Health Assessment Test 3 Flashcards
(273 cards)
1
Q
Alveoli
A
functional units of the lung; the thin-walled chambers surrounded by networks of capillaries that are the site of respiratory exchange of carbon dioxide and oxygen
2
Q
Angle of Louis
A
manubriosternal angle, the articulation of the manubrium and body of the sternum, continuous with the second rib
3
Q
Apnea
A
Cessation of breathing
4
Q
Asthma
A
an abnormal respiratory condition associated with allergic hypersensitivity to certain inhaled allergens, characterized by bronchospasm, wheezing, and dyspnea
5
Q
Atelectasis
A
an abnormal respiratory condition characterized by collapsed, shrunken, deflated section of alveoli
6
Q
Bradypnea
A
slow breathing,
7
Q
Bronchiole
A
one of the smaller respiratory passageways into which the segmental bronchi divide
8
Q
Bronchitis
A
inflammation of the bronchi with partial obstruction of bronchi due to excessive mucus secretion
9
Q
Bronchophony
A
the spoken voice sound heard through the stethoscope, which sounds soft, muffled, indistinct over normal lung tissue
10
Q
Bronchovesicular
A
the normal breath sound heard over major bronchi, characterized by moderate pitch and an equal duration of inspiration and expiration
11
Q
Chronic Obstructive Pulmonary Disease (COPD)
A
a functional category of abnormal respiratory conditions characterized by airflow obstruction (ex: emphysema, chronic bronchitis)
12
Q
Cilia
A
millions of hairlike cells lining the tracheobronchial tree
13
Q
Consolidation
A
the solidification of portions of lung tissue as it fills up with infectious exudate, as in pneumonia
14
Q
Crackles
A
(rales) abnormal, discontinuous, adventitious lung sounds heard on inspiration
15
Q
Crepitus
A
coarse, crackling sensation palpable over the skin when air abnormally escapes from the lung and enters the subcutaneous tissue
16
Q
Dead Space
A
passageways that transport air but are not available for gaseous exchange (ex: trachea, bronchi)
17
Q
Dyspnea
A
difficult, labored breathing
18
Q
Egophony
A
the voice sound of “eeeeee” heard through the stethoscope
19
Q
Emphysema
A
the chronic obstructive pulmonary disease characterized by enlargement of alveoli distal to terminal bronchioles
20
Q
Fissure
A
the narrow crack dividing the lobes of the lungs
21
Q
Fremitus
A
a palpable vibration from the spoken voice felt over the chest wall
22
Q
Friction Rub
A
a coarse, grating, adventitous lung sound heard when the pleurae are inflamed
23
Q
Hypercapnia
A
(hypercarbia) increased levels of carbon dioxide in the blood
24
Q
Hyperventilation
A
increased rate and depth of breathing
25
Hypoxemia
decreased level of oxygen in the blood
26
Intercostal Space
space between the ribs
27
Kussmaul Respiration
a type of hyperventilation that occurs with diabetic ketoacidosis
28
Orthopnea
ability to breathe easily only in an upright position
29
Paroxysmal Nocturnal Dyspnea
sudden awakening from sleeping with shortness of breath
30
Percussion
striking over the chest wall with short, sharp blows of the fingers to determine the size and density of the underlying organ
31
Pleural Effusion
abnormal fluid between the layers if the pleura
32
Rhonchi
low-pitched, musical, snoring, adventitious lung sound caused by airflow obstruction from secretions
33
Tachypnea
rapid, shallow breathing, >24 breaths per minute
34
Vesicular
the soft, low-pitched, normal breath sounds heard over peripheral lung fields
35
Vital Capacity
the amount of air following maximal inspiration that can be exhaled
36
Wheeze
high-pitched, musical, squeaking adventitious lung sound
37
Whispered Pectoriloquy
a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue
38
Xiphoid Process
sword-shaped lower tip of the sternum
39
Angina Pectoris
acute chest pain that occurs when myocardial demand exceeds its oxygen supply
40
Aortic Regurgitation
(aortic insufficiency) incomplete aortic valve that allows backward flow of blood into left ventricle during diastole
41
Aortic Stenosis
calcification of aortic valve cusps that restricts forward flow of blood during systole
42
Aortic Valve
the left semilunar valve separating the left ventricle and the aorta
43
Apex of the Heart
tip of the heart pointing down toward the 5th left intercostal space
44
Apical Impulse
(point of maximal impulse, PMI) pulsation created as the left ventricle rotates against the chest wall during systole, normally at the 5th left intercostal space in the midclavicular line
45
Base of the Heart
broader area of heart's outline located at the 3rd right and left intercostal space
46
Bell (of the stethoscope)
cup-shaped endpiece used for soft, low-pitched heart sounds
47
Bradycardia
slow heart rate, <50 beats per minute in the adult
48
Clubbing
bulbous enlargement of distal phalanges of fingers and toes that occurs with chronic cyanotic heart and lung conditions
49
Coarctation of Aorta
severe narrowing of the descending aorta, a congenital heart defect
50
Cor Pulmonale
right ventricular hypertrophy and heart failure due to pulmonary hypertension
51
Cyanosis
dusky blue mottling of the skin and mucous membranes due to excessive amounts of reduced hemoglobin in the blood
52
Diaphragm (of the stethoscope)
flat endpiece of the stethoscope used for hearing relatively high-pitched heart sounds
53
Diastole
the heart's filling stage
54
Dyspnea
difficult, labored breathing
55
Edema
swelling of legs or dependent body part due to increased interstitial fluid
56
Erb's Point
traditional auscultory area in the 3rd left intercostal space
57
First Heart Sound (S1)
occurs with closure of the atrioventricular (AV) valves signaling the beginning of systole
58
