Midterm A Flashcards
(298 cards)
1
Q
How often should a patient’s registration form be updated?
A
Every year
2
Q
What information does a patient’s medication summary include?
A
- Dosage
- Route
- Frequency
- Whether the patient has received the dose at a particular time
3
Q
What is a consultation note?
A
Input from a consulting subspecialty physician
4
Q
What is the SOAP format for physician’s progress notes?
A
- Subjective (what the patient tells you
- Objective (what you find in the physical exam)
- Assessment (problem list)
- Plan (management)
5
Q
What is the range for normal blood pressure values in the average healthy adult at rest?
A
90/60-120/80
6
Q
What is the range for normal heart rates in the average healthy adult at rest?
A
60-100 BPM
7
Q
What is the range for normal respiratory rates in the average healthy adult at rest?
A
12-20 breaths per minute
8
Q
What is the range for normal body temperatures in the average healthy adult at rest?
A
97.8-99.1 degrees Fahrenheit
9
Q
What is the range for normal pulse ox values in the average healthy adult at rest?
A
95-100%
10
Q
What is systolic blood pressure?
A
The pressure exerted on the wall of the arteries during heart contraction (systole)
11
Q
What is diastolic blood pressure?
A
The pressure exerted on the wall of the arteries during heart relaxation (diastole)
12
Q
What range of systolic blood pressures classifies a patient as having Stage 1 hypertension
A
140-159mmHg
13
Q
What range of diastolic blood pressures classifies a patient as having Stage 1 hypertension
A
90-99 mmHg
14
Q
What range of systolic blood pressures classifies a patient as having Stage 2 hypertension
A
Greater than or equal to 160mmHg
15
Q
What range of diastolic blood pressures classifies a patient as having Stage 2 hypertension
A
Greater than or equal to 100mmHg
16
Q
What are Cheyne-Stokes respirations?
A
Apnea alternating with tachypnea (fast breathing >20bpm)
17
Q
What is Kussmaul’s breathing?
A
Deep labored hyperventilation associated with metabolic acidosis
18
Q
Patients with what comorbidity would exhibit Kussmaul’s breathing?
A
Diabetes
19
Q
What is orthopnea?
A
Shortness of breath while laying flat
20
Q
How much lower are axillary temperatures in relation to oral temperatures?
A
Axillary temps are 1 degree Celsius lower than oral temps
21
Q
How much higher are rectal temperatures in relation to oral temperatures?
A
Rectal temps are 0.4-0.5C higher than oral temps
22
Q
What are the sources of obtaining core temperature?
A
PA > esophagus > bladder > nasopharyngeal > rectal
23
Q
What is the first step in the sequence of a patient interview?
A
Greeting the patient and establishing a rapport
24
Q
What are the questions included in the CAGE questionnaire?
A
- Have you ever felt the need to CUT DOWN on your drinking?
- Have you ever felt ANNOYED by criticism of your drinking?
- Have you ever felt GUILTY about drinking?
- Have you ever had an EYE-OPENER to steady your nerves or get rid of a hangover?
25
What are the 5 stages of the Kubler-Ross theory of response to death?
1) Denial/isolation
2) Anger
3) Bargaining
4) Depression/sadness
5) Acceptance
26
What is the definition of nonmaleficence regarding professional ethics?
"First, Do No Harm"
27
What is subjective data?
What the patient tells you
28
What is objective data?
What you detect during the exam
29
What are the seven attributes of symptoms of present illness (CHLORIDE)?
- CHaracter or quality
- Location
- Onset
- Radiation
- Intensity
- Duration
- Exacerbating or alleviating factors
* Associated manifestations
30
What are the 4 cardinal techniques of physical examination?
1) Inspection
2) Palpation
3) Percussion
4) Auscultation
31
What electrolyte value is used to monitor salt/water balance and evaluate fluid and electrolyte balance?
Sodium
32
What are the normal adult lab values for sodium?
136-145mEq/L
33
What electrolyte value is important to assess cardiac function?
Potassium
34
What are the normal adult lab values for potassium?
3.5-5.0mEq/L
35
What electrolyte value is used to investigate acid/base balance and proper balance of body fluids?
Chloride
36
What are the normal adult lab values for chloride?
90-110mEq/L
37
What is the normal range for CO2 lab values in adult patients?
23-29mEq/L
38
What lab value reveals important information about how well the kidneys and liver are working?
