Exam 2 Flashcards
(160 cards)
1
Q
Connective tissue of vessel
A
Tunica adventitia
2
Q
Smooth muscle of vessel
A
Tunica media
3
Q
Endothelium of vessel
A
Tunica intima
4
Q
Put risk factors in…
A
HPI
5
Q
Pregnant women’s blood pressure…..during pregnancy
A
Decreases
6
Q
Unilateral edema is from…
A
Peripheral vascular disease
7
Q
Bilateral edema is…
A
From the heart
8
Q
Normal reperfusion for capillary refill is…
A
Less than 2 seconds
9
Q
Carotid pulse point
A
60-70
10
Q
Radial pulse point
A
> 80
11
Q
Femoral pulse point
A
70-80
12
Q
Pulses paradoxus
A
Decrease in SBP and pulse amplified with inspiration
13
Q
Pulsus biferiens
A
Biphasic pulse, double peak
14
Q
Pulsus parvus et tardus
A
Pulse is weaker and slower than expected
15
Q
Pulsus alternans
A
Alternating strong and weak beats
16
Q
Diaphragm
A
High frequency, deep pressure
17
Q
Bell
A
Low frequency, light pressure
18
Q
Allen test
A
Assess patency of the ulnar artery
19
Q
What is one of the first symptoms with PAD?
A
Claudication
20
Q
Arterial ulcers start out…
A
In the toes
21
Q
Ulcers from veins are…
A
Usually in ankles
22
Q
Arterial occlusion 3 p’s
A
Pain/paresthesias
Pallor
Pulselessness
23
Q
Claudication
A
Walking Cramp/ache/pain Unilateral Constant Atherosclerosis Relief: stop activity/stand still
24
Q
Pseudoclaudication
A
Walking or standing Parasthetic pain Bilateral Variable (not constant) Spinal stenosis/herniated disc Relief: sit down/lay down
25
Debakey 1
60%
26
Debakey 2
10-15%
27
Debakey 3
25-30%
28
Stanford A
Proximal
29
Stanford B
Distal
30
Quincke's pulse
Blanching and flushing of the nail bed related to aortic insufficiency
Change in blanching and flushing is in conjunction with the cardiac cycle
31
Varicose veins
Dilation of vessel due to incompetent valves, collateral circulation developed, most easy to detect while patient is standing
32
Preeclampsia
```
>40
Primagravida
Obese
Multigestational
Hx of HTN or gestational HTN
Renal disease/DM
```
33
Arterial insufficiency
```
Pallor with elevation
Rumor
Intermitten claudication
Diminished/absent pulses
Thin, shiny, loss of hair
Ulceration on toes
```
34
Venous insufficiency
```
No pain
Normal pulses
Edema
Normal color/cyanosis/brown
Ulceration medial ankles
```
35
Lipodermatosclerosis
Thick skin and fibrotic due to WBC trapped in capillaries from chronic venous insufficiency
36
Stage 1 mild venous insufficiency
18-22 pressure, mild discomfort, ankle swelling
37
Stage 2 moderate venous insufficiency
20-30 pressure, hyperpigmentation, edemas
38
Stage 3 severe chronic venous insufficiency
>40 pressure, chronic pain, non healing ulceration
39
Virchow's triad
Hypercoagulability
Abnormalities
Stasis
40
PE classic triad
Dyspnea
Chest pain
Hemoptysis
41
Thromboangiitis obliterans
Arterial obstruction in the upper extremity
20-40
Emboli
Diminished or absent pulses at the wrists
42
Temporal arteritis
50+ years
| Temporal headache, visual disturbances, claudication
43
Kawasaki disease
Acute vasculitic illness
Males>females
Coronary artery aneurysms complication
Strawberry tongue
44
Coarctation of the aorta
Narrowing of the aorta distal to the L subclavian artery
Men>women
Disparity in pulses in upper and lower extremities
Severe HTN!