Fourth Heart Sound (S4)
(S4 gallop; atrial gallop) very soft, low-pitched ventricular filling sound that occurs in late diastole
59
Gallop Rhythm
the addition of a 3rd or a 4th heart sound that makes the rhythm sound like the cadence of a galloping horse
60
Inching
technique of moving the stethoscope incrementally across the precordium through the auscultory areas while listening to the heart sounds
61
LVH (Left Ventricular Hypertrophy)
increase in thickness of myocardial wall that occurs when the hear pumps against chronic outflow obstruction (ex: aortic stenosis)
62
MCL (Midclavicular Line)
imaginary vertical line bisecting the middle of the clavicle in each hemithorax
63
Mitral Regurgitation
(mitral insufficiency) incompetent mitral valve allows regurgitation of blood back into left atrium during systole
64
Mitral Stenosis
calcified mitral valve impedes forward flow of blood into left ventricle during diastole
65
Mitral Valve
left AV valve separating the left atria and ventricle
66
Palpitation
uncomfortable awareness of rapid or irregular heart rate
67
Paradoxical Splitting
opposite of a normal split S2 so that the split is heard in expiration, and in inspiration the sounds fuse to one sound
68
Pericardial Friction Rub
high-pitched, scratchy extracardiac sound heard when the precordium is inflamed
69
Physiologic Splitting
normal variation in S2 heard as two separate components during inspiration
70
Precordium
area of the chest wall overlying the heart and great vessels
71
Pulmonic Regurgitation
(pulmonic insufficiency) backflow of blood through incompetent pulmonic valve into the right ventricle
72
Pulmonic Stenosis
calcification of pulmonic valve that restricts forward flow of blood during systole
73
Pulmonic Valve
right semilunar valve separating the right ventricle and pulmonary artery
74
Second Heart Sound (S2)
occurs with closure of the semilunar valves, aortic and pulmonic, and signals the end of systole
75
Summation Gallop
abnormal mid-diastolic heart sound heard when both the pathologic S3 and S4 are present
76
Syncope
temporary loss of consciousness due to decreased cerebral blood flow (fainting), caused by ventricular asystole, pronounced bradycardia, or ventricular fibrillation
77
Systole
the heart's pumping phase
78
Tachycardia
rapid heart rate, >90 beats per minute in the adult
79
Third Heart Sound (S3)
soft, low-pitched ventricular filling sound that occurs in early diastole (S3 gallop) and may be an early sign of heart failure
80
Thrill
palpable vibration on the chest wall accompanying severe heart murmur
81
Tricuspid Valve
right AV valve separating the right atria and ventricle
82
Allen Test
determining the patency of the radial and ulnar arteries by compressing one artery site and observing the return of skin color as evidence of patency of the other artery
83
Aneurysm
defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defect
84
Arrhythmia
variation from the heart's normal rhythm
85
Arteriosclerosis
thickening and loss of elasticity of arterial walls
86
Atherosclerosis
plaques of fatty deposits formed in the inner layer (intima) of the arteries
87
Bradycardia
slow heart rate, <50 beats per minute in the adult
88
Bruit
blowing, swooshing sound heard through a stethoscope when an artery is partially occluded
89
Cyanosis
dusky blue mottling of the skin and mucous membranes due to excessive amounts of reduced hemoglobin in the blood
90
Diastole
the heart's filling phase
91
Homan's Sign
calf pain that occurs when the foot is sharply dorsiflexed (pushed up, toward the knee); may occur with deep vein thrombosis, phlebitis, Achilles tendinitis, or muscle injury
92
Ischemia
deficiency of arterial blood to a body part due to constriction or obstruction of a blood vessel
93
Lymphedema
swelling of extremity due to obstructed lymph channel, nonpitting
94
Lymph Nodes
small oval clumps of lymphatic tissue located at grouped intervals along lymphatic vessels
95
Pitting Edema
indentation left after examiner depresses the skin over swollen edematous tissue
96
Profile Sign
viewing the finger from the side to detect early clubbing
97
Pulse
pressure wave created by each heartbeat, palpable at body sites where the artery lies close to the skin and over a bone
98
Pulsus Alternans
regular rhythm, but force of pulse varies with alternating beats of large and small amplitude
99
Pulsus Bigeminus
irregular rhythm, every other beat is premature; premature beats have weakened amplitude
100
Pulsus paradoxus
beats have weaker amplitude with respiratory inspiration, stronger with expiration
101
Systole
the heart's pumping phase
102
Tachycardia
rapid heart rate, >90 beats per minute in the adult
103
Thrombophlebitis
inflammation of the vein associated with thrombus formation
104
Ulcer
open skin lesion extending into dermis with sloughing of necrotic inflammatory tissue
105
Varicose Vein
dilated tortuous veins with incompetent valves
106
Describe the most important points about the health history for the respiratory system
frequency of upper respiratory problems and if season affects it. Allergies with medications, pollen, smoke, mold or pet exposure. Characteristics and severity of allergic reactions. Frequency of asthma exacerbations and triggers. History of lower respiratory problems such as asthma, COPD, pneumonia, and TB. History of additional health problems.
107
Describe the pleura and its function.
The thin, slippery pleura are serous membranes that form an envelope between the lungs and the chest wall.
108
List the structures that compose the respiratory dead space.
Trachea and Bronchi
109
Summarize the mechanics of respiration.