Blood Urea Nitrogen (BUN)
39
What are the normal adult lab values for BUN?
10-20mg/dl
40
What are creatinine lab values used to diagnose?
Impaired renal function
41
If kidney function is impaired, how will the creatinine levels change?
The Cr levels will be elevated in the blood
42
What are normal creatinine levels in males?
0.6-1.2 mg/dl
43
What are normal creatinine levels in females?
0.5-1.1mg/dl
44
What lab value is used to diagnose or monitor diabetes?
Glucose
45
What are the normal lab values for glucose?
70-100mg/dL
46
What is the normal WBC range?
4,300-10,800
47
What is the normal Hgb range in females?
12-16
48
What is the normal Hgb range in males?
13-18
49
What is the normal range for hematocrit in men?
45-52%
50
What is the normal range of hematocrit in women?
37-48%
51
What is Mean Corpuscular Volume?
The average volume of a red cell
52
What is the normal range of mean corpuscular volume?
86-98 femtoliters
53
What is the normal range for platelet count?
150,000-400,000
54
What is CBC with diff?
Complete blood count with differential - a machine generated percentage of the different types of white blood cells
55
What does a PT test measure?
Extrinsic pathway to assess clotting ability of blood
56
What is a normal prothrombin time?
11-15 seconds
57
What is INR?
International normalized ratio - allows for standardization of the value no matter where the test is done
58
What are normal INR values?
1.0-1.5
59
What does PTT measure?
The efficacy of the intrinsic and common coagulation pathways.
60
What test is used to monitor the treatment effects with heparin?
PTT
61
What is the normal range of PTT?
30-50 seconds
62
How do cardiac myocytes maintain polarity?
Membrane pumps control distribution of ions to keep the inside of the cells electronegative
63
Which pump maintains the electrical polarity of the myocyte membranes?
The sodium/potassium pump
64
How does the sodium/potassium pump work? What form of energy does it use?
Pumps 3 Na+ OUT of the cell for every 2 K+ that come IN the cell. It uses ATP to keep the cell polarized.
65
Which cardiac cells are the power source of the heart?
Pacemaker cells
66
Which cardiac cells depolarize spontaneously?
Pacemaker cells
67
What is the dominant pacemaker of the heart?
Sino-atrial node in the right atrium
68
What is the intrinsic rate of the SA node?
60-100bpm
69
What is the intrinsic rate of the atrial foci?
60-75bpm
70
What is the intrinsic rate of the AV node (junctional foci)?
40-60bpm
71
What is the intrinsic rate of the HIS bundle/purkinje system (ventricular foci)?
30-40bpm
72
Which cardiac cells serve as the hard wiring of the heart and carry current throughout the heart?
Electrical conducting cells
73
What are the electrical conducting cells of the ventricles?
Purkinje system
74
What are the electrical conducting cells of the atria?
Bachman's bundle
75
Which cardiac cells constitute the largest part of the heart tissue and are responsible for the labor of contracting and relaxing?
Myocardial cells
76
The waves of an EKG reflect the electrical activity of which cardiac cell types?
Myocardial cells
77
What is the voltage of one small square on an EKG paper? One large square?
Small square: 0.1mv
| Large square: 0.5mv
78
What is the length of time indicated by one small square on an EKG paper? One large square?
Small square: 0.04sec
| Large square: 0.2sec
79
What electrical activity of the heart is occurring during the P wave?
Atrial depolarization
80
What does the 1st portion of the P wave represent?
Right atrial depolarization
81
What does the 2nd portion of the P wave represent?
Left atrial depolarization
82
What is the purpose of the AV node delay?
It slows conduction from the atria to the ventricles to allow the atria to finish contracting before the ventricles begin to contract. Allows the atria to completely empty their volume into the ventricles.
83
What are the 3 parts of ventricular conduction?
1) Bundle of His
2) Bundle branches
3) Terminal purkinje fibers
84
What electrical activity of the heart is occurring during the QRS complex?
The beginning of ventricular depolarization and contraction
85
What is represented by R/R' waves?
Bundle branch blocks
86
What electrical activity of the heart is occurring during the T wave?
Ventricular repolarization
87
Where is the PR interval?
Start of the P wave to the beginning of the QRS complex
88
Where is the ST segment?
The end of the QRS complex to the beginning of the T wave
89
Where is the QT interval?
Includes the QRS complex, ST segment, and T wave
90
What is indicated by a positive deflection on an EKG?
