Final A Flashcards
(225 cards)
1
Q
What are the fissures on the left lung? How many lobes are there?
A
Oblique fissure splits the left lung into 2 lobes
2
Q
What is visceral pleura?
A
The serous membrane that covers the outer surface of each lung
3
Q
What is parietal pleura?
A
The membrane that lines the inner rib cage and upper surface of the diaphragm
4
Q
What is the primary muscle of inspiration?
A
Diaphragm
5
Q
How does the intrathoracic pressure change during inspiration?
A
It decreases below atmospheric pressure, drawing air in
6
Q
When the work of breathing is increased, which accessory muscles are most important for respiratory effort?
A
Sternocleidomastoids
7
Q
What is hemoptysis?
A
Blood-streaked sputum
8
Q
Pain in conditions such as pneumonia, pneumothorax, and PE arise from what area of the thoracic cavity?
A
The parietal pleura
9
Q
What measurement can predict 5 year survival in patients with COPD better than FEV1 can?
A
Degree of dyspnea
10
Q
What conditions cause wheezing?
A
Asthma, emphysema - partial airway obstructions from secretions, inflammation, or other airway obstruction
11
Q
How long does an acute cough last?
A
Less than 3 weeks
12
Q
How long does a subacute cough last?
A
3-8 weeks
13
Q
How long does a chronic cough last?
A
More than 8 weeks
14
Q
What is the leading cause of preventable death in the U.S.?
A
Smoking
15
Q
What is tactile fremitus?
A
Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall when the patient speaks
16
Q
What does chest percussion during a pulmonary exam help you determine?
A
Whether the underlying tissues are air-filled, fluid-filled, or solid
17
Q
What are vesicular breath sounds?
A
Normal soft-intensity, low-pitched gentle sighing sounds created by air moving through the smaller airways (bronchioles and alveoli)
18
Q
When are vesicular breath sounds best heard?
A
On inspiration
19
Q
What are bronchovesicular breath sounds?
A
Moderate-intensity and moderate-pitched blowing sounds created by air moving through the larger airways (bronchi)
20
Q
When are bronchovesicular breath sounds best heard?
A
Either inspiration or expiration
21
Q
What are bronchial/tubular breath sounds?
A
High-pitched, loud, harsh sounds created by air moving through the trachea
22
Q
When are bronchial/tubular breath sounds best heard
A
Expiration
23
Q
What do crackles/rales sound like?
A
Fine, short, interrupted crackling, high pitched
24
Q
What causes crackles/rales?
A
Air passing through fluid or mucus in any airway
25
When are crackles/rales best heard?
On inspiration
26
Where are crackles/rales most commonly heard?
At the base of the lower lung lobes
27
What do gurgles/rhonchi sound like?
Continuous, low-pitched, coarse, harsh - a moaning/snoring quality
28
When are gurgles/rhonchi best heard?
On expiration
29
Which adventitious/abnormal breath sounds can be altered by coughing?
Gurgles (rhonchi)
30
What causes gurgles/rhonchi?
Air passing through narrowed air passages as a result or secretions, swelling, or tumors
31
Where are gurgles/rhonchi heard?
Can be heard at most lung areas but best heard over the trachea and bronchi
32
What does a friction rub sound like?
Superficial grating or creaking sounds
33
When are friction rubs heard?
During both inspiration and expiration
34
What causes friction rub sounds?
Rubbing together of inflamed pleural surfaces
35
Where are friction rubs heard the best?
In areas with the greatest thoracic expansion like the lower anterior and lateral chest
36
What is stridor?
Wheeze-like sounds in the trachea heard when a person breaths
37
What causes stridor?
Blockage of airflow in the trachea or back of throat
38
What is whispered pectoriloquy?
When listening with a stethoscope, there is increased loudness of words that a patient whispers in areas of tissue abnormality
39
What is bronchophony?
When words that a patient says in a normal voice are heard clearly with a stethoscope
40
What is egophony?
When the patient says the vowel "e", it sounds more like a nasal "a" when listening with a stethoscope
41
What causes egophony?
Consolidated lung tissue
42
What is the most common congenital deformity of the anterior chest wall?
Pectus excavatum
43
What is pectus excavatum?
When several ribs and the sternum grow abnormally and produce a caved in or sunken appearance of the chest wall
44
What is pectus carinatum?
A deformity of the chest characterized by protrusion of sternum and ribs
45
What is pectus carinatum also called?