45
Subclavian steal syndrome
Subclavian artery stenosis
BP differences in arms
Syncope/presyncope
Neuro
46
Vascular thoracic outlet syndrome
Compression of arteries at clavicle
Arterial or venous
Young active people
Numbness/tingling, arm/hand fatigue, edema, color changes, diminished pulse
47
Non modifiable risk factors
Age
| Family history
48
Metabolic syndrome
```
2 out of 5 of the following:
Abdominal obesity
Triglycerides >150
HDL men <40, women <50
HTN >130/88
Glucose >100
```
49
Pericarditis
Inflammation of the pericardium
2-4 days post MI
Worse with deep inspiration
50
Dressler syndrome
2-10 weeks postinfarct, chest pain, pleuropericarditis, fever
51
Viral pericarditis MCC
Coxsackie B virus in young adults
52
Cardiac tamponade
```
Pulsus paradoxus 75%
Impending doom
Tachycardia
*muffled heart tones
Friction rub
```
53
Beck's triad
JVD
Hypotension
Muffled heart sounds
Seen in cardiac tamponade
54
Cullen's sign
Peri umbilical cyanosis
AAA
55
Grey-turner's sign
Flank cyanosis
AAA
56
Janeway lesions
Palms of soles, crop up every few hours to daysa
57
Osler nodes
Painful blue or pink lesions on pads of fingers or toes
58
Valsalva maneuver
Forced expiration through closed airway, high intrathoracic pressure impeding venous return to the right atria
59
Aortic area
2nd right intercostal space, right sternal border
60
Pulmonic area
2nd left intercostal space, left sternal border
61
2nd pulmonic area
3rd left intercostal space, left sternal border
62
Tricuspid area
4th and 5th left intercostal space, left sternal border
63
Apex/mitral area
5th left intercostal space in medial clavicular line
64
A wave
Right atrial contraction
If absent, a fib
65
C wave
Closure of tricuspid valve
66
v wave
Venous filling
Increasing volume and increasing pressure in right atrium
67
X descent
Low atrial pressure just before passive atrial filling
68
Y descent
Decrease in pressure after tricuspid valve opens and blood moves from right atria to right ventricle
Absent- tamponade
69
Increased JVD
Severe right sided ADCHF
70
Hepatojugular reflux
Tests for right sided heart failure
71
Describing when auscultating
Timing
Location
Intensity
Pattern/configuration
72
S1
Closure of AV valves
Ventricular systole
Loudest at apex
73
S2
Closure of AV and PV valves
Ventricular diastole/relaxation
Loudest at base
74
Paradoxical split
Appears with expiration
*pathology
Anything that delays closure of aortic valve
75
Physiological split
Appears with inspiration
*normal
Heard best at base
76
S3
Early diastole
Over 40, consider LV failure
Best at apex LLD
77
S4
Presystole
| Best at apex
78
Special test for aortic regurgitation
Pt leans forward, exhales, stops breathing on exhalation
Auscultating along LSB and apex with the diaphragm
79
Jugular venous distension
Measures estimated right atrial pressures
80
Hepatojugular reflux
Aids in diagnosing peripheral congestion in CHF
81
Standing/valsalva
Decrease LV volume
| Decrease vascular tone
82
Squatting
Increase LV volume
| Increase vascular tone
83
Normal central venous pressure in JVD
<9
84
What is the best location to hear mitral murmurs?
Apex
85
What is the best location to hear tricuspid murmurs?
LLSB
86
What is the best location to hear aortic/pulmonic murmurs?
Base
87
Where does mitral regurgitation radiate?
Axilla
88
Where does aortic stenosis radiate?
Carotids and down sternal border
89
High pitch murmurs
MR and AR
90
Medium pitch murmurs
AS and PS
91
Low pitch murmurs
MS and TS
92
What murmurs are blowing?
MR/AR/TR
93
What murmurs are coarse/harsh?
AS/VSD/ASD
94
What murmurs are rumbling?
MS and austin flint murmur of AR
95
What murmurs are machine like?