A wave of depolarization towards a positive electrode
91
What is indicated by a negative deflection on an EKG?
A wave of depolarization away from a positive electrode
92
What is indicated by a biphasic wave on an EKG?
Depolarizing wave moving perpendicular to a positive electrode
93
What direction is a wave of repolarization moving as indicated by a negative deflection?
Towards a positive electrode
94
What direction is a wave of repolarization moving as indicated by a positive deflection?
Away from a positive electrode
95
What leads make up a 12 lead EKG?
6 limb leads (3 standard leads, 3 augmented leads) and 6 precordial leads
96
How many electrodes are needed for a 12 lead EKG?
10
97
What view of the heart is seen with standard limb leads?
The frontal plane. It views electrical forces moving up, down, left and right throughout the circle.
98
What are the negative and positive electrodes in Lead 1?
Right arm negative, left arm positive. 0 degree orientation.
99
What are the negative and positive electrodes in Lead 2?
Right arm negative, left leg positive. 60 degree angle of orientation.
100
What are the negative and positive electrodes in Lead 3?
Left arm negative, left leg positive. 120 degree angle of orientation.
101
What view of the heart is seen with the precordial leads?
The horizontal plane, view electrical forces moving anteriorly and posteriorly
102
Which electrodes are positive and negative in the precordial lead system?
All precordial electrodes are positive with a negative central terminal that's made by connecting all 3 limb leads
103
Which leads provide an anterior view of the heart?
V2, V3, V4
104
Which leads provide a left lateral view of the heart?
I, aVL, v5, v6
105
Which leads provide an inferior view of the heart?
II, III, aVF
106
Which leads provide a view of the right ventricle?
aVR, V1
107
Any lead in the 12 lead EKG that views the wave of atrial depolarization (P wave) as moving towards it will record a _______ deflection on the EKG.
Positive
108
Which leads in the 12 lead EKG show a positive P wave?
Left lateral leads and inferior leads - I, aVL, v5, v6, II, aVF
109
Which leads on a 12 lead EKG produce a biphasic wave during atrial depolarization (P wave)?
III and v1 because they lie perpendicular to the wave of atrial depolarization
110
Which lead in the frontal plane shows a negative P wave on a 12 lead EKG?
aVR because the current is going away from it
111
Which lead shows the most positive P wave amplitude?
Lead II
112
Which lead shows the most negative P wave amplitude?
aVR
113
How long is the PR interval?
0.12-0.2 seconds (3-5mm)
114
What electrical activity of the heart is represented by septal Q waves?
Depolarization of the interventricular septum
115
Q waves are seen as tiny negative deflections in which leads?
Left lateral leads - I, aVL, V5, V6
116
What is the normal amplitude of Q waves?
Less than or equal to 0.1mV
117
What pathology is denoted by a large negative Q wave in the inferior leads (II, III, aVF)?
Inferior MI
118
Where does the average vector of current swing during ventricular depolarization (QRS complex)?
Leftward 0-90 degrees
119
In which leads is the QRS complex positive?
Most of the left lateral and inferior leads
120
In which lead is the QRS complex negative?
aVR
121
Which leads in the frontal plane show a biphasic QRS wave?
III and aVL
122
Which leads record deep S waves?
V1 and V2
123
Which leads in the horizontal plane show a biphasic QRS?
V3 and V4
124
Which lead records the smallest R wave?
V1
125
Which lead records the largest R wave?
V5
126
What leads show the transition zone of the QRS?
V3 and V4
127
How long does a normal QRS last?
0.06-0.1seconds
128
Elevation or depression of the ST segment by more than __mm indicates pathologic process
1mm
129
It's typical to find positive T waves in the same leads that have what?
Tall positive R waves
130
The duration of the QT interval is proportional to what?
Heart rate
131
The QT interval composes __% of the normal cardiac cycle
40%
132
What glands present as an airway emergency when they become enlarged?
Submandibular glands
133
Which of the paranasal sinuses are accessible during a physical exam?
Frontal and maxillary sinuses
134
What questions can you ask to assess thyroid function?
Temperature intolerance/sweating? Any new palpitations or change in weight?
135
What is a consensual pupillary reaction?
When you test one eye with a pen light there is pupillary constriction in the opposite eye
136
What is tested by the Rinne test?
Compares air conduction and bone conduction
137
What is the purpose of the Weber test?