1) Supply oxygen to the body for energy production
2) remove CO2 as a waste product of energy reactions
3) maintain homeostasis of arterial blood
4) maintain heat exchange
110
List the elements included in the inspection of the respiratory system
Shape and configuration of chest wall, spinous process should appear in straight line. Thorax is symmetrical, in an elliptical shape, with downward sloping ribs, about 45 degrees relative to the spine, anteroposterior diameter should be less than the transverse diameter. Ration 1:2 and 5:7. Skin color and condition. Neck and trapezius muscles developed normally for age and occupation. position the person takes to breathe.
111
Discuss the significance of a "barrel chest."
equal anteroposterior-to-transverse diameter. Ribs are horizontal instead of downward slope.
112
List and describe common thoracic deformities
Barrel chest: equal anteroposterior-to-transverse diameter. ribs are horizontal instead of downward slope.
Pectus Excavatum: sunken sternum (funnel breast)
Pectus Carinatum: pigeon-breasted - forward protrusion
Scoliosis: lateral S-shaped curvature of thoracic and lumbar spine
Kyphosis: exaggerated posterior curvature of the thoracic spine (hunchback)
113
List and describe 3 types of normal breath sounds
bronchial (tracheal): high-pitch, loud, harsh, hollow & tubular, inspiration < expiration
Bronchovesicular: moderate pitch, moderate amplitude. inspiration = expiration
Vesicular: low pitch, soft, rustling, inspiration > expiration.
114
Define 2 types of adventitous breath sounds
Crackles (rales): popping sounds not cleared by coughing
| Pleural friction rub: grating quality, things rubbing against each other
115
The manubriosternal angle is also called _____? Why is it a useful landmark?
angle of louis
useful place to start counting ribs
116
How many degrees is the normal costal angle?
90 degrees or less
117
When comparing the anteroposterior diameter of the chest with the transverse diameter, what is the expected ratio? What is the significance of this?
1:2. Anteroposterior = transverse diameter or barrel chest. Ribs are horizontal, occurs in chronic emphysema from hyperinflation of the lungs.
118
What is tripod position?
Leaning forward with arms branded against their knees, chair or bed. Gives them leverage to aid in expiration.
119
List 3 factors that affect normal intensity of tactile fremitus.
1) Relative location of bronchi to the chest wall
2) thickness of the chest wall
3) pitch and intensity
120
During percussion, which sound would you expect to predominate over normal lung tissue?
Resonance
121
Normal findings for diaphragmatic excursion are:
3-5 cm. in adults
122
List 5 factors that can cause extraneous noise during auscultation
1) examiner's breathing on stethoscope tubing
2) stethoscope tubing bumping together
3) patient shivers
4) patient's hairy chest
5) rustling of paper gown or paper drapes
123
Describe the 3 types of normal breath sounds
bronchial (tracheal) --> trachea and larynx --> harsh, hollow, tubular
bronchovesicular --> over major bronchi, where fewer alveoli are located --> mixed
vesicular --> peripheral lung fields --> rustling
124
Define the apical impulse and describe its normal location, size, and duration.
Point of maximal impulse, PMI. It's the pulsation created as the left ventricle rotates against the chest wall during systole, normally at the 5th intercostal space in the midclavicular line. It's normally 1x2 cm, and short (normally the first half of systole)
125
Which normal variations may affect the location of the apical impulse?
rolling the person midway to the left
126
Which abnormal conditions may affect the location of the apical impulse?
left ventricular dilation due to cardiac enlargement
127
Explain the mechanism producing normal first and second heart sounds.
S1: Closure of AV valves (beginning of systole)
S2: closure of semilunar valves (end of systole)
128
Describe the effect of respiration on the heart sounds.
During inspiration, intrathoracic pressure is decreased. More blood enters the vena cava, increasing venous return to Right heart, increasing Right ventricular stroke volume. prolongs right ventricular systole and delays pulmonary vavle closure.
129
Describe the characteristics of the first heart sound and its intensity at the apex of the heart and at the base.
Mitral component usually precedes the tricuspid component, but usually heard as fused. Can hear all over precordium, but usually loudest at the apex and lower at the base.
130
Which conditions increase the intensity of S1?
exercise, anxiety, anemia, fever, pregnancy, thyrotoxicosis
131
Which conditions decrease the intensity of S1?
Obesity, COPD
132
Describe the characteristics of the second heart sound and its intensity at the apex of the heart and at the base.
aortic component of the second heart sound (A2) slight precedes the pulmonic component (P2). Can hear all over the precordium, but less intense at apex, more intense at base.
133
Which conditions increase the intensity of S2?
increased systolic pressure, increased contractility
134
Which conditions decrease the intensity of S2?
Lowered systolic pressure, decreased contractility
135
Explain the physiologic mechanism for normal splitting of S2 in the pulmonic valve area.
inspiration separates the timing of the two valves' closure and the aortic valve closes 0.06 seconds before the pulmonic valve.
136
Define the third heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation.
Soft, low-pitched ventricular filling sound that occurs in early diastole (S3) and may be an early sign off heart failure. Occurs immediately after S2, when AV valves open and atrial blood first pours into the ventricles. best heard at the apex using the bell.
137
Differentiate a physiologic S3 from a pathologic S3.
Physiologic: children & young adults, may persist after 40 (especially in women) usually disappears when sitting up
Pathologic: adults, ventricular gallop. occurs while sitting up. decreased compliance of ventricles
138
Define the fourth heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation.
S4 gallop. atrial gallop. very soft, low-pitched ventricular filling sound that occurs in late diastole. heard immediately before S1. Need a good bell to hear. best heard at apex.
139
Explain the position of the valves during each phase of the cardiac cycle.
