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PCM - Final (Lectures) Flashcards

1
Q

What cardiac issues are pts with Marfan’s syndrome prone to?

A

Aortic aneurisyms and leaking -> they have a weak aorta

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2
Q

What does having your pt lean forward when listening to the heart help with?

A

Increases heart sounds and helps hear pericarditis

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3
Q

Why would you want to have a pt stand up when listening for murmurs?

A

To hear if the murmurs are louder or quieter

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4
Q

What are the symptoms of acromegaly?

A

Big jaws, prominent masculine features, big nose, lots of hair, etc -> predisposition for coronary heart disease and hypertension

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5
Q

What are the symptoms of hyperthyroidism

A

Bulging eyes, tremors, tachycardias, sweaty, anxious -> extra stress on the heart

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6
Q

What are symptoms of myxedema?

A

Very hypothyroid -> have slow HR, hyperlipidemia, hypertension, dry skin, patchy hair loss, trouble hearing

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7
Q

How does body temperature affect HR?

A

For every 1 degree above 100.4 degrees will increase heart rate by 10 bpm

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8
Q

What is Schamroth’s window?

A

The little light that comes through when you put your nails together -> lost in clubbed fingers

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9
Q

What are palpable thrills?

A

Turbulent blood flow causing murmurs thats felt on the outside of the body

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10
Q

As you percuss during PE of the heart, where should you start and end?

A

Start at. Lateral border of the chest and move more medial

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11
Q

Which murmur grades are palpable and which are not?

A

Grades 1-3 have NO palpabile thrill and sounds 4-6 DO have a palpable thrill

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12
Q

A _____________ murmur begins after S1 and stops before S2; brief gaps are audible between the murmur and the heart sounds

A

Midsystolic murmur - Listen carefully for the gap just before S2

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13
Q

A _____________ murmur starts with S1 and stops at S2, without a gap between murmur and heart sounds

A

parasystolic (holosystolic)

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14
Q

A _______________ murmur usually starts in mid- or late systole and persists up to S2

A

A late systolic murmur

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15
Q

A ______________ murmur starts immediately after S2 without a discernible gap and then usually fades into silence befor the next S1

A

Early diastolic murmur

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16
Q

A _____________ murmur starts a short time after S2. It may fade away, as illustrated or merge into a late diastolic murmur

A

Middiastolic murmur

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17
Q

What is the range of a moderately reduced EF?

A

30-39

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18
Q

What is the range of a mildly reduced EF?

A

40-49

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19
Q

What is a kussmauls sign?

A

When the jugular veins increase during inspiration -> this is seen in pts with R heart failure, constrictive pericarditis or RV infarction - Venous Column (JVP) should fall during inspiration, not rise**This is seen in R heart failure, constrictive pericarditis or RV infarction

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20
Q

What is the landmark for the inspection of the apex of the heart?

A

Left 5th ICS, medial to MCL

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21
Q

____ heart sound is the sound of the mitral and tricuspid valves closing and marks the beginning of what?

A

S1; beginning of ventricular systole

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22
Q

____ heart sound is the sound of the aortic and pulmonic valves closing and marks what events of the cardiac cycle?

A

S2; marks end of systole and beginning of diastole

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23
Q

Where is S1 the loudest?

A

At the apex

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24
Q

Where is S2 the loudest?