To test if there is conductive hearing loss, sensorineural hearing loss, or both
138
What cranial nerve is assessed by asking the patient to stick out their tongue and looking for symmetry?
Cranial nerve 12 (hypoglossal)
139
What cranial nerve is assessed by noting the rise of the soft palate when the patient opens their mouth and says "ah"?
Cranial nerve 10 (vagus)
140
What could be indicated by a dry cough during an airway exam?
Possible tracheobronchial compression
141
What structures are seen in a MAL1 view?
Full visibility of tonsils, uvula, and soft palate
142
What structures are seen in a MAL2 view?
Visibility of hard and soft palate, upper portion of tonsils and uvula
143
What structures are seen in a MAL3 view?
Soft and hard palate, base of uvula
144
What structures are seen in a MAL4 view?
Only hard palate
145
What causes angina (chest pain)
Rapid arrhythmias that increase the oxygen demands of the myocardium
146
What are the causes of arrhythmias? (HIS DEBS)
- Hypoxia
- Ischemia/irritability
- Sympathetic stimulation
- Drugs
- Electrolyte disturbances
- Bradycardia
- Stretch
147
What lead yields the most information about an arrhythmia?
Lead II
148
What are the 5 steps of analyzing an ekg?
1) Calculate rate
2) Determine regularity
3) Assess P waves
4) Determine PR interval
5) Determine QRS duration
149
What are the 5 types of arrhythmias?
1) Sinus origin - follows the normal pathway, but too fast/slow/irregular
2) Ectopic rhythms - activity originates somewhere other than sinus node
3) Reentrant arrhythmias - activity is trapped within a racetrack
4) Conduction blocks - blocks and delays in conduction pathway
5) Pre-excitation syndromes - activity follows accessory pathways that bypass the normal ones
150
What 3 pathologies is sinus tachycardia normally seen in?
- Congestive heart failure
- Severe lung disease
- Hyperthyroidism
151
What pathology is sinus bradycardia normally seen in?
Acute myocardial infarction
152
How is sinus arrhythmia defined?
Normal EKG but rhythm is slightly irregular, usually reflects variation in heart rate that accompanies inspiration and expiration
153
How does HR change with the respiratory cycle in sinus arrhythmia?
Inspiration accelerates HR and expiration decelerates HR
154
What are escape beats?
When myocardial cells spring into act and take over pacing when sinus arrest occurs (SA node stops firing)
155
What is the treatment for asystole?
CPR and epinephrine IV
156
What is junctional escape rhythm?
Depolarization originates near the AV node and there are NO P waves
157
What 2 questions can you ask to determine whether an ectopic arrhythmia is ventricular or supra ventricular?
- Are normal P waves present?
| - Is the QRS complex narrow (less than 0.12 secs) or wide (more than 0.12secs)?
158
What are the 2 types of single ectopic supraventricular beats?
- PACs that originate in the atria
| - Junctional premature beats that originate in the AV node
159
What is the treatment for single atrial and junctional premature beats?
They do not require treatment because they don't indicate underlying cardiac disease
160
What are the 5 types of sustained supra ventricular arrhythmias?
1) Paroxysmal supraventricular tachycardia (PSVT)
2) Atrial flutter
3) Atrial fibrillation
4) Multifocal atrial tachycardia (MAT)
5) Paroxysmal atrial tachycardia (PAT)
161
What is Paroxysmal supra ventricular tachycardia (PSVT)?
Sudden tachycardia of 150-250bpm with regular, narrow QRS complexes and retrograde P waves (if visible)
162
What usually initiates Paroxysmal supra ventricular tachycardia (PSVT)?
A supraventricular premature beat
163
What helps to diagnose and terminate Paroxysmal supra ventricular tachycardia (PSVT)?
Carotid massage, it causes baroreceptors to sense changes in pressure and initiate reflex bradycardia. Allows the rate to slow down so we can visualize P waves and diagnose the tachycardia.
164
What is atrial flutter?
Regular rhythm and an atrial rate of 250-350bpm - characterized by saw tooth waves
165
What is atrial fibrillation?
"Irregularly irregular" beat without discernible p waves - atrial rate of 350-500BPM and variable ventricular rate.
166
How does a carotid massage affect atrial flutter?
May increase the block
167
How does a carotid massage affect atrial fibrillation?
May slow ventricular rate
168
What is multifocal atrial tachycardia (MAT)?