Systole: AV valves shut, semilunar valves open
Diastole: AV valves open, semilunar valves close
140
Define venous pressure and jugular venous pulse.
Venous pressure: the pressure exerted on the walls of the veins by the circulating blood
Jugular Venous Pulse: rhythmic expansion of an artery that may be felt with the examiner's finger over the patient's jugular vein.
141
Differentiate between the carotid artery pulsation and the jugular vein pulsation.
Carotid Artery Pulsation: smooth, rapid upstroke, a summit that is rounded and smooth and a downstroke that is more gradual and has a dicrotic notch caused by closure of the aortic valve.
Jugular Vein Pulsation: results from a backwash, a waveform moving backward caused by events upstream
142
List the areas of questioning to address during the health history of the cardiovascular system.
Chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis or pallor, edema, nocturia, cardiac history, family cardiac history, personal habits
143
Define bruit, and discuss what it indicates.
blowing, swishing sound indicating blood flow turbulence; normally none is present. possible atherosclerotic narrowing.
144
Define heave or lift, and discuss what it indicates.
sustained forceful thrusting of the ventricles during systole. It occurs with ventricular hypertrophy as a result of increased workload.
145
State 4 guidelines to distinguish S1 from S2.
S1: start of systole, louder at apex, coincides with carotid artery pulse, coincides with R wave
S2: End of systole, louder at base
146
Define pulse deficit, and discuss what it indicates.
pulse deficit indicates weak contraction of the ventricles; occurs with atrial fibrillation, premature beats and heart failure. can be checked by auscultating the apical beat while simultaneously palpating the radial pulse.
147
Define preload and afterload.
preload: the venous return that builds during diastole
afterload: the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure.
148
List the characteristics to explore when you hear a murmur, including the grading scale of murmurs.
timing, loudness, pitch, pattern, quality, location, radiation, posture.
grade I: barely audible
grade II: faint, but audible
grade III: easy to hear
grade IV: loud, thrill palpable on chest
grade V: very loud, one corner of diaphragm off chest
grade VI: loudest, heard without stethoscope touching the chest
149
Discuss the characteristics of an innocent or functional murmur.
blowing, swooshing sound that occurs with turbulent blood flow in the heart.
150
Describe the structure and function of arteries and veins.
arteries contain elastic fibers which allow the walls to stretch with systole and recoil with diastole. Veins drain deoxygenated blood and its waste products from tissues and return it to the heart.
151
List the pulse sites accessible to examination.
temporal, carotid, brachial, ulnar, radial, femoral, popliteal, dorsalis pedis, posterior tibial
152
Describe 3 mechanisms that help return venous blood to the heart.
1) contracting skeletal muscles that push blood flow
2) breathing (creates a pressure gradient)
3) intraluminal valves that ensure unidirectional flow.
153
Define the term capacitance vessels, and explain its significance.
the distensibility of blood vessels located within the body; it is inversely related to elasticity. Reduce stress on the heart. Can expand & hold more blood when blood volume increases.
154
List the risk factors for venous stasis.
elderly, diabetes, obesity, peripheral vascular disease, pregnancy, prolonged standing, inactive lifestyle, smoking, varicose veins, tight clothing
155
Describe the function of the lymphatic system.
1) conserve fluid and plasma proteins that leak out of the capillaries
2) form part of the immune system that defends against disease
3) absorb lipids from the intestinal tract
156
Describe the function of lymph nodes.
filter fluid before it's returned to the bloodstream and filter out potentially harmful microbes.
157
Name the related organs in the lymphatic system.
spleen, tonsils, thymus
158
List the symptom areas to address during history taking of the peripheral vascular system.
leg pain or cramps, skin changes on arms or legs, swelling in arms or legs, lymph node enlargement, medications
159
Fill in the grading scale for assessing the force of an arterial pulse: 0 = ____. 1+ _____. 2+_____. 3+______.
0: absent
1+: weak
2+: normal
3+: increased, full, bounding
160
List the steps in performing the modified Allen test.
1) firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times
2) ask the person to open hand without hyperextending it, release pressure on the ulnar artery while maintaining pressure on the radial artery.
161
List the skin characteristics expected with arterial insufficiency to the lower legs.
thin, shiny skin with loss of hair.
162
Compare the characteristics of leg ulcers associated with arterial insufficiency with ulcers with venous insufficiency.
Arterial insufficiency with ulcers: deep muscle pain in the calf or foot, claudication, pain at rest, coolness, pallor
Venous insufficiency: aching pain in the calf or lower leg. worse at the end of the day. firm, brawny edema, coarse, thick skin
163
Fill in the description of the grading scale for pitting edema. 1+____. 2+____. 3+___. 4+____.
1+: slight pitting/2 mm, disappears rapidly
2+: somewhat deeper pit/ 4mm. disappears in 10-15 seconds
3+: deep pit/6mm. may last >1 min.
4+: very deep pit/8 mm. lasts 2-5 min.
164
Describe the technique for using the Dopplar ultrasonic stethoscope to detect peripheral pulses.
position the person supine, with legs externally rotated so you can reach the medial ankles easily. place a drop of coupling gel on the end of the handheld transducer, place the transducer over the pulse sight, swiveled at 45 degree angle.
165
Raynaud's phenomenon has associated progressive tricolor changes of the skin from ___ to ____ and then to ____. State the mechanism for each of these color changes.
white, blue, red.