Pigeon chest
46
What is the normal ratio of anteroposterior to transverse diameter of an adult chest?
1:2
47
What is the chest diameter ratio in patients with barrel chest?
1:1
48
What is flail chest?
A portion of the chest caves in - normally due to a blunt chest injury
49
What type of breathing is caused by flail chest?
Paradoxical - the chest wall collapses in during inhalation and moves out during exhalation (opposite in normal breathing)
50
What is the definition of functional residual capacity?
The volume of air left in the lungs after a passive exhalation - 30mL/kg
51
What does spirometry measure?
The volume and/or flow of air that can be inhaled and exhaled
52
What lung diseases can be diagnosed using spirometry?
- Asthma
- Bronchitis
- Emphysema
53
Which common complaint can be investigated using a spirometry test?
Shortness of breath
54
Which test of respiration can measure whether exposure to chemicals at work affects lung function?
Spirometry
55
Which test of respiratory checks lung function before someone has surgery?
Spirometry
56
What lung volumes cannot be measured using spirometry?
FRC and RV
57
Average tidal volume
500mL
58
Average residual volume (RV)
1200mL
59
Average volume for Total Lung Capacity (TLC)
6000mL
60
Average volume for Vital Capacity (VC)
4800mL
61
Average volume for Functional Residual Capacity
2400mL
62
What is FEV1?
Forced expiratory volume - the volume of gas exhaled in 1 second by a force expiration after a full inspiratory
63
What is the most commonly used parameter to predict survival in COPD patients?
FEV1
64
What is FVC?
Forced vital capacity - vital capacity measured with a forced expiration
65
What is a normal FEV1/FVC ratio?
80%
66
What does the FEV1/FVC ratio measure?
The percent of forced vital capacity that is exhaled in the first second
67
What is the issue in obstructive lung disease?
There is difficulty exhaling all the air from the lungs because of damage to the lungs or narrowing of the airways inside the lungs
68
What is the issue in restrictive lung disease?
There is an underlying condition that causes stiffness in the lungs and a restriction with lung expansion
69
How is FEV1 changed in patients with obstructive lung diseases?
Decreased
70
How is the FEV1/FVC ratio changed in patients with obstructive lung disease?
Decreased
71
The diagnosis of COPD is made with the FEV1/FVC ratio is less than __%
70
72
How is the FEV1/FVC ratio changed in patients with restrictive lung disease?
It remains the same or may even be increased because both FEV1 and FVC are equally reduced. FVC may decline more - causing the ratio to increase
73
What test is used to determine gas exchange?
Arterial blood gas
74
Supplemental oxygen should be administered at a PaO2 less than __mmHg
60
75
A patient is at risk of death with a PaO2 less than __mmHg
26
76
Normal ABG pH range
7.35-7.45
77
Normal ABG pCO2 range
35-45
78
Normal ABG pO2 range
80-100
79
Normal ABG HCO3 range
22-26
80
List materials found in an X-ray in order of most radiodense (white) to least radiodense (black)
Metal, bone, soft tissue, fat, air
81
What instrument used for lung testing is contraindicated in cases of severe bronchospasm and bleeding?
Flexible bronchoscopy
82
What procedure is done under general anesthesia and is used to remove large tissue samples for biopsy or when severe airway bleeding is present?
Rigid bronchoscopy
83
What is the purpose of a VQ scan?
To evaluate the circulation of air and blood within a patient's lungs in order to determine the ventilation/perfusion ratio
84
A VQ scan is commonly done to check for the presence of what abnormalities in the airways?
Blood clots or abnormal blood flow due to a pulmonary embolism
85
What layer of the skin is supplied with blood and contains sweat glands and hair follicles?
Dermis
86
Skin color depends on what 4 pigments?
- Deoxyhemoglobin
- Oxyhemoglobin
- Carotene
- Melanin
87
An increase in which skin pigment causes cyanosis?
Deoxyhemoglobin
88
What are the 2 types of hair found on the skin?
- Vellus (short, fine)
| - Terminal (scalp, eyebrows)
89
What are the only skin surfaces where sebaceous glands are not present?
Palms and soles
90
What are the 2 types of sweat glands?
- Eccrine: widely distributed and open onto surface, control body temp
- Apocrine: axillary and genital regions, stimulated by stress
91
What are the ABCDEs when screening moles for melanoma?
