CMR wk 2 Flashcards
(139 cards)
1
Q
what sign does clubbing look for?
A
Schamroth’s sign (diamond window between touching posterior fingers) = no clubbing if present
2
Q
what can cause clubbing
A
-chronic low O2
-disease not related to O2 (IBD, cirrhosis)
3
Q
how to inspect for peripheral cyanosis
A
hands/toes distally, blue discoloration
4
Q
causes of peripheral cyanosis
A
-cold
-poor circulation
-sepsis
-COPD
-DVT
-PVD
-Raynaud’s
5
Q
how to inspect for central cyanosis
A
inner mucous membranes of mouth + inner eyelids, blue discoloration (can be entire body)
6
Q
what happens in the blood during central cyanosis
A
deoxyhemoglobin (deoxy Hb) increases in blood
deoxy Hb = hemoglobin with no oxygen
-normal oxygenated blood has <80-85% oxygenated blood
7
Q
what is hair loss in LE concerning for
A
PAD (peripheral artery disease)
8
Q
symptoms of chronic venous insufficiency in LE
A
-ankle swelling
-flaking/itchy skin
-stasis ulcers
-skin color xs
-friable skin
9
Q
PE findings for chronic venous insufficiency in LE
A
-edema
-skin pigmentation (brown/red)
-varicosities
10
Q
causes of chronic venous insufficiency in LE
A
-smoking
-lack of exercise
-obesity
-aging
-female
-DVTs
11
Q
chronic venous insufficiency in LE can lead to
A
venous stasis ulcers
12
Q
why does distal extremity muscle atrophy occur
A
can be from CHF causing muscle loss from degeneration + lack of use
13
Q
distal extremity muscle atrophy can lead to
A
cachexia (loss of body fat, muscle, bone)
14
Q
2 types of lesions and where they occur
A
Janeway lesions (non-tender) on palms/soles
Osler’s nodes (tender) on palms/soles
15
Q
what are Janeway lesions and Osler’s nodes concerning for
A
infective endocarditis (valve infections)
16
Q
nail changes that occur with PAD
A
hypertrophic, brittle nails
17
Q
why do you test capillary refill
A
check state of peripheral perfusion
18
Q
when do you test capillary refill
A
with dyspnea, cold extremities, cyanosis
19
Q
how to test capillary refill
A
-squeeze distal fingertip + blanch nailbed
-normal if pink returns < 2 sec.
20
Q
where does fluid accumulate with edema
A
interstitial space
21
Q
4 questions to ask about edema
A
-Chronic / acute
-Unilateral / bilateral
-Painful ?
-Pitting ?
22
Q
when do you test for edema
A
leg pain / swelling
23
Q
how do you test for edema
A
push on distal anterior medial tibia b/l (on bone) for > 5 sec.
depression stays > 10 sec. = pitting present
24
Q
what should you rule out if pitting edema present
A
DVT
CHF
nephrotic syndrome
25
grading pitting edema
+1 (2mm, mild)
+2 (4mm)
+3 (6mm)
+4 (8mm, severe)
26
what does JVP+/JVD indicate
edema, CHF (volume overload)
27
low JVP best seen in what pt position
supine
28
high JVP best seen in what pt position
90 degrees (sitting upright)
29
steps to find JVP
-raise pt's head 30-45 degrees
-pt turns head to left
-use a light, find right IJV + EJV pulsations (flutters) [top of IJV pulsation = meniscus]
-place ruler upright on sternal angle
-make 90 degree angle with ruler and straight edge to the meniscus
central venous pressure/JVP = ruler measurement + 5 cm
30
where is right IJV usually located
triangle between SCM muscle + clavicle
31
where is right EJV usually located
over top of SCM muscle, more superior to IJV
32
what distance does central venous pressure/JVP measure
right atrium -> chest wall, chest wall -> meniscus
33
elevated JVP =
>8 cm above right atrium
or
>3 cm above sternal angle
34
when do you measure ABI (ankle brachial index)
if concerns for PAD
35
why do you do a neuro exam w cardiac complaint
bc vessel disease can cause vision loss, stroke risk, peripheral neuropathy
36
what neuro test result do you expect w Acute Limb Ischemia? why?