White: deficit in blood supply
blue: slight relaxation
red: return of blood
166
The manubriosternal angle is:
a. the articulation of the manubrium and the body of the sternum.
b. a hollow, U-shaped depression just above the sternum
c. also known as the breastbone
d. a term synonymous with costochondral junction
A. the articulation of the manubrium and the body of the sternum
167
Select the correct description of the left lung.
a. narrower than the right lung with three lobes.
b. narrower than the right lung with two lobes.
c. wider than the right lung with two lobes.
d. shorter than the right lung with three lobes.
b. narrower than the right lung with two lobes
168
Some conditions have a cough with characteristic timing. The cough associated with chronic bronchitis is best described as:
a. continuous throughout the day.
b. productive cough for at least 3 months of the year for 2 years in a row
c. occurring in the afternoon/evening because of exposure to irritants at work
d. occurring in the early morning
b. productive cough for at least 3 months of the year for 2 years in a row
169
Symmetric chest expansion is best confirmed by:
a. placing hands on the posterolateral chest wall with thumbs at the level of T9 or T10 and then sliding the hands up to pinch up a small fold of skin between the thumbs.
b. inspection of the shape and configuration of the chest wall.
c. placing the palmar surface of the fingers of one hand against the chest and having the person repeat the words "ninety-nine."
d. percussion of the posterior chest
a. placing hands on the posterolateral chest wall with thumbs at the level of T9 or T10 and then sliding the hands up to pinch up a small fold of skin between the thumbs.
170
Absence of diaphragmatic excursion occurs with:
a. asthma
b. an unusually thick chest wall
c. pleural effusion or atelectasis of the lower lobes.
d. age-related changes in the chest wall.
c. pleural effusion or atelectasis of the lower lobes.
171
Auscultation of breath sounds is an important component of respiratory assessment. Select the most accurate description of this part of the examination.
a. hold the bell of the stethoscope against the chest wall; listen to the entire right field and then the entire left field.
b. hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side-to-side comparisons.
c. listen from the apices to the bases of each lung field using the bell of the stethoscope.
d. select the bell or diaphragm depending upon the quality of sounds heard; listen for one respiration in each location, moving from side to side.
b. hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side-to-side comparisons.
172
Select the best description of bronchovesicular breath sounds:
a. high pitched, of longer duration on inspiration than expiration
b. moderate pitched, inspiration equal to expiration
c. low pitched, inspiration greater than expiration
d. rustling sound, like the wind in the trees.
b. moderate pitched, inspiration equal to expiration
173
After examining a patient, you make the following notation: Increased respiratory rate, chest expansion decreased on left side, dull to percussion over left lower lobe, breath sounds louder with fine crackles over left lower lobe. These findings are consistent with a diagnosis of:
a. bronchitis
b. asthma
c. pleural effusion
d. lobar pneumonia
d. lobar pneumonia
174
Upon examining a patient's nails, you note that the angle of the nail base is >160 degrees and that the nail base feels spongy to palpation. These findings are consistent with:
a. adult respiratory distress syndrome.
b. normal findings for the nails.
c. chronic congenital heart disease and COPD
d. atelctasis
c. chronic congenital heart disease and COPD
175
Upon examination of a patient, you note a coarse, low-pitched sound during both inspiration and expiration. This patient complains of pain with breathing. These findings are consistent with:
a. fine crackles
b. wheezes
c. atelectatic crackles
d. pleural friction rub
d. pleural friction rub
176
In order to use the technique of egophony, ask the patient to:
a. take several deep breaths and then hold for 5 seconds.
b. say "eeeeee" each time the stethoscope is moved.
c. repeat the phrase, "ninety-nine" each time the stethoscope is moved.
d. whisper a phrase as auscultation is performed.
b. say "eeeeee" each time the stethoscope is moved.
177
When examining for tactile fremitus, it is important to:
a. have the patient breathe quickly
b. ask the patient to cough
c. palpate the chest symmetrically
d. use the bell of the stethoscope
c. palpate the chest symmetrically
178
The pulse oximeter measures:
a. arterial oxygen saturation
b. venous oxygen saturation
c. combined saturation of arterial and venous blood
d. carboxyhemoglobin levels
a. arterial oxygen saturation
179
A pleural friction rub is best detected by:
a. observation
b. palpation
c. auscultation
d. percussion
c. auscultation
180
A barrel-shaped chest is characterized by:
a. equal anteroposterior-to-transverse diameter and ribs being horizontal.
b. anteroposterior-to-transverse diameter of 1:2 and an elliptical shape
c. anteroposterior-to-transverse diameter of 2:1 and ribs being elevated
d. anteroposterior-to-transverse diameter of 3:7 and ribs sloping back
a. equal anteroposterior-to-transverse diameter and ribs being horizontal.
181
Apex of the lungs (location)
3 to 4 cm above the inner third of the clavicles
182
base of the lungs (location)
rests on the diaphragm
183
lateral left side of the lungs (location)
sixth rib, midclavicular line
184
lateral right side of the lungs (location)
fifth intercostal space
185
posterior apex of the lungs (location)
C7
186
Description of a normal chest
elliptical shape with an anteroposterior-to-transverse diameter in the ratio of 1:2
187
Description of a barrel chest
anteroposterior = transverse diameter
188
Description of pectus excavatum
sunken sternum and adjacent cartilages
189
Description of pectus carinatum
forward protrusion of the sternum with ribs sloping back at either side
190
Description of Scoliosis
lateral S-shaped curvature of the thoracic and lumbar spine
191
Description of Kyphosis
exaggerated posterior curvature of the thoracic spine
192
The precordium is:
a. a synonym for the mediastinum
b. the area on the chest where the apical impulse is felt
c. the area on the anterior chest overlying the heart and great vessels.
d. a synonym for the area where the superior and inferior venae cavae return unoxygenated venous blood to the right side of the heart.
c. the area on the anterior chest overlying the heart and great vessels.