```
A - asymmetry
B - irregular borders
C - color change and variation
D - diameter
E - elevation or enlargement
```
92
Moles greater than or equal to __mm are indicative of possible melanoma
6
93
6 or more cafe-au-lait spots with diameters greater than 1.5 cm suggests what underlying condition?
Neurofibromatosis
94
What skin disease is characterized by depigmented macules on face, hands, or feet?
Vitiligo
95
What is Tetralogy of Fallot?
A birth defect of the heart consisting of four abnormalities that results in insufficiently oxygenated blood pumped to the body
96
Cyanosis visible peripherally in the fingertips can be indicative of what underlying diseases?
- CHF
| - Raynaud's disease
97
Central cyanosis can be present in the case of what underlying condition?
Congenital heart disease
98
What causes jaundice?
Liver disease or hemolysis of RBCs
99
What is erythema?
A red hue on the skin caused by increased blood flow to the area
100
What skin disease occurs when the immune system mistakes skin cells as a pathogen?
Psoriasis
101
What is the most common form of psoriasis?
Plaque psoriasis
102
What allergic skin disease is associated with asthma?
Atopic eczema
103
What skin rash presents in the shape of a butterfly and involves with bridge of the nose?
Lupus-Malar rash
104
What name is given to a patch of closely grouped skin papules more than 1 cm across
Plaque
105
What is a cyst?
A nodule filled with expressible material, either liquid or semisolid
106
What is a wheal?
A skin elevation caused by swelling that can itch - associated with an allergic reaction
107
What is angioedema?
A vascular reaction representing localized edema caused by dilation and increased permeability of capillaries
108
What skin rash is defined as a raised lesion less than 5mm across and filled with clear fluid - seen in herpes or chicken pox?
Vesicles
109
What are vesicles more than 5mm across called?
Bulla
110
What is erythema multiforme?
A skin condition possibly mediated by deposition of immune complex (mostly IgM) on microvasculature of the skin and oral membranes
111
What are 2 forms of erythema multiforme?
- Stevens-Johnson syndrome
| - Toxic epidermal necrolysis
112
What is lichenification?
Rough, thick epidermis with exaggerated skin lines
113
What is a keloid?
Hypertrophic scarring that extends beyond the borders of the initiating injury
114
What term is given to a nonscarring loss of superficial epidermis - usually found with chickenpox?
Erosion
115
What is excoriation?
Linear or punctate erosions caused by scratching or picking at a primary lesion
116
What are the 4 stages of pressure ulcers?
1) Skin not broken but is discolored
2) Epidermis is broken, creating a shallow open sore
3) Break in skin extends through dermis into subQ and fat
4) Breakdown extends into muscle
117
What is cellulitis?
Localized or diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin
118
In what patients is cellulitis common?
Diabetes and immunocompromised
119
What vascular lesions are associated with liver disease, pregnancy, and vitamin B deficiency?
Spider angioma
120
What are 1st degree burns?
The least serious burns that cover only the outer layer of skin but not all the way through
121
What are 2nd degree burns?
When the first layer of skin has been burned through and the second layer of skin is also burned
122
What are 3rd degree burns?
The most serious burns involving all 3 layers of the skin that causes permanent tissue damage
123
Where does the spinal cord begin and end?
From the medulla in the brain to the 1st or 2nd lumbar vertebra
124
What is the cauda equina?
The region where the nerve roots fan out like a horses tail at the end of the spinal cord (L1-L2)
125
What is cauda equina sydrome?
When damage to the cauda equina causes loss of function to the lumbar plexus - can lead to severe back pain, bowel/bladder dysfunction, sexual dysfunction, etc
126
What part of the peripheral nervous system coordinates involuntary operations of the GI tract?
Enteric nervous system
127
Name and function of cranial nerve I
Olfactory - sensory - smell
128
Name and function of cranial nerve II
Optic - sensory - vision
129
Name and function of cranial nerve III
Olfactory - motor - pupillary reactions, extraocular movements and eyelid movement
130
What can be caused by damage to cranial nerve III?
- Strabismus (lazy eye)
- Ptosis (drooping)
- Diplopia (double vision)
131
Name and function of cranial nerve IV
Trochlear - motor - downward movement of eye
132
What can be caused by damage to cranial nerve IV?
