotid upstroke
Suggests aortic insufficiency
122
Why should you auscultate carotid arteries
Check for bruits
123
Thrills
Turbulence produced by damaged valve that can be palpated on chect wall as a vibration
124
Where should you palpate for thrills
Aortic, pulmonic, left parasternal, and apical areas
125
How do you assess PMI
Palpate with finger pads at the apex of the heart
(best felt in left pateral position)
126
Normal PMI amplitude
Brisk or tapping
127
Sustained PMI
Suggests LV hypertrophy from aortic stenosis or HTN
128
Diffuse PMI
Suggests dialated ventricle from, CHF or cardiomyopathy
(diameter greater 3cm)
129
When assessing PMI what should be noted
Location
Amplitude
Duration
Diameter
130
Patient complains of paroxysmal nocturnal dyspnea
Suggests LV heart failure, mitral stenosis, nocturnal asthma attacks
131
Typical causes of dependent edema
CHF, hypoalbuminemia
132
Edema in nephrotic syndrome
Periorbital, tight rings
133
Edema in liver failure
Abdominal (ascites)
134
Stroke risk factors unique to women
pregnancy, hormone therapy, early menopause
135
Global risk factors to assess for CVD risk
* Family history of premature CVD
* Smoking
* Poor DIet
* Physical Inactivity
* Obesity
* HTN
* Dyslipidemias
* Diabetes
* Pulse
136
Conditions which cause elevated JVP
* Acute and chronic right and left sided heart failure
* tricuspid stenosis
* chronic pulmonary hypertension
* superior vena cava obstruction
* pericardial disease such as tamponade or constrictive pericarditis
137
Venous pressure appears elevated on expiration only
Obstructive lung disease, not an indicator of heart failure
138
What does an elevated JVP indicate
Increased risk of death from heart failure
139
Pulse in cardiogenic shock
Small, thready, or weak
140
Intensity of heart sounds at the apex
S1 is louder than S2
141
Intensity of heart sounds at the base
S2 is louder than S1
142
Systole
Period between S1 and S2
143
Diastole
Period between S2 and S1
144
If S3 is present, when is it heard
Just after S2
145
If S4 is present, when is it heard
Just before S1
146
When would you expect S1 to be diminished
1st degree heart block
147
When would you expect S2 to be diminished
Aortic stenosis
148
What is a useful tool for timing the sound of a murmur?
Palpation of carotid artery while auscultating
(sounds/murmurs coinciding with the upstroke are systolic. Sounds/murmurs heard after upstroke are diastolic)
149
How do you palpate for thrills
Press the ball of your hand firmly on the chest to check for buzzing or vibration
150
Why place patient in left lateral position
Brings left venricle closer to chest wall
Accentuates mitral murmurs
151
What to assess while patient is in left lateral position
palpate PMI
auscultate tricuspid and mitral heart sounds
152
Technique for auscultation while in left lateral position
Lightly place bell on the apical pulse
153
How can you accentuate aortic murmurs
Have patient lean forward, exhale completely, and hold breath
Listen at the right and left sternal borders with the diaphragm
154
Timing of murmur refers to
whether it is diastolic or systolic
155
Duration of murmur refers to
Whether it is early mid or late in either systolic or diastolic cycles
156
Grade 1 murmur
only detected after very careful auscultation
157
Grade 2 murmur
Soft murmur that is readily evident
158
Grade 3 murmur
Moderately intense
159
Grade 4 murmur
Loud murmur with no palpable thrill
160
Grade 5 murmur
Loud murmur with palpable thrill. Cannot be heard without auscultation
161
Grade 6 murmur
Loud with palpable thrill. Does not require auscultation to be heard
162
What characteristics should be used to describe heart murmurs
Quality
(Harsh, musical, soft, bowing, etc)
Pitch
(high, medium, low)
Location
(anatomical location where it is best heard)
163
Murmur heard over pulmonic region between S1 and S2
Systolic pulmonic stenosis
164
Murmur heard over pulmonic region between S2 and S1
Diastolic pulmonic regurg
165
Murmur heard over tricuspid area between S1 and S2
Systolic tricuspid regurg
166
Murmur heard over tricuspid area between S2 and S1
Diastolic tricuspid stenosis
167
Murmur heard over mitral are between S1 ans S2
Systolic mitral regurg
168
Murmur heard over mtral area between S2 and S1
Diastolic mitral stenosis
169
Murmur heard over aortic region between S1 and S2
Systolic aortic stenosis
170
Murmur heard over aortic region between S2 and S1
Diastolic aortic regurg
171
peripheral signs of venous insufficiency
* Hyperpigmentation
* edema
* cyanosis
* venous stasis ulcers
172
Peripheral signs of arterial insufficiency
* intermittent claudication
* peripheral extremity hair loss
* coldness
* numbness
173
1+ pulse
Diminished, weaker than expected
174
2+ pulse
Brisk, expected
175
3+ pulse
Increased
176
4+ pulse
Bounding
177
Pulse sites
* Radial
* Brachial
* Femoral
* carotid
* popliteal
* dorsalis pedis
* posterior tibial
178