193
Select the best description of the tricuspid valve.
a. left semilunar valve
b. right atrioventricular valve
c. left atrioventricular valve
d. right semilunar valve
b. right atrioventricular valve.
194
The function of the pulmonic valve is to:
a. divide the left atrium and the left ventricle.
b. guard the opening between the right atrium and the right ventricle.
c. protect the orifice between the right ventricle and the pulmonary artery.
d. guard the entrance to the aorta from the left ventricle.
c. protect the orifice between the right ventricle and the pulmonary artery.
195
Atrial systole occurs:
a. during ventricular systole
b. during ventricular diastole
c. concurrently with ventricular systole
d. independently of ventricular function.
b. during ventricular diastole.
196
The second heart sound is the result of:
a. opening of the mitral and tricuspid valves
b. closing of the mitral and tricuspid valves
c. opening of the aortic and pulmonic valves
d. closing of the aortic and pulmonic valves
d. closing of the aortic and pulmonic valves.
197
The examiner has estimated the jugular venous pressure. Identify the finding that is abnormal.
a. Patient elevated to 30 degrees, internal jugular vein pulsation at 1 cm above sternal angle
b. Patient elevated to 30 degrees, internal jugular vein pulsation at 2 cm above sternal angle
c. Patient elevated to 40 degrees, internal jugular vein pulsation at 1 cm above sternal angle
d. Patient elevated to 45 degrees, internal jugular vein pulsation at 4 cm above sternal angle
d. Patient elevated to 45 degrees, internal jugular vein pulsation at 4 cm above sternal angle.
198
The examiner is palpating the apical impulse. The normal size of this impulse:
a. is less than 1 cm
b. is about 2 cm
c. is 3 cm
d. varies on the size of the person
b. is about 2 cm.
199
The examiner wishes to listen in the pulmonic valve area. To do this, the stethoscope would be placed at the:
a. second right interspace
b. second left interspace
c. left lower sternal border
d. fifth interspace, left midclavicular line
b. second left interspace.
200
Select the statement that best differentiates a split S2 from S3.
a. S3 is lower pitched and is heard at the apex
b. S2 is heard at the left lower sternal border
c. The timing of S2 varies with respirations
d. S3 is heard at the base; timing varies with respirations
a. S3 is lower pitched and is heard at the apex.
201
The examiner wishes to listen for a pericardial friction rub. Select the best method of listening.
a. with the diaphragm, patient sitting up and leaning forward, breath held in expiration
b. using the bell with the patient leaning froward
c. at the base during norma respiration
d. with the diaphragm, patient turned to the left side
a. with the diaphragm, patient sitting up and leaning forward, breath held in expiration.
202
When auscultating the heart, your first step is to:
a. identify S1 and S2
b. listen for S3 and S4
c. listen for murmurs
d. identify all four sounds on the first round
a. identify S1 and S2
203
You'll hear a split S2 most clearly in what area?
a. apical
b. pulmonic'
c. tricuspid
d. aortic
b. pulmonic
204
The stethoscope bell should be pressed lightly against the skin so that:
a. chest hair doesn't simulate crackles
b. high-pitched sounds can be heard better
c. it doesn't act as a diaphragm
d. It doesn' interfere with amplification of heart sounds
c. it doesn't act as a diaphragm
205
A murmur heard after S1 and before S2 is classified as:
a. diastolic ( possibly benign)
b. diastole ( always pathologic)
c. systolic ( possibly benign)
d. systolic ( always pathologic)
c. systolic (possibly benign)
206
When assessing the carotid artery, the examiner should palpate:
a. bilaterally at the same time, while standing behind the patient
b. medial to the sternomastoid muscle, one side at a time
c. for a bruit while asking the patient to hold his or her breath briefly
d. for unilateral distention while turning the patient's head to one side.
b. medial to the sternomastoid muscle, one side at a time
207
# Fill in the following blanks.
S1 is best heard at the ___ of the heart, whereas S2 is loudest at the ___ of the heart. S1 coincides with the pulse in the ______ and coincides with _____ wave if the patient is on an ECG monitor.
Apex, base, carotid artery, R
208
Tough, fibrous, double-walled sac that surrounds and protects the heart
pericardium
209
thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves
endocardium
210
reservoir for holding blood
atrium
211
ensures smooth, friction-free movement of the heart muscle
pericardial fluid
212
muscular pumping chamber
ventricle
213
muscular wall of the heart
myocardium
214
Briefly relate the route of a blood cell from the liver to tissue in the body.
liver to right atrium via inferior vena cava, through tricuspid valve to right ventricle, through the pulmonic valve to the pulmonary artery, picks up oxygen in the lungs, returns to left atrium, to left ventricle via mitral valve, through aortic valve to aorta, and out to the body.
215
List the major risk factors for heart disease and stroke identified in the text.
hypertension, smoking, high cholesterol levels, obesity, and diabetes. Physical inactivity, family history of heart disease, and age are other risk factors.
216
A function of the venous system is:
a. to hold more blood when blood volume increases
b. to conserve fluid and plasma proteins that leak out of the capillaries
c. to form a major part of the immune system that defends the body against disease
d. to absorb lipids from the intestinal tract.
a. to hold more blood when blood volume increases
217
The organs that aid the lymphatic system are:
a. liver, lymph nodes and stomach
b. pancreas, small intestine, and thymus
c. spleen, tonsils, and thymus
d. pancreas, spleen, and tonsils
c. spleen, tonsils, and thymus
218
Ms T has come for a prenatal visit. She complains of dependent edema, varicosities in the legs, and hemorrhoids. The best response is:
a. "If these symptoms persist, we will perform an amniocentesis."
b. "If these symptoms persist, we will discuss having you hospitalized."
c. "The symptoms are caused by the pressure of the growing uterus on the veins. They are usual conditions of pregnancy."
d. "At this time, the symptoms are a minor inconvenience. You should learn to accept them."
c. "The symptoms are caused by the pressure of the growing uterus on the veins. They are usual conditions of pregnancy."