- Diplopia
| - Strabismus
133
Name and function of cranial nerve V
Trigeminal - mixed - sensory for eye area, motor for temporal and masseter area
134
Name and function of cranial nerve VI
Abducens - motor - proprioception and lateral movement of eyeball
135
Name and function of cranial nerve VII
Facial - mixed - sensory for taste on anterior 2/3 of tongue, motor for facial expression, closing eyes and mouth
136
What can be caused by injuries to cranial nerve VII?
- Bell's palsy
- Loss of taste
- Decreased salivation
- Loss of ability to close eyes
137
Name and function of cranial nerve VIII
Vestibulocochlear - sensory - equilibrium/balance, hearing
138
What can be caused by injuries to cranial nerve VIII?
- Vertigo
- Atasia
- Nystagmus
- Tinnitus
- Deafness
139
Name and function of cranial nerve IX
Glossopharyngeal - mixed - sensory for posterior 1/3 of tongue and breathing rate and gag reflex, motor for swallowing and speech
140
Name and function of cranial nerve X
Vagus - mixed - sensory for taste/breathing rate/visceral sensations/gag reflex, motor for swallowing, coughing, speaking
141
Name and function of cranial nerve XI
Accessory - motor - swallowing, head and shoulder movement
142
Name and function of cranial nerve XII
Hypoglossal - motor - movement of tongue during speech and swallowing
143
Spinal nerves involved in upper abdominal reflex
T7-T9
144
Spinal nerves involved in lower abdominal reflex
T10-T11
145
Spinal nerves involved in cremaster reflex
T12-L2
146
What is the cremaster reflex?
Testicle and scrotum rise when inner thigh of male is stroked
147
Spinal nerves involved in plantar reflex
L4-S2
148
What is the plantar reflex?
Toes should flex with stroking of lateral aspect of the foot
149
What sign are you looking for when testing the plantar reflex?
Babinski sign - a dorsiflexion of big toe when testing the plantar reflex
150
Spinal nerves involved in biceps reflex
C5-C6
151
Spinal nerves involved in brachioradialis reflex
C5-C6
152
Spinal nerves involved in triceps reflex
C6-C8
153
Spinal nerves involved in patellar reflex
L2-L4
154
Spinal nerves involved in achilles reflex
S1-S2
155
What level of consciousness (LOC) does a patient have if they are only aroused with painful stimuli?
Stupor
156
What LOC does a patient have if they are aroused with gentle shaking?
Obtundation
157
What LOC does a patient have if they will recognize you when you speak with a loud voice?
Lethargy
158
What things should you be assessing during a mental status exam?
- Attention
- Language
- Memory
- Higher cognitive abilities
- Cortical functions
159
What cranial nerves are you testing by observing pupil size, shape, and reaction to light?
3, 4, 6
160
How can you test function of cranial nerve V?
Palpate the strength of muscle contractions over temporal and masseter areas while patient clenches teeth
161
How can you test function of cranial nerve VII?
Inspect symmetry of facial expression
162
How can you test function of cranial nerve XI?
Inspect for atrophy or fasciculations in trapezius muscles
163
How can you test function of cranial nerve XII?
Inspect for tongue midline with protrusion, strength of tongue, quality of speech
164
What does a grade of 0 on a muscle strength test indicate?
No muscular contraction
165
What does a grade of 3 on a muscle strength test indicate?
Active movement against gravity
166
What does a grade of 5 on a muscle strength test indicate?
Active movement against resistance
167
How can you test stereognosis?
Have patient identify familiar objects in their hands with their eyes closed
168
How can you test graphesthesia?
Write on a patient's hand with something blunt and have them identify number or letter you wrote
169
How can you test two-point localization?
Find the minimal distance on a patient's finger or thumb that they are able to discriminate between two points
170
What does a 4+ grade for a deep tendon reflex represent?
Very brisk, hyperactive, with clonus
171
What does a 3+ grade for a deep tendon reflex represent?
Brisker than average, possibly but not necessarily indicative of disease
172
What does a 2+ grade for a deep tendon reflex represent?
Average, normal
173
What does a 1+ grade for a deep tendon reflex represent?
Somewhat diminished, low normal
174
What is Brudzinski's sign? What does it suggest?
Pain with flexion of hips and knees while patient is supine, suggests meningeal inflammation
175
What is Kernig's sign?
Pain and increased resistance with straightening the knee while supine
176
What are the s/s of a CVA?
```
Brain - confusion, trouble talking, dizziness, loss of balance
Eyes - trouble seeing
Face/arms/legs - numbness or weakness
Stomach - throwing up
Body - feeling tired
Legs - trouble walking
```
177
What is a focal seizure?