decreased motor strength + sensation (can indicate acute arterial occlusion present)
37
OMM results expected with cardiac complaint
TART changes T1-T5
38
if HTN present, what eye exam do you perform
check optic nerve w fundoscopic exam
39
why do you check throat if chest pain present
concerned for GERD/acid reflux
40
what dental disease is a marker for chronic inflammation
gingivitis
41
why do you check the neck if palpitations present
thyroid exam for goiter/Grave's disease
42
what is PAD (peripheral arterial disease) synonymous with
PVD (peripheral vascular disease)
43
what is PAD
narrowing of blood vessels in extremities, causes less blood flow to musculature relative to its metabolism
44
risk factors for PAD
-old age
-smoking
-HTN
-male
-HLD
-DM
45
5 Ps of PAD
-claudication (Pain in legs w walking)
-Pulselessness (in DP or PT pulses)
-Pallor (in distal extremities)
-Paresthesia (numbness) - w severe ischemia
-Paralysis (weakness) - w severe ischemia
Claudia Parks, Partly Pulls Pals
46
additional symptoms of PAD
-smooth shiny skin
-decreased toenail growth
-cool/numb LE
-non-healing ulcers
-muscle atrophy
47
what does highest BP between both brachial arteries tell you
non-invasive estimate of BP exiting the heart
48
how to find ABI
compare highest BP from brachial a. of arm -> to each leg individually
49
what does ABI tell you
if pathways between heart and respective ankles (arteries) interfere w blood flow
50
equation to find ABI
systolic BP at ankle of concern
_____(divided by)_____
highest systolic BP from either arm
51
what can ABI tell you besides diagnose PAD
predicts mortality + adverse cardiac events independent of traditional CV risk factors
52
who should ABI test
everyone age 70+
everyone age 50+ w hx of DM or smoking
everyone w sxs concerning for PAD
53
what order should you find systolic BPs of all extremities? why?
1. right arm
2. right leg
3. left leg
4. left arm
BP may drift during exam, arm at beginning and end = some quality control
54
abnormal systolic BP differences between arms + what this means? common in what pts?
> 10 mmHg
subclavian / axillary arterial stenosis, common if at risk for atherosclerosis
55
ABI result values
< 0.90 = PAD diagnosis
0.90 - 1.40 = normal
> 1.40 = non-compressible, calcified vessel
56
PAD classifications + outcomes
< 0.5 = severe PAD -> refer to vascular specialist
0.5 - 0.8 = moderate PAD -> refer to vascular specialist
0.8 - 0.9 = mild PAD -> treat risk factors
57
what is happening during moderate PAD
moderate arterial obstruction + associated claudication
58
what is happening during severe PAD
-likely multi-vessel disease
-nonhealing ulcerations
-ischemic rest pain
-pedal gangrene
59
how long should pt rest prior to ankle BP
15-30 min.
60
define JVP
(jugular venous pressure) in cm H2O
an estimate of right atrial pressure using height of the right IJV (internal jugular vein) in relation to angle of Louis (sternal angle)
61
define JVD
(jugular venous distension)
when JVP is 3-4 cm above sternal angle with head elevated to 30-45 degrees, or >8 cm total distance above right atrium
62
what condition does JVP evaluate for
heart failure
63
elevated right heart pressure is usually caused by what condition
left heart failure
64
why is the IJV (internal jugular vein) used to determine JVP (jugular venous pressure)
-IJV is more in line w right atrium than EJV
-EJV can be occluded in sicker pts
65
EJV vs IJV in size, location, route to heart
EJV
-smaller
-superficial
-indirect route, has 2 right angles
IJV
-larger
-deep
-direct
66
vein pulsations
-movement
-number of pulses / per cardiac cycle
-inspiration effect
-soft + diffuse
-2 pulses / per cardiac cycle
-respirophasic
67
artery pulsations
-movement
-number of pulses / per cardiac cycle
-inspiration effect
-discrete + robust
-1 pulse / per cardiac cycle
-no change w inspiration
68
question you're answering when measuring JVP/checking for JVD
is increased right atrium pressure present?
69
classic triad of sxs seen with Cardiac Tamponade
JVD
muffled heart sounds
hypotension
70
components of a CBC
WBC count
WBC differential count
RBC count
Hematocrit (Hct)
Hemoglobin (Hb)
Mean corpuscular volume (MCV)
Mean corpuscular hemoglobin (MCH)
Mean corpuscular hemoglobin concentration (MCHC)
Red cell distribution width (RDW)
Reticulocyte count
Platelet count
71
define WBC count
number of leukocytes per volume of blood
72
define WBC differential count
% of different types of WBCs in blood
73
meaning of + neutrophils in WBC differential count
bacterial infection
74
meaning of + lymphocytes in WBC differential count
viral infection
inflammation
lymphoma
75
meaning of + basophils in WBC differential count
allergies
inflammation
76
meaning of + eosinophils in WBC differential count
allergies
parasites
malignancy
77
meaning of + monocytes in WBC differential count
chronic / sub-acute infection
leukemia
lymphoma
autoimmune
78
define RBC count
number of RBCs per volume of blood (these cells carry oxygen to rest of body)
79
when to test WBC count
infection
physiological stress
80
when to test RBC count
congenital heart disease
anemia
polycythemia vera
COPD
bone marrow pathology
81
define Hematocrit (Hct)