219
A pulse with an amplitude of 3+ would be considered:
a. irregular, with 3 premature beats
b. increased, full
c. normal
d. weak
b. increased, full
220
Inspection of a person's right hand reveals a red, swollen are. To further assess for infection, you would palpate the:
a. cervical node
b. axillary node
c. epitrochlear node
d. inguinal node
c. epitrochlear node
221
In order to screen for deep vein thrombosis, you would:
a. measure the circumference of the ankle
b. check the temperature with the palm of the hand
c. compress the dorsalis pedis pulse, looking for blood return
d. measure the widest point with a tape measure.
d. measure the widest point with a tape measure.
222
During the examination of the lower extremities, you are unable to palpate the popliteal pulse, you should:
a. proceed with the examination. It is often impossible to palpate this pulse
b. refer the patient to a vascular surgeon for further evaluation
c. schedule the patient for venogram
d. schedule the patient for an arteriogram
a. proceed with the examination. It is often impossible to palpate this pulse
223
While reviewing a medical record, a notation of 4+ edema of the right leg is noted. The best description of they type of edema is:
a. mild pitting, no perceptible swelling of the leg
b. moderate pitting, indentation subsides rapidly
c. deep pitting, leg looks swollen
d. very deep pitting, indentation lasts a long time
d. very deep pitting, indentation lasts a long time
224
The examiner wishes to asses for arterial deficit in the lower extremities. After raising the legs 12 inches off the table and than having the person sit up and dangle the leg, the color should return in:
a. 5 seconds or less
b. 10 seconds or less
c. 15 seconds
d. 30 seconds
b. 10 seconds or less
225
A 54 year old woman with five children has varicose veins of the lower extremities. Her most characteristic sign is:
a. reduced arterial circulation
b. blanching, deathlike appearance of the extremities on elevation
c. loss of hair on feet and toes
d. dilated, tortuous superficial bluish vessels.
d. dilated, tortuous superficial bluish vessels.
226
Atrophic skin changes that occur with peripheral arterial insufficiency include:
a. thin, shiny skin with loss of hair
b. brown discoloration
c. thick, leathery skin
d. slow-healing blisters on the skin
a. thin, shiny skin with loss of hair
227
Intermittent claudication is:
a. muscular pain relieved by exercise
b. neurologic pain relieved by exercise
c. muscular pain brought on by exercise
d. neurologic pain brought on by exercise
c. muscular pain brought on by exercise
228
A known risk factor for venous ulcer development is:
a. obesity
b. male gender
c. history of hypertension
d. daily aspirin therapy
a. obesity
229
Brawny edema is:
a. acute in onset
b. soft
c. nonpitting
d. associated with diminished pulses
c. nonpitting
230
Arteriosclerosis is the:
a. deposition of fatty plaques on the intima of arteries
b. loss of elasticity of the walls of blood vessels
c. loss of lymphatic tissue that occurs in the aging process
d. progressive enlargement of the intramuscular calf veins
b. loss of elasticity of the walls of blood vessels
231
To assess the thorax, what should you do?
Assess areas side to side to compare.
231
Raynaud's phenomenon occurs:
a. when the patient's extremities are exposed to heat and compression
b. in hands and feet as a result of exposure to cold, vibration, and stress
c. after removal of lymph nodes or damage to lymph nodes and channels.
d. as a result of leg cramps due to excessive walking or climbing stairs
b. in hands and feet as a result of exposure to cold, vibration, and stress
232
When assessing lung sounds, you should
A. Use the bell of the stethoscope
B. Have the patient breathe quickly
C. Move the stethoscope after complete exhalation
D. Listen through clothing so you don't embarrass the patient
Move the stethoscope after complete exhalation
233
When assessing thoracic expansion:
A. You should auscultate an "aa" sound when they say "ee"
B. The diaphragm should drop 5-7 cm with deep inspiration
C. Your thumbs will move 3-5 cm during inspiration
D. You will percuss for a change from hyper resonance to dullness with deep inspiration.
C. Your thumbs will move 3-5 cm during inspiration
234
When comparing the size of the thoracic cavity, the AP diameter is usually 2:1 in a healthy adult.
A. True
B. False
A. True.
235
Bronchial breath sounds are high pitched sounds typically auscultated over the trachea.
A. True
B. False
A. True
236
Vesicular breath sounds are low pitched soft sounds typically auscultated over the peripheral lung fields.
A. True
B. False
A. True
237
Rhonchi are high pitched wheezing sounds.
A. True
B. False
B. False
238
Tactile fremitus is:
A. Using the ulnar or palmar aspect of your hand to palate vibrations when the patient says 99
B. Auscultating when the patient speaks 99
C. Inspecting for symmetry with deep inspiration
D. Percussing the intercostal spaces for resonant sounds
A. Using the ulnar or palmar aspect of your hand to palpate vibrations when the patient says 99
239
When you auscultate while the patient says 99, it is called:
A. Whispered pectoriloquy
B. Bronchophony
C. Egophony
D. Tactile fremitus
B. Bronchophony
241
A pleural friction rub is when:
A. There is inflammation of the pleural lining
B. You auscultate a loud inspiratory wheeze
C. There is atelectasis in the right lower lobe
D. Breath sounds are very diminished or absent
A. There is inflammation of the pleural lining.
242
HYPERRESONANCE NOTED WITH PERCUSSION IS TYPICALLY FOUND WITH COPD
a. true
b. false
a. true
243
Adventitious sounds include:
a. Absent breath sounds
b. Wheezing
c. Normal breath sounds
d. Christmas bells
b. wheezing
244
Tactile fremitus is:
a. Increased vibrations palpated with normal lungs
b. Increased vibrations palpated in a patient with pneumonia
c. Increased vibrations palpated in a patient with emphysema
d. Are greater on the right side of the thorax than on the left side
b. Increased vibrations palpated in a patient with pneumonia
245
There are 3 lobes on the left side and 2 on the right.