A seizure that starts in one area of the brain
178
What is a generalized seizure?
A seizure that involves both hemispheres of the brain
179
What are the symptoms of a seizure?
- Blackout
- Involuntary movement of limbs
- Hallucinations
- Odd sounds and sensations
- Episodes of staring
180
What seizure drug is a first line treatment for all seizure types?
Lamotrigine
181
What type of seizures is Topiramate used for?
Tonic-clonic and focal
182
What type of seizure is Oxcarbazepine used for?
Focal
183
What branch of the vagus nerve is stimulated by a vagus nerve stimulator?
Left
184
What is multiple sclerosis?
The body's immune system attacks myelin covering the nerves which interrupts nerve impulses traveling to and from the brain
185
What are the anesthetic considerations for a patient with multiple sclerosis?
- Local anesthetics can exacerbate symptoms
- NDMBs can be used in normal doses
- Temperature maintenance is important, demyelinated axons are more sensitive to heat
186
What is Parkinson's disease?
Slow loss of dopamine-producing neurons
187
What are the clinical features of Parkinson's?
Tremors, rigidity, bradykinesia, dementia
188
What are the anesthetic concerns associated with ALS?
- General anesthesia can cause ventilatory depression post op
- Regional contraindicated in patients with motor neuron disease for fear of exacerbating disease
189
What is myasthenia gravis?
Autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatiguability
190
What is the first noticeable symptom of myasthenia gravis?
Weakness of the eye muscles
191
What are the anesthetic considerations in patients with myasthenia gravis?
- Resistance to depolarizing NMB drugs, may need to increase dose
- Sensitivity to non-depolarizing NMB drugs, need only 10% normal dose
- Avoid cholinesterase inhibitors
192
What is a cholinergic crisis?
Muscles stop responding to bombardment of Ach leading to flaccid paralysis, respiratory failure, and SLUDGE
193
What are the anesthetic considerations for patients with muscular dystrophy?
- Avoid sux and volatiles due to risk of hyperkalemic cardiac arrest and rhabdomyolysis
- A general must be a TIVA
- Avoid shivering and increased O2 demand
194
Where is mitral valve best heard
Apex
195
Where is tricuspid valve best heard
Lower left sternal border
196
Where is pulmonic valve best heard
2nd/3rd interspaces left of sternum
197
Where is aortic valve best heard
2nd interspace right of sternum
198
Normal PR interval
0.12-0.2 seconds
199
What pressure is reflected by jugular venous pressure?
Right atrial pressure
200
What are thrills
Humming vibration felt during palpation carotid
201
What are bruits
Murmur sound of vascular origin heard with diaphragm of stethoscope
202
What sounds are heard with diaphragm of stethoscope
High pitched S1 and S2, regurgitation
203
What sounds are heard with bell of stethoscope
Low pitched S3 and S4, stenosis
204
What causes S1 sounds
Closure of mitral and tricuspid valves
205
What causes S2 sounds
Closure of aortic and pulmonic valves
206
What causes S3 sounds
Rapid movement of blood against ventricular walls
207
What conditions could cause S3 heart sounds
- Anemia
- Fever
- Pregnancy
- Thyrotoxicosis
208
Grade I murmur
Very faint
209
Grade II murmur
Quiet but heard immediately
210
Grade III murmur
Moderately loud
211
Grade IV murmur
Loud with palpable thrill
212
Grade V murmur
Very loud, thrill, heard w/ stethoscope partly off chest
213
Grade VI
Very loud, thrill, heard with stethoscope entirely off chest
214
Common systolic murmurs
- Aortic stenosis
- Mitral valve prolapse
- Mitral regurg
- Tricuspid regurg
215
Common diastolic murmurs
- Aortic regurgitation
| - Mitral stenosis
216
What is skin mobility
Ease with which skin lifts up
217
What is skin turgor
Speed with which skin returns into place
218
Discharge rate for junctional pacemakers
40-60bpm
219
Heart rhythm that results in sudden death
Ventricular fibrillation
220
Most common cause of sinus arrhythmia
Inspiration and expiration
221
Murmur shape of aortic stenosis
Crescendo/decrescendo
222
Murmur shape of mitral regurgitation
Plateau
223
Murmur shape of aortic regurgitation
Decrescendo
224
Murmur shape of mitral stenosis
Crescendo
225
Which murmurs are pansystolic
Mitral and tricuspid regurg