An irregular rhythm occurring at 100-200BPM. Occurs from random firing of at least 3 different atrial foci
169
What is it called when the EKG has a MAT rhythm but the rate is less than 100bpm?
Wandering Atrial Pacemaker
170
How does a carotid massage affect MAT?
No effect
171
MAT is common in patients with what comorbidity?
Severe lung disease
172
What is Paroxysmal Atrial Tachycardia (PAT)?
Regular rhythm with a rate of 100-200bpm. Caused by enhanced automaticity of ectopic atrial focus.
173
What is displayed on the EKG with an automatic type PAT?
A warm-up period with an irregular rhythm follow by a cool-down period where the rhythm terminates
174
What is the most common cause of PAT?
Digitalis toxicity
175
How do you differentiate PSVT and PAT?
- There is a warm-up and cool down period with PAT
| - A carotid massage will help PSVT but not PAT
176
What are the 5 types of ventricular arrhythmias?
1) PVCs
2) V tach
3) Torsade de Pointes
4) V fib
5) Accelerated idioventricular rhythm
177
What is the most common ventricular arrhythmia?
PVCs
178
What are the EKG characteristics of a PVC?
Wide QRS complex and bizarre because ventricular depolarization doesn't follow normal conduction pathway
179
What is bigeminy?
1 normal sinus beat for every 1 PVC
180
What is trigeminy?
2 normal sinus beats for every 1 PVC
181
What is the "R-on-T" phenomenon?
When PVCs fall on the T wave of the previous beat, can precipitate V tach
182
When should you worry about PVCs?
- If they are frequent
- If there's a run of 3 or more
- If they are multiform (vary in site of origin)
- If they occur in the setting of an acute MI
183
What is V tach?
A run of 3 or more consecutive PVCs at a rate of 120-200bpm, may be slightly irregular
184
What is Torsades De Pointes?
"Twisting of the points" - A form of v tach seen in patients with prolonged QT intervals
185
What can cause prolonged QT intervals?
- Electrolyte disturbances (low Ca2+, Mg2+, or K+)
- Myocardial infarction
- R-on-T phenomenon
- Drugs (anti-arrhythmics, tricyclics, phenothiazines, antihistamines when taken with erythromycin, anti-fungals)
186
What is the most frequently encountered arrhythmia in adults who experience sudden death?
V fib
187
What is accelerated idioventricular rhythm?
Benign, regular rhythm at a rate of 50-100BPM that is seen during an acute MI. It represents a ventricular escape focus that has accelerated to drive the heart.
188
What are the 2 common treatments of arrhythmias?
1) Programmed electrical stimulation (ex. catheter ablation)
| 2) Implantable cardioverter-defibrillators
189
What is left ventricular pressure during diastole?
Less than 5mmHg
190
What action produces the first heart sound S1?
Closing of the mitral and tricuspid valves (beginning of systole)
191
What action produces the second heart sound S2?
Closing of the aortic and pulmonic valves (beginning of diastole)
192
What can cause a 3rd heart sound in children and young adults?
The rapid movement of blood against the ventricular wall
193
What is does an S3 gallop indicate in older adults?
A pathologic change in ventricular compliance
194
What is indicated by S4 (a 4th heart sound)?
It marks atrial contraction and reflects a pathologic decrease in ventricular compliance
195
What is an A2 sound?
Aortic valve closer
196
What is a P2 sound?
Pulmonic valve closure
197
What causes heart murmurs?
Turbulent blood flow caused by a stenotic or regurgitant valve
198
What is a stenotic valve?
An abnormally narrowed valvular orifice that obstructs blood flow
199
What is a regurgitant valve?
A valve that doesn't close fully and allows blood to leak backward
200
Where are the sounds of the mitral valve heard best?
At the cardiac apex, 4th/5th ICS, midclavicular line
201
Where are the sounds of the tricuspid valve heard best?
At the lower left sternal border - 4th intercostal space
202
Where are the sounds of the pulmonic valve heard best?
In the 2nd and 3rd left interspaces close to the sternum
203
Where are the sounds of the aortic valve heard best?
Anywhere from the right 2nd interspace to the apex
204
What is preload?
The load the stretches the cardiac muscle before contraction
205
What increases preload?
Inspiration, increased blood volume due to exercise, congestive heart failure
206
What decreases preload?
Exhalation, decreased left ventricular output, pooling of blood in the venous system/capillary beds
207
Stimulation from the sympathetic nervous system increases what aspect of the heart?