PDA
96
What murmurs are intensified with inspiration?
Right sided murmurs (tricuspid stenosis/regurgitation)
97
What murmurs are intensified with expiration?
Left sided murmurs (mitral stenosis/regurgitation)
98
Common characteristics of still/innocent murmurs
Usually midsystolic, 1 or 2 grade, young patients, no radiation, brief and blowing, located in the second left intercostal space near left sternal borer
99
Systolic murmurs
Aortic and pulmonic stenosis
Mitral and tricuspid regurgitation
Murmurs of ventricular and atrial septal defects
Hypertrophic cardiomyopathy
100
Aortic stenosis murmur
```
Midsystolic
Crescendo/decrescendo
Medium pitch
Coarse/harsh
Ejection sound after S1
Radiates to carotids
```
101
Mitral regurgitation murmur
```
Best heard at apex, transmits to left axilla
Holosystolic
Plateau
Loud
High pitch
Blowing
```
102
Mitral valve prolapse
Late systolic
Apex and left lower sternal border
*easily missed in supine position
Midsystolic click**
103
Systolic clicks
Usually secondary to mitral valve prolapse
Mid to late systole, heard best at apex
Change position with physical maneuvers
104
Ejection sounds
Usually AS/PS associated
Heard at base with expiration
Do not change with positional changes
105
Pulmonic stenosis
```
Crescendo decrescendo
Ejection sound
Coarse/harsh
Medium pitch
Fills systole
Radiates to carotids
Palpable thrill
```
106
Tricuspid regurgitation
```
Holosystolic
Lower left sternal border
Blowing
Increase on inspiration
Widely split S2 and distended jugular veins
```
107
Hypertrophic cardiomyopathy
```
Crescendo decrescendo systolic
Harsh
Lower left sternal border
Bifid carotid pulse
Does not radiate to carotids
```
108
Ventral septal defect murmur
```
Holosystolic
Very loud
High pitch
Harsh/coarse
Thrill or left on LSB
```
Most common pathologic murmur in children
109
Atrial septal defect murmur
```
Systolic
Loud, harsh, high pitched
Pulmonic area
Wide fixed s2 splitting
Rumbling, early diastolic murmur
```
110
Diastolic murmurs
Mitral and tricuspid stenosis
Aortic and pulmonic regurgitation
ASD early diastolic rumbling
111
Mitral stenosis
Heard best at apex LLD
Low pitch rumble
Does not radiate
Opening snap after s2
112
Tricuspid stenosis
```
LLSB
Mid-late low pitch rumble
Louder on inspiration
S1 split
Jugular venous pulse is prominent (right side of heart)
```
113
Aortic insufficiency/regurgitation
```
Best at LSB with patient sitting forward and exhaling
Early diastolic
Decrescendo
Soft
High pitch
Blowing
Water hammer/corrigan pulse
Austin flint M
Ejection sound at base
```
114
Patent ductus arteriosis murmur
Loudest in late systole, has a loud and harsh machine like quality
115
Pericardial friction rub
Scratchy, rubbing sound like a rocking chair "to and fro"
116
Venous hum
Low pitch, low intensity, heard best in supraclavicular fossa
Intensified if patient sits or stands
117
Pregnant women heart sound change
Audible s1 and s2 splitting
S3 at 20 weeks of gestation
Systolic ejection murmurs in pulmonic area in 90% of pregnant women
118
Cyanotic congenital heart defects
5 T's
```
Tetralogy of fallot
Transposition of great arteries
Truncus arteriosus
Total anomalous pulmonary venous return
Tricuspid atresia
```
119
Acyanotic congenital heart defects
```
ASD
VSD
PDA
Coarctation
Aortic stenosis
Pulmonic stenosis
```
120
Transposition of great vessels
Significant cyanosis, not compatible with life without immediate intervention
121
Tetralogy of fallot
Pulmonary stenosis
Thickened right ventricle wall
Ventricular septal defect
Aorta overrides septal defect
122
Cor pulmonale
Enlargement of right ventricle secondary to pulmonary malfunction