% of whole blood occupied by RBCs
82
when to test Hematocrit (Hct)
CHF
fluid xs
hemorrhage
83
define Hemoglobin (Hb)
amount of hemoglobin molecules per volume of blood (these cells carry oxygen to rest of body)
84
when to test Hemoglobin (Hb)
polycythemia vera
smoking
high altitude
menorrhagia
hemorrhage
malignancy
iron deficiency anemia
85
define Mean corpuscular volume (MCV)
average size of RBCs in blood sample
86
high MCV =
low MCV =
high MCV = RBCs LARGER than normal
low MCV = RBCs SMALLER than normal
87
when to test Mean corpuscular volume (MCV)
*FIRST step in anemia workup
88
define Mean corpuscular hemoglobin (MCH)
amount of hemoglobin per RBC
89
when to test Mean corpuscular hemoglobin (MCH)
anemia workup
alcoholism
liver pathology
90
define Mean corpuscular hemoglobin concentration (MCHC)
average hemoglobin concentration per volume of blood, but includes size of RBC
91
when to test Mean corpuscular hemoglobin concentration (MCHC)
anemia workup (spherocytosis)
92
define Red cell distribution width (RDW)
range of variation in RBCs size + shape
93
when to test Red cell distribution width (RDW)
anemia workup (thalassemia)
alcoholism
liver pathology
multiple blood transfusions
94
define Reticulocyte count
number of immature RBCs per volume of blood
95
define Platelet count
number of platelets per volume of blood
96
when to test Reticulocyte count
anemia workup
sickle cell disease
systemic inflammation
malignancy
97
what question are you answering with Reticulocyte count
if new RBCs are being released into circulation
98
when to test platelet count
essential thrombocythemia
malignancy
HIV
99
at what level of Platelet count can spontaneous bruising / bleeding occur
below 20k
100
what does CBC screen for
anemia
leukemia
101
what symptoms would you order CBC for
weakness
fatigue
fever
inflammation
infections
bruising / bleeding
102
what does CBC monitor
blood dyscrasias
HIV
chemotherapy
any treatment that xs blood cell counts
103
leuko-
white
104
cyto-
cell
105
-osis
abnormal process
106
-penia
lack / deficiency
107
poly-
many
108
-emia
blood
109
thrombo-
lump / clot
110
if anemia is on a CBC, what lab do you look at next? why?
MCV
to see if it is microcytic, macrocytic, normocytic
111
3 things pts should not do prior to BP reading
exercise
caffeine
smoking
112
how is arm positioned during BP reading
antecubital fossa is level with the heart
113
BP cuff position on arm
2.5 cm above antecubital fossa
114
bell or diaphragm to take BP
bell
115
what rate do you deflate BP cuff at
2-3 mmHg / sec
116
how far apart are 2 high BP readings to make HTN diagnosis? what's the exception?
a few weeks
exception if hypertensive emergency w BP 180/110 +
117
what is "gold standard" for measuring out of office BP
ambulatory blood pressure monitoring (ABPM)
118
draw JNC 7 vs ACC/AHA chart
119
6 lifestyle modifications from JNC 8 to lower BP
-DASH diet
-weight loss
-reduce sodium < 2.4 gm daily
-30+ min. aerobic exercise almost daily
-alcohol < 2 drinks daily (men), < 1 drink daily (women)
-quit smoking
120
HTN urgency vs emergency
HTN urgency = 180+/110+
HTN emergency = end stage organ damage
121
define lipids
a group of fats + fat-like substances
122
2 important types of lipids
cholesterol + triglycerides
123
how are lipids transported in the blood
transported by lipoprotein particles
each particle = combination of protein / cholesterol / triglyceride / phospholipid
124
3 types of lipoproteins
HDL (high-density lipoproteins)
LDL (low-density lipoproteins)
VLDL (very low-density lipoproteins)
125
2 sources of cholesterol
-produced by body
-diet
126
where is excess cholesterol deposited in body
becomes plaques on the walls of blood vessels
127
define atherosclerosis
hardening of the arteries
128
NCEP III recommendation for lipid panel age
healthy adults: > 20 years of age
129
ACP + USPSTF recommendation for lipid panel age
healthy adult males: by age 35
healthy adult females: by age 45
130
lipid panel retesting guidelines
-every 5 years if normal results
-every year if abnormal
131
should pt fast for lipid panel test
yes, should be fasting
132
4 lipid parameters in a lipid panel
total cholesterol
LDL
HDL
triglycerides
133
3 parts total cholesterol is made up of
HDL (good) cholesterol
LDL (bad) cholesterol
triglycerides
134
main target of interventions for cardiovascular disease
lowering LDL (bad cholesterol) is the goal
135
total cholesterol
normal
borderline
high
normal: < 200 mg/dL
borderline: 201-240 mg/dL
high: > 240 mg/dL
136
HDL (good cholesterol)
optimal
normal
low
(higher is better)
optimal: > 60 mg/dL
normal: 40-59 mg/dL
low: < 40 mg/dL
137
LDL (bad cholesterol)
ideal
normal
borderline high
high
very high
(lower is better)
ideal: < 100 mg/dL
normal: 100-129 mg/dL
borderline high: 130-159 mg/dL
high: 160-189 mg/dL
very high: > 190 mg/dL
138
triglycerides
normal
borderline
high
very high
(lower is better)
normal: < 150 mg/dL
borderline: 150-199 mg/dL
high: 200-499 mg/dL
very high: > 500 mg/dL
139
cardiac risk ratio
elevated risk for coronary heart disease
normal risk for coronary heart disease
low risk for coronary heart disease
risk ratio = total cholesterol / HDL
elevated: > 5.0
normal: < 5.0
low: < 3.5