Myocardial contractility
208
What decreases myocardial contractility?
Anything that decreases blood flow or oxygen delivery to the myocardium
209
What is after load?
The degree of vascular resistance to ventricular contraction
210
What does jugular venous pressure reflect?
Pressure in the right atrium
211
What is reflected by the A wave on a CVP waveform?
Rise in atrial pressure that accompanies atrial contraction
212
What is reflected by the C wave on a CVP waveform?
Right ventricular contraction causing the tricuspid valve to bulge towards the right atrium
213
What is reflected by the X wave on a CVP waveform?
Ventricular ejection, atrial relaxation and filling
214
What is reflected by the V wave on a CVP waveform?
Tricuspid valve closes and right atrium fills with blood (preload)
215
What is reflected by the Y wave on a CVP waveform?
Tricuspid valve opens and blood flows into the right ventricle
216
What is orthopnea quantified by?
The number of pillows the patient sleeps with
217
What is paroxysmal nocturnal dyspnea?
Episodes of sudden dyspnea or orthopnea that awakens the patient from sleep
218
What is measured by METs?
How hard your body is working
219
How much should you inflate the blood pressure cuff when manually measuring a patient's BP?
30mmHg above pressure at which pulse disappears
220
What are thrills?
Humming vibrations felt during palpation of the carotid artery
221
What are bruits?
Murmur like sounds of vascular rather than cardiac origin.
222
Which artery should be assessed in patients with carotid obstruction?
Brachial artery
223
What is represented by the point of maximal impulse (PMI)?
The brief early pulsation of the left ventricle as it moves anteriorly during contraction and touches the chest wall.
224
Where on the patient should you assess PMI?
Have the patient lie supine and assess the 4th or 5th interspace around the midclavicular line
225
What is the diameter of the PMI?
Less than 2.5cm from the midsternal line
226
What is the duration of the PMI?
Usually first 2/3rd of systole
227
Which heart sounds do you listen for with the diaphragm of your stethoscope?
The high-pitched sounds of S1/S2, murmurs due to aortic and mitral regurgitation, pericardial friction rubs
228
Which heart sounds do you listen for with the bell of your stethoscope?
Low-pitched sounds of S3/S4 and mitral stenosis murmurs
229
In what patients might an S3 heart sound be heard?
In patients with anemia, fever, pregnancy, or thyrotoxicosis
230
How is the intensity of a heart murmur graded? What are the criteria?
On a 6 point scale.
I - very faint
II - quiet but heard immediately
III - moderately loud
IV - loud with a palpable thrill
V - very loud, thrill, heart w/ stethoscope partly off the chest
VI - very loud, thrill, heard with stethoscope entirely off the chest
231
________ murmurs almost always indicate heart disease
Diastolic
232
What are 2 types of diastolic murmurs?
- Aortic regurgitation
| - Mitral stenosis
233
What is the purpose of taking a review of systems?
To gain understanding of overall, general health of the patient
234
What observations do you want to make when evaluating the airway for a DL?
MAL score, thyromental distance, mouth opening, cervical flexion/extension, range of motion, masses/scars
235
What is the discharge rate for junctional pacemakers?
40-60BPM
236
Where can you measure core body temperature?
Pulmonary artery, esophagus, bladder, nasopharynx, rectum
237
What is the normal number of adult teeth?
32
238
What is aortic stenosis?
Abnormally narrowed valvular orifice that obstructs blood flow and has a harsh sound
239
What causes the S3 heart sound in athletes/children?
Ventricular filling and the rapid deceleration of the column of blood against the wall
240
What causes the S3 heard sound in adults?
Pathological change in ventricular compliance
241
What is the definition of functional residual capacity?
The volume of air left in the lungs after a passive exhalation - 30mL/kg
242
What is the definition of a Grade IV murmur?
Loud with palpable thrill
243
Where do tears originate from?
Lacrimal gland
244
Where do tears drain into?
Lacrimal sac
245
What part of the eye focuses light?
Retina
246
What part of the eye controls pupillary size?
Iris
247
What part of the eye controls the thickness of the lens and allows the eye to focus?
Ciliary body
248
If this part of the eye is not regulated, patients could get increased intraocular pressure or glaucoma
Aqueous humor
249
What is the posterior part of the eye that contains the retina, choroid, fovea, macula, optic disc, and vessels?
Fundus
250
What is the definition of ventricular tachycardia?