Crackles, left parasternal systolic heave
123
Acute rheumatic fever
Connective tissue disease from strep pharyngitis or skin infection
Jones criteria
Stenotic and regurgitant, mitral or aortic regurgitant
Friction rub
124
Kawasaki disease
Inflammation of walls in medium sized arteries
Common issue is coronary artery aneurysm
125
Pectins excavatum
Depression in sternum
126
Pectus carinatum
Outward pointing of the chest wall
127
Flail chest
Paradoxical breathing
128
Tachypnea
Fast and shallow breathing
129
Hyperventilation
Fast and deep breathing
130
Tactile fremitus
"99"
Decreased- increased air
Increased- consolidation or fluid
131
Tracheal position toward affected side
Atelectasis, fibrosis, pneumo
132
Tracheal position away from affected side
Tension pneumo, enlarged thyroid
133
Crepitus
Crackly or crinkling sensation, air in subcutaneous tissue
134
Vesicular sounds
Low pitched, low intensity over healthy lung tissue
135
Bronchovesicular sounds
Over major bronchi, moderate in pitch and intensity
136
Bronchial sounds
Highest in pitch and intensity, only over the trachea
137
Amphoric breath sounds
Blowing over the mouth of a bottle
Stiff walled pulmonary cavity
138
Cavernous breath sound
Hollow, rigid pulmonary wall
139
Crackles aka rales
Discontinuous sounds
Fine- high pitched, short
Medium- lower, mid stage of inspiration
Coarse- low pitched, long in duration
140
Rhonchi
Deeper, rumbling
Pronounced during inspiration
Due to passage of air through obstructed airway
141
Wheezes
Continuous, high pitched musical sounds
Narrowed or obstructed airway (asthma)
142
Friction rub breath sound
Outside respiratory tree
Dry, crackly, grating, low pitched sound
Inflamed, roughened surfaces rubbing together, pleurisy
143
Mediastinal crunch (ham man sign)
Mediastinal emphysema
Loud crackles, clicking and gurgling
Synchronous with heartbeat
144
Bronchophony
Greater clarity and increased loudness of spoken sounds
145
Whispered pectoriloquy
Extreme bronchophony where even a whisper is clearly heard
Specific for consolidation
146
Egophony
E's become a's
147
Infants in respiratory exam
Do not percuss
Listen to crying babies when taking a deep breath in
148
Stridor
High pitched, piercing sound most often during inspiration due to obstruction high in respiratory tree
149
Respiratory grunting
Expel trapped air/fetal lung fluid
150
Peripartum cardiomyopathy
9/10th month pregnancy within 5 months post partum, start having heart failure symptoms
SOB, edema, abnormal weight gain
151
Asthma
Small airways obstruction due to inflammation and hyperreative airways
Worse at night and in the cold
Wheezing, chest tightness, cough
152
Pleurisy
Very painful, wont take a deep breath in, inflammatory process with visceral and parietal pleura
153
Pneumonia
Most common cause of consolidation
Cough, fever, dyspnea, chest pain, rigors, sputum, tachypnea, tachycardia, rales/ronchi
Egophony, whispered pect.
154
Tuberculosis
Upper lobe, coug with blood streaked sputum
155
Bronchiolitis
Bronciolar inflammating leading to hyperinflation of the lungs, most infants younger than 6 months
156
Croup
Viral, 1.5 to 3 years
Stridor, barking cough, wheeze
157
Cystic fibrosis
Cough and sputum less than 5 years old
158
Emphysema
Alveoli enlarge, barrel chested, non productive cough, smoking hx, overinflated and hyperresonate
159
Chronic bronchitis
Large airway inflammation, chronic irritant exposure
Cough and sputum, recurrent bacterial infection
Patients older than 40
160
Bronchiectasis
Chronic dilation of bronchi or bronchioles caused by repeated pulmonary infections and bronchial obstruction
