cp exam 1/20

Question 1

what age child treat BP same as adult?

Answer 1

13

Question 2

what is mean arterial pressure?

Normal values?

Answer 2

arterial pressure in large arteries over time,

• depends on mean blood flow and arterial compliance
• normal 70-110mmHg

Question 3

normal RR

• adult
• child
• newborn

Answer 3

adult 12-20 breaths/min

• child 20-30 breaths/min
• newborn 30-40 breaths/min

Question 4

tachypnea

Answer 4

RR >=22 breaths/min

Question 5

bradypnea

Answer 5

<=10 breaths/min

Question 6

hyperpnea

Answer 6

increased depth and rate of breath

Question 7

dyspnea

- on exertion

Answer 7

SOB

- SOB brought on by exercise or activity

Question 8

dyspnea

- orthopnea

Answer 8

SOB i reclining or supine position

Question 9

dyspnea

- paroxysmal nocturnal dyspnea

Answer 9

sudden inability breath during sleep

Question 10

how to rate dyspnea?
lowest?
highest?
severe?

Answer 10

Borg dyspnea scale
low 0-10 highest
severe 5

Question 11

normal O2 sat

Answer 11

95-100%

Question 12

hypoxemia O2

Answer 12

<90%,

PaO2 60 mmHg

Question 13

hypoxia

anoxia

Answer 13

low O2 level in tissue

no oxygen in O2

Question 14

symptoms:
- diffuse, retrosternal pain
sensation tightness, achiness in chest
dyspnea
sweating
indigestion
dizziness, syncope
anxiety

Answer 14

ischemic cardiac pain - angina or MI

Question 15

symptoms in women

• indegestion or gaslike pain
• dizziness, nausea
• unexplained weakness, fatigue
• discomfort or pain between shoulder blades
• recurring chest discomfot
• sense impending doom

Answer 15

ischemic cardiac pain - angina or MI

Question 16

how to rate angina pain

• light, barely noticeable
• moderate bothersome
• most severe pain ever

Answer 16

1+
2+
4+

Question 17

where can cardiac pain refer?

Answer 17

• shoulders
  back
  arm
  neck, jaw

Question 18

where can dissecting aortic aneurysm pain refer?

Answer 18

• back

Question 19

diaphoresis associated with

+/- CO?

Answer 19

decreased CO

Question 20

PAD associated with
+/- arterial pulses?
where to start exam?

Answer 20

decreased or absent pulse

examine bilateral start most distal

Question 21

dependent rubor with what condition?

Answer 21

PAD

Question 22

nail clubbing associated with what conditions?

Answer 22

• enlarged soft tissue at base of nails

- chronic O2 deficiency, chronic pulmonary disease, heart failure

Question 23

PAD trophic changes

Answer 23

pale, shiny, dry skin loss of hair

decreased temp

Question 24

what pathology associated with?
abnormal pigmentation 
ulceration
dermatitis
gangrene

Answer 24

PAD

Question 25

what pathology? pain, cramping, LE fatigue during exercise relieved by rest - can occur in calf, thigh, hip, buttock - can have pain at rest w less arterial blood supply, typically forefoot at night

Answer 25

intermittent claudication associated w PAD

Question 26

how to measure change in volume of irregular body parts (can't use measuring tape)

Answer 26

volumeter

Question 27

edema grade? mild, barely perceptible <1/4 inch pitting

Answer 27

1+

Question 28

edema grade? moderate, easily identified depression returns within 15 sec 1/4-1/2in

Answer 28

2+

Question 29

edema grade? very severe depression lasts >30 sec >1 inch pitting

Answer 29

4+

Question 30

causes of peripheral edema?

Answer 30

chronic venous insufficiecy lymphedema bilateral - CHF

Question 31

which to test first - venous or arterial circulation?

Answer 31

venous, may invalidate some arterial tests

Question 32

what test is this? why? - pt standing, palpate one segment vein while percussing vein 20 cm higher - if pulse wave felt by lower hand then intervening valves are incompetent

Answer 32

percussion test | competence of greater saphenous vein

Question 33

what test is this? why? - pt supine with legs elevated 60deg to empty venous blood - tourniquet placed proximal thigh, occludes venous flow in superficial vein - patient stands - note if vein fill in normal pattern, approx 30 sec

Answer 33

trendelenburg test, retrograde filling test | - competence of communicating veins, saphenous system

Question 34

what test is this? why? - pt supine, passively elevate LE 45deg for 1 min - place in dependent position - observe time for veins to refill - if >15sec then what?

Answer 34

venous filling time - time to refill veins after emptying - >15 sec refill indicates venous insufficiency

Question 35

what test is this? why? - pneumatic device cuff placed around calf, attached to pressure transducer and microprocessor - occlude venous return, allow arterial inflow - record increasing volume w cuff and time to return to baseline w cuff delflation - compare times in sitting, standing, up on toes

Answer 35

air plethysmography APG - measure patency of venous system (open, unobstructed) - measure volume

Question 36

ABI test- measure what arteries

Answer 36

brachial, post tib, dorsalis pedis

Question 37

ABI normal value? | borderline?

Answer 37

1-1.40 | 0.91-0.99 borderline

Question 38

ABI - clinically sig change?

Answer 38

clin sig change >0.15 or | >0.1 in pt with symptoms

Question 39

ABI <=0.5 means

Answer 39

severe arterial disease risk for critical limb ischemia may have pain at rest

Question 40

what test? why? elevate foot, then sit with foot hanging (dependent position) observe chnage in skin color

Answer 40

rubor of dependency - >30sec for change indicates arterial insufficiency - insufficiency - pallor when elevated, reactive hyperemia in dependent position

Question 41

possible causes of leg cramps?

Answer 41

intermittent claudications, PAD diuretic use hypokalemia

Question 42

what imaging to get info about lymph flow?

Answer 42

``` lymphangiography lymphoscintigraphy (xray) ```

Question 43

``` what diagnostic imaging? show abnormalities of lung fluid overall cardiac shape and size possible cardiomegaly aneurysm ```

Answer 43

chest xray

Question 44

what diagnostic imaging? - diagnose, evaluate ischemic heart disease - myocardial infarction - identify myocardial blood flow, areas of stress-inducted ischemia, old infarcts

Answer 44

myocardial perfusion imaging

Question 45

what diagnostic imaging? non invasive test uses ultrasound assess internal structures- size of chambers, wall thickness, EF, valve movement, septum, abnormal wall movement

Answer 45

echocardiogram

Question 46

what diagnostic test? insert catheter through vessels to R side heart measures ventral venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure

Answer 46

swan ganz catheter | central line

Question 47

what diagnostic test? 3D image of heart to examine coronary arteris, aorta, pericardium, myocardium

Answer 47

cardiac MRI

Question 48

what enzyme test for myocardial infarction

Answer 48

- troponin I or T along with symptom (ischemia, new ST change on ECG, pathological Q waves on ECG, myocardial wall motion abnormality on imaging, intracoronary thrombus) - elevated CK (serum creatine kinase) or CPK (creatine phosphokinase)