Run of 3 or more PVCs are a rate of 120-200BPM
251
An irregularly irregular pulse is associated with which dysrhythmia?
Atrial fibrillation
252
What is the normal range for platelet count?
150,000-400,000
253
What is a normal thyromental distance?
6cm
254
What are the causes of conductive hearing loss?
Cerumen (wax), otitis externa, squamous cell carcinoma, osteomas perforation of eardrum, cholesteatoma
255
The Snellen eye chart tests what?
Visual acuity
256
Pain in which sinuses are palpable?
Maxillary and frontal
257
What does the eustachian tube connect?
The middle ear and the nasopharynx
258
What is candidaisis?
Fungal infection due to yeast - can be found on the tongue and looks like yellow/whitish film
259
What are thrills?
Humming vibrations felt during palpation of the carotid artery
260
Where do you listen to hear the mitral valve?
Apex of the heart, 4th-5th intercostal space at midclavicular line
261
What is a bruit?
Murmur like sound of vascular rather than cardiac origin
262
Where is an aortic stenosis best heard?
Over the aortic area - 2nd intercostal space right sternal margin
263
Where is the pulmonic valve auscultated?
2nd left intercostal space
264
What part of the stethoscope should you use for high pitched sounds like S1, S2, friction rubs, and regurgitations?
Diaphragm
265
What part of the stethoscope should you use to listen to low-pitched sounds like S3, S4, and stenosis?
The bell
266
What does ADL stand for?
Activities of daily living
267
Which type of hearing loss can be caused by cholesteatoma?
Conductive hearing loss
268
Which hearing pathway covers the inner ear?
Sensorineural
269
Which hearing pathway covers the middle and outer ear?
Conductive
270
Which hearing pathway is damaged by viruses, drugs, noise exposure, and Meniere's disease?
Sensoneurial
271
What cranial nerve is involved in the sensoneurial hearing pathway?
8 (vestibulocochlear)
272
What artery passes upward just in front of the ear and is palpable during an examination?
Superficial temporal artery
273
Which salivary glands lie superficial to and behind the mandible?
Parotid glands
274
What part of the ear do the auricle, ear canal, and eardrum belong to?
External ear
275
What part of the ear do the ossicles and eustachian tube belong to?
Middle ear
276
What part of the ear do the cochlea and cochlear nerve belong to?
Inner ear
277
What is presbyopia/hyperopia?
Far-sightedness
278
What is myopia?
Near-sightedness
279
What are scotomas?
Dark spots surrounded by normal vision
280
What is diplopia?
Double vision
281
What causes hoarseness?
Diseases of the larynx or extralaryngeal lesions pressing on laryngeal nerves
282
What are nevi?
Moles
283
How can longstanding diabetes mellitus lead to a difficult intubation?
It can cause limited cervical mobility
284
What is ptosis?
Drooping of the upper eye lid
285
What is exophthalmos?
Protrusion of the eyeball
286
What part of the eyes are being tested by asking the patient to follow your finger as you sweep through the 6 cardinal directions of gaze?
Extraocular muscles
287
What is nystagmus?
Fine rhythmic oscillation of the eyes
288
Why can a history of radiation to the neck cause a difficult intubation?
It can cause fibrosis and immobility of the larynx
289
Which geographic subdivisions are used as patient identifiers?
Any geographic subdivision smaller than a state
290
A MAP greater than __mmHg is needed to perfuse the organs
60
291
A MAP greater than __mmHg is needed to perfuse the organs in hypertensive patients
70
292
What is an example of nonverbal communication?
Offering tissue
293
What fundamental of interviewing involves expressing your desire to work with the patient?
Partnering
294
What mental health problem is common yet under-diagnosed and under-treated?
Depression
295
What position should the patient be in when you are auscultating with both the diaphragm and the bell? Where on the chest wall should you listen?
Patient is reclining, listen to RICS 2, LICS 2-5, and apex
296
What position should the patient be in when you are auscultating with only the bell? Where on the chest wall should you listen?
Patient is in left lateral decubitus, listen to the apex
297
What position should the patient be in when you are auscultating with only the diaphragm? Where on the chest wall should you listen?
Patient is sitting up and leaning forward while holding their breath, listen to RICS 2, LICS 2-5, and apex
298
What are the 4 types of systolic murmurs?
1) Aortic stenosis
2) Mitral valve prolapse
3) Mitral regurgitation
4) Tricuspid regurgitation