A

at the base

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25
Define preload
Stretching of myocytes prior to contraction. Its the end diastolic pressure (volume) at the beginning of systole
26
Define afterload
Load on the heart during ejection of blood from ventricle. Its the ventricular pressure at end of systole (end systolic volume)
27
What does an increased after load do to the volume of blood ejected each beat?
Decreases it (bc the heart had to work harder to contract)
28
What does an increased HR do to the output of blood /min versus the output of blood per beat?
It increases the output of blood/minute but decreases the output/beat
29
How do you determine stroke volume?
EDV - ESV -\> volume of blood ejected from the ventricle per beat
30
How do you determine cardiac output?
stroke volume X HR -\> volume of blood per minute pumped by the heart
31
How do you determine ejection fraction?
SV/EDV -\> measures contractility
32
What is a normal EF?
50-60%
33
What is a severely reduced EF?
15-29%
34
What is a barrel chest a tell tale sign of?
COPD - Barrel chest is an increased Anterior-posterior diameter
35
What is pectus carinatum versus excavatum?
Pectus carinatum = central protrusion (pigeon chet) Pectus excavatum = central depression (funnel chest)
36
What is S3?
Due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase
37
What is S4?
Atrial gallop from forceful contraction of atria against a stiffened ventricle
38
What abnormal heart sound is considered physiologic in children/young adults but pathologic in its \>40yo?
S3
39
What abnormal heart sound can be normal in trained athletes?
S4
40
What abnormal heart sound sounds like "Ten-Nes-See"?
S4
41
What abnormal heart sound sounds like "Ken-Tuck-Y"?
S3
42
Define hypopnea
decreased depth (shallow) and rate (slow) of respiration
43
What is a normal respiratory rate?
14-20/min - quiet and regular
44
Define bradypnea
regular rhythm but slower than normal rate -\> RR\<14/min
45
Define hyperpnea
increased depth (deep) of breathing and rate (fast) of respiration \*\*This is normal in exercise\*\*
46
Define tachypnea
Rapid breathing -\> RR \> 20/min
47
Define dyspnea
Feeling short of breath
48
Define hypoxemia
oxygen deficiency in arterial blood
49
define apnea
no breathing
50
define atelectasis
collapse of lung tissue that affects the alveoli from normal O2 absorption
51
define pleximeter finger
Hyperextended middle finger of non-dominant hand in percussion
52
Define plexor finger
"tapping" finger, dominant hand, for percussion
53
Define infrascapular and infraclavicular
below the scapulae and below the clavicles
54
Define interscapular
between the scapulae
55
How does a pulse oximeter work?
Oxygenated hemoglobin absorbs infrared light and allows red light to pass through, whereas deoxygenated blood is the opposite and absorbs red light. Pulse oximeters direct beams of red and infrared through a measurement site - Device senses pulse, records red light (oxyhemoglobin) and blue light (deoxyhemoglobin and the pulse rate is displayed. % saturation = red/(red + blue)
56
What are the steps to use an incentive spirometer?
1) Move the slider on the outside to the level you want to reach 2) Hold spirometer in front of you (can sit or stand but keep spirometer level) 3) breathe out to start, then close lips tightly around mouthpiece 4) Breath in with a slow, deep breath. Breath in as deeply as possible and as you breath in the piston inside will move up. The goal is to move the piston as high as possible. When you can't breathe in anymore, hold breath for 2-5 sec
57
What does a pulmonary function test tell you?
How well the lungs are working -\> can diagnose certain lung disorders (obstructive vs. restrictive) \*\* just tells obstructive or restrictive and how things change if given albuterol
58
What 3 muscles in the neck are considered accessory breathing muscles and become apparent when someone is experiencing respiratory distress?
Trapezius Scalenes Sternomastoid
59
Tracheal deviation can be seen in what 4 pathologies?
Pneumothorax (tensions and non-tension) Pleural effusion Atelectasis Mass
60
Clubbing is seen in what 8 pathologies?
Congenital heart disease Interstitial lung disease Bronchiectasis Pulmonary fibrosis Cystic fibrosis Lung abscess Malignancy (lung cancer) IBS
61
What are characteristics of chronic bronchitis?
Overweight and cyanotic Elevated hemoglobin peripheral edema rhonchi and wheezing
62
What is the clinical diagnosis of chronic bronchitis?
Daily productive cough for 3 months or more and in at least 2 consecutive years
63
What is the pathologic diagnosis for emphysema?
permanent enlargement and destruction of airspaces distal to the terminal bronchi
64
What are characteristics of emphysema
older and thin severe dyspnea quiet chest hyperinflation with flattened diaphragms on chest X-ray
65
Explain flail chest
multiple rib fractures resulting in paradoxical movements of the thorax -\> on inspiration the injured area caves inward and on expiration it moves outward
66
How does thoracic hyposcoliosis affect breathing?
Can compress the lungs/organs on whatever side the curvature deviates towards. This can present as reduced lung capacity on a pulmonary function test.
67
Define tactile fremitus
feeling vibrations of words spoken typically 99 is used