A. true
B. false
B. false
246
You can easily auscultate the right middle lobe posteriorly.
A. True
B. False
B. False
247
A normal respiratory rate for a newborn is:
a. 10-20 bpm
b. 50-60 bpm
c. 30-40 bpm
d. 20-30 bpm
c. 30-40 bpm
248
Course crackles are high pitched adventitious sounds auscultated on expirations.
A. True
B. False
B. False - auscultated on inspirations.
Nice couple of pages in the book. 444-445. tells you all about wave forms – NEED TO KNOW THEM!!!! Course crackles are low pitched!
249
Atelectasis is a condition when the alveolar collapse; it sounds like fine crackles on inspiration.
A. True
B. False
A. True
250
Pleural friction rub is heard equally on inspiration and expiration.
A. True
B. False
A. True
251
Wheezes are only heard on inspiration.
A. True
B. False
B. False
252
The aortic valve is auscultated at the:
a. 3rd ICS, RLSB
b. 5th ICS, MCL
c. 2nd ICS, LUSB
d. 2nd ICS, RUSB
D. 2nd ICS, RUSB
5th ICS, MCL: mitral valve. Think m for mitral.
ALL PEOPLE EAT TURKEY MEAT
Aortic, Pulmonic, Erbs, Tricuspid, Mitral
253
A systolic murmur is a whoosing sound heard:
a. Best with the patient taking a deep breath
b. Between the S1 and S2 heart sounds
b. between the S1 and S2 heart sounds
254
An S3 heart sound:
a. Is noted after the S2 heart sound
b. Is noted before the S1 heart sound
c. Sounds like “tennessee”
d. Is best heard with the diaphragm
a. Is noted after the S2 heart sound
255
The S1 heart sound is:
a. Auscultated loudest at the apex
b. Caused by closing of the semilunar valves
c. Heard best with the bell
d. Auscultated loudest at the base
a. Auscultated loudest at the apex
256
The S2 heart sound is:
a. Best auscultated with the bell
b. Can be normally split during inspiration
c. Loudest at the base
d. Caused by the closing of the mitral valve
b and c. can be normally split during inspiration, and is loudest at the base.
257
A normal apical pulse area is 1cmx2cm in size.
A. True
B. False
A. True
258
The mitral valve is assessed at the:
a. 4th ICS
b. 3rd ICS
c. 2nd ICS
d. 5th ICS, MCL
d. 5th ICS, MCL
259
You should always listen for the S1 and S2 heart sounds first when assessing heart sounds.
A. True
B. False
A. True
260
The valves that can be best heard at the apex of the heart are the pulmonic and aortic valves.
A. True
B. False
B. False
261
When assessing the carotid arteries, you should always palpate both sides simultaneously to compare them.
A. True
B. False
B. False
262
To check for a blood clot in the leg, you would do a:
a. Check of the patients radial pulse
b. Homans sign
c. Allens test
d. Ankle Branchial Index
b. homans sign
263
Arteries are thicker than veins with elastic properties, allowing them to withstand increases in pressure.
A. True
B. False
A. True
264
Intermittent claudication is:
a. When a patient experiences leg pain with exercise
b. A blood clot in the vein of the leg
c. Assessed using the homans sign
d. A blockage caused by an arterial plaque
a. When a patient experiences leg pain with exercise
265
S1 is heard loudest at:
a. 3rd ICS LSB
b. 2nd ICS LSB
c. 2nd ICS RSB
d. 5th ICS MCL
d. 5th ICS MCL (mitral valve)
266
Which statement is NOT true about S2?
a. It is heard loudest at the base of the heart
b. It is caused by the closure of the semilunar valves
c. It is best heard with the bell
d. It is at the end of systole
c. it is best heard with the bell
267
Heart sounds are the same thing as murmurs.
A. True
B. False
B. false
268
All of the following regarding S3 are true except:
a. Sounds like Kentucky
b. Is often a sign of heart failure
c. Is caused by resistance to ventricular filling
d. Is best heard with the diaphragm
d. it is best heard with the diaphragm
269
All of the following are true about S4 except:
a. Occurs during diastole
b. Occurs right before the S1
c. Is heard best with the bell
d. Is always an abnormal finding
d. is always an abnormal finding
270
Diastolic murmurs are always pathologic.
A. True
B. False
A. True
271
Systolic murmurs occur between S2 and S1.
A. True
B. False
B. False
272
Which statement is not true?
a. Kyphosis is a flexion deformity
b. The tripod position may indicate resp distress
c. Normal thorax a/p ratios is 1:1
d. Clubbing of the nails may indicate resp disease
c. Normal thorax a/p ratios is 1:1
273
What is not true about lung auscultation?
a. In bronchial breath sounds; I>E
b. The pt must breathe deeply in and out of their mouth
c. Wheezes can be caused by acute bronchites
d. Crackles can be fine or coarse
a. In bronchial breath sounds; I > E
