ICM-2 Flashcards
1
Q
Pulse pressure
A
Systolic - Diastolic
2
Q
MAP
A
- Diastolic + 1/3 (Systolic - Diastolic)
- Lowest MAP 50 mmHG
3
Q
Blood pressure cuff techniques
A
- 2.5 cm above ante-cubital
- Position arm w/ brachial artery @ LVL with Heart
- (+) 30 mmHG to where the pulse disappears
- Taking pressure standing will give drop in systolic and rise in diastolic
4
Q
BP Values
A
- 160 / >100 = hypertension 2
5
Q
Pulse rate values
A
- Normal = 60 to 100 / min
- Tachycardia = >100 /min
- Bradycardia = < 60 /min
6
Q
Pulse Rhythm
A
- Regular irregular = premature atrial or ventricular contractions
- Irregularly irregular = atrial fibrillation
7
Q
Pulse volume
A
- 0 = absent
- 1 = diminished, barely palpable
- 2 = normal
- 3 = full or inreased
- 4 = Pounding
8
Q
Pulse character (contour/amplitude)
A
- Pulsus alternans: alternating weak/strong = left ventricle failure
- Pulsus bisferiens: 2 main peaks or 2 strong systolic bears (stop) mid systolic dip = aortic stenosis & regurgitation)
- Pulsus Bigeminus: 2 beats in rapid sucession - normal beat + premature beat (pre-ventricluar contraction)
9
Q
Pulse character (contour/amplitude)
A
- Pulsus paradoxus: exaggeration of normal fall in amplitude during inspiration - Systolic BP drop = 12-15 mmHG (severe airway obstruction)
- Water hammer: “collapsing pulse” greater amplitude, rapid rise, sudden descent = back flow through aortic valve
- Pulsus differens = indicate stenosis on one side
10
Q
Respiration
A
- Normal values = 14-20 bPM
- Bradypnea = slow breathing = disease in CNS or metabolic disorder
- Tachypnea = Rapid/shallow greater than 24 bpm = restrictive lung disease or pleuritic chest pain
- Hyperpnea = Rapid/deep = exercise/anxiety
- Ataxic = rhythm random w/depression in bPM = midbrain damage
11
Q
Swollen gums is indicative of?
A
-Hyperplasia (increase in number or size) due to antiepileptic drugs ex. phenytoin)
12
Q
Where is the salivary duct (paotid) located on Buccal Mucosa?
A
-opposite the upper second pre-molar tooth on each side
13
Q
Where are the lymph nodes located on Head/Neck?
A
- Anterior Triangle (Base is mandible/Apex is jugular notch)
- Posterior Triangle (Base is mid clavicle/Apex is Occipital bone)
- Superficial group
- Deep group
- Supra-clavicular fossa
14
Q
Lymphs in Anterior Triangle
A
- Preauricular
- Parotid
- Tonsillar
- Submandibular
- Submental
15
Q
Lymphs in Posterior Triangle
A
- Post. auricular
- Occipital
- Supraclavicular
16
Q
Virchow’s Nodes
A
- Hard palpable non tender node in LEFT supraclavicular region
- Diagnosis probable abdominal malignancy
17
Q
Thyrogloassal Cyst
A
- Swellings in thyroid region move on swallowing.
- Move up on tongue protrusion
18
Q
Bruits
A
- Heard in hypevascular gland
- Grave’s disease
19
Q
Palmar Arythema/Dupuytren’s contracture
A
- Arythema: Swelling & redness on the exterior of the palm
- Contracture: thickening of palmar apenerosis which causes the pinky to auto flex (node could appear)
- Could be a sign of liver disease
- Can be coupled with cirrhosis
20
Q
With ear Tenderness
A
- Press Targus against external ear and pull up & down.
- Press over mastoid process = pain = middle ear infection
21
Q
Speculum exam
A
- Tilt head to opposite side of exam
- Pull ear upward, backward & slight away from head
- Hold otoscope like a pen (pinky against head)
22
Q
Tympanic membrane (ear drum)
A
- Color: Pearly grey/white
- Structures: Handle of malleus, jumbo, cone of light
- Abnormal: redness, perforation of ear drum
23
Q
Tuning fork Tests
A
- Air Conduction
- Bone Conduction
- Weber test: 512 KHZ fork and place on forehead and sound should be heard by both ears
- Rinne Test: Compare AC with BC
- Absolute bone test: Compare your BC with patient’s
24
Q
Properties of Nose
A
- Middle meatus drains to maxillary sinus, Frontal & ethmodial
- Superior meatus drains to posterior ethmodial & sphenodial sinuses
25
General appearance of Skin color
- Cyanotic (blueish low O2)
- Jaundice (Yellowish blockage in hepatic)
- Hyperpigmented (decrease/increase in melanin)
- Pallid (Pale or dull)
- Cherry red (Carbon monoxide)
26
Olser's nodes/Janeway lesions
- Appear on toes or fingers
- Mini hemorrhages (dark brown spots)
- Caused by bacterial endocarditis
27
Nail color
- Leuconychia (whiteness under nail bed could be indicative of renal/liver failure)
- Yellowish (Sepsis, Infective endocarditis, trauma)
- Blueish (clubbing/cyanotic)
- Koilonychia (concave nail bed = low iron anemia)
28
Aetiology of clubbing
- Abdominal: IBD, cirrhosis, celiac disease
- Resp: Carcinoma bronchus, pulm tuberculosis, cystic fibrosis, asbestos
- Cardiovascular: Chronic cyanosis, congenital heart disease
- Clinical test: Schamroth's sign missing diamond shape between index fingers
29
Eyes abnormalities
- Jaundice
- Arcus senilus (blue opaque ring due to hypercholesteremia)
- Anaemia (under eye lid)
- Xanthelasma
30
Mouth abnormalities
- Fetor (Bad breath)
- Angular stomatitis (Cracks/cuts on side of mouth can be due to vit/mineral def or fungal)
- Tongue
- Teeth
31
Neck
- JVP: can be measured by measuring from angle of manubrium to Jugular
- Carotid
- Thyroid
- Lymph
32
Chest inspection
- Pulsations:
1. Apical
2. Chest wall
3. Suprasternal
4. Epigastric
33
Apex Beat
- Most inferior & lateral position
- 1/2 inch medial to mid clavicle line left of 5th intercostal space
- If cant hear LEAN pt. forward or turn pt. to left side
- Sustained/Heaving = Aortic Stenois/hypertension
- Hyperdynamic = Regurgitation/exercise
34
Cardiac Murmurs
- Systolic: Aortic/pulmonary stenosis (best heard with breath in expiration)
- Diastolic: mitral/tricuspid stenosis/regurg (best heard with bell & breath held in expiration)
35
Mitral area/Tricuspid
- Tricuspid: immediately left of lower sternum (medial)
| - Mitral: left of tricuspid (lateral)
36
Aortic area/Pulmonary
- Aortic: 2nd intercostal immediately right of sternum
| - Pulmonary: 2nd intercostal immediately left of sternum