68
What pathologies result in decreased or absent tactile fremitus?
COPD bilaterally pleural changes unilaterally -\> effusions, fibrosis, air (pneumothorax) or infiltrating tumor
69
What pathologies result in increased tactile fremitus?
Pneumonia (consolidation) -\> usually unilateral but can be bilateral depending on how bad the pneumonia is
70
What percussion sound is always pathologic?
Hyperresonant
71
When percussing over a deflated lung in an airfilled thorax, what type of sound would you expect to hear?
hyperresonant
72
What pathologies is asymmetry with diaphragmatic excursion indicative of?
Pleural effusion High diaphragm secondary to atelectasis or phrenic nerve paralysis
73
What do the A's in the ABC mnemonic for chest X-ray interpretation stand for?
Adequate/assessment of quality (position, inspiration, exposure, rotation) Airway (trachea midline, carina)
74
What does the B in the ABC mnemonic for chest X-Ray interpretation stand for?
Bones and soft tissues (osteopenia/osteoporosis, fractures/metastatic lesions, subcutaneous emphysema)
75
What does the C in the ABC mnemonic for chest X-Ray interpretation stand for?
Cardiac size, valves (normal \<50% of chest diameter of PA films and \<60% on AP films, check for heart shape, calcifications and prosthetic valves)
76
What does the D in the ABC mnemonic for chest X-Ray interpretation stand for?
Diaphragms (round?, flat?, free airway underneath?) \*\*Flat = emphysema\*\*
77
What does the E in the ABC mnemonic for chest X-Ray interpretation stand for?
effusions/endotracheal tube (ETT)/EKG leads/wires
78
What does the F's in the ABC mnemonic for chest X-Ray interpretation stand for?
Fields and fissures (infiltrates, masses, consolidation, air bronchogram, pneumothorax, and vascular markings) Foreign body (piercings, bullet fragment, lines
79
What does the G's in the ABC mnemonic for chest X-Ray interpretation stand for?
Great vessels (aortic size and shape) Gastric bubble (nasogastric tube?)
80
What does the H in the ABC mnemonic for chest X-Ray interpretation stand for?
Hilar masses (lymphadenopathy, widening (aortic dissection), mass (don't mistake the thymus in children as a mass)
81
What does the I in the ABC mnemonic for chest X-Ray interpretation stand for?
Impression (what are your overall findings)
82
What are kissmaul respirations indicative of?
Severe metabolic acidosis -\> hyperventilation to reduce amount of CO2
83
what is lloyd's punch?
assesses costovertebral angle tenderness
84
What is pyelonephritis?
Inflammation of the kidney due to a bacterial infection
85
Label all
86
What pathology is indicated by the arrows and what artifact is seen in this image?
Pneumothorax on the right and EKG leads are seen here
87
What pathology is seen here?
CHF -\> some lung congestion seen due to CHF
88
What pathology is seen here?
Emphysema -\> enlarged lungs and flattened diaphragm
89
What pathology is seen here?
Pulmonary fibrosis from the use of amnioterone -\> used in heart treatment
90
What pathology is seen here?
Pleural effusion bc there is fluid on the right and it moved in the lateral decubitus view
91
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92
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93
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94
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95
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96
Level of JVP visibility gives an indication of what?
Right atrial pressure \*\*Internal jugular is better than external jugular
97
What is normal JVP?
0-9
98
What is the most common cause of an elevated JVP?
An elevated right ventricular diastolic pressure
99
What is the A wave on a JVP curve?
Right atrial contaction, Tricuspid valve open -\> coincides with S1 and precedes carotid pulsation
100
A giant A wave on a JVP curve is seen in what 5 pathologies?
Obstruction between RA and TV (right atrial myxoma) Increased pressure in RV Pulmonary hypertension Recurrent pulmonary emboi A-V dissociation (complete heart block, VT) -\> RA contracts against the closed tricuspid valve
101
What is the C wave on a JVP curve?
Backward push by closure of the tricuspid valve during isovolumetric systole and by impact of carotid artery adjacent to the JV
102
What is an X wave on a JVP curve?
Passive atrial filling and atrial relaxation. Blood flows into the RA from the cava and closure of the tricuspid valve
103
What does a steep X descent in a JVP curve indicate?
Cardiac tamponade and constrictive pericarditis
104
What is the v wave on a JVP curve?
INcreasing volume and pressure in RA when tricuspid valve is closed
105
What is a prominent V wave on a JVP curve indicative of?
Pulmonary hypertension and tricuspid valve regurgitation
106
What is a Y slope or Y descent on a JVP curve?
Open tricuspid valve and rapid RV filling in RV diastole
107
What pathology is a deep Y descent on a JVP curve indicative of?
Severe tricuspid regurgitation
108
What pathology does a slow Y descent in a JVP curve indicate?
Obstruction to RV filling (tricuspid stenosis or RA myxoma)
109
Increased JVP is seen in what 4 pathologies?
SVC obstruction Severe heart failure Constrictive pericarditis, cardiac tamponade, RV infarction Restrictive cardiomyopathy

COM: PCMI (15 decks)

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