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PCM1 > PCM1 F > Flashcards

PCM1 F Flashcards

1
Q

how to straighten ear canal in adults? children?

A

pull up, out, posterior

pull down, out, posterior

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2
Q

appearance of normal tympanic membrane

A

translucent and pearly

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3
Q

conductive hearing loss

A

external/middle ear problem (conductive phase)

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4
Q

sensorineural hearing loss

A

inner ear, cochlear nerve, or central brain connection problem (sensorineural phase)

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5
Q

whisper test

A

whisper combination of 3 #s/letters (3/6 = normal)

also can rub fingers near one ear at a time and allow patient to tell examiner which ear they hear it from

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6
Q

weber test

A

tests for lateralization of hearing - tuning fork on top of head and if sound lateralizes to one ear = +

+ -> conduction loss in that ear or sensorineural loss in opposite ear

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7
Q

rinne test

A

compairs air/bone conduction - tuning fork placed on mastoid bone and once not heard it is removed and placed close to ear canal to see if they can hear

normal: AC>BC
abnormal: AC=BC or BC>AC (conductive hearing loss)

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8
Q

weber/rinne results

A

weber abnormal/rinne normal = sensorineural loss in opposite ear

rinne abnormal = conductive loss to that ear

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9
Q

where to palpate sinuses

A

frontal - under bony brows (ages 8+)

maxillary - press up on cheeks

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10
Q

strep throat vs pharyngitis

A

pharyngitis = swelling

strep = pharyngitis w/ white/yellow patches on tonsils and tiny red hemorrhages on soft palate

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11
Q

why can nausea be a Sx of UR issues?

A

pharynx right next to abdominal organs on the homonucleus sensory map

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12
Q

highest likelihood for GABHS (strep) if:

A 
5-15 y/o
winter/early spring
no cough
tender anterior cervical lymphadenopathy 
tonsillar exudate
fever
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13
Q

centor score?

A

strep vs pharyngitis evauluation

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14
Q

outer/middle/inner ear infections

A

outer (external) - otitis externa

middle (behind eardrum) - acute otitis media (AOM)

inner - labryinthitis

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15
Q

OM w/ effusion (serous OM)

A

inflammation of fluid in middle ear w/o bacterial/viral infection (unlike AOM)

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16
Q

suppurative OM

A

OM w/ purulent material in middle ear

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17
Q

chronic OM w/ effusion

A

fluid remains and continues to return w/o infection making Pt susceptible to new infections and may effect hearing (>6 weeks)

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18
Q

chronic suppurative OM

A

persistent ear infection that often tears/perforates eardrum (>6 weeks)

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19
Q

otitis externa

A

bacteria enter small break in skin of canal, Pts report drainage from canal and pain w/ touch

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20
Q

otosclerosis

A

abnormal bone growth around stapes

Sx: hearing loss in middle age

  • conductive - ossicle sclerosis, immovable mass
  • sensory - otic capsule sclerosis
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21
Q

causes of conductive hearing loss

A

obstruction, lack of ossicle movement, middle ear fluid

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22
Q

causes of sensorineural hearing loss

A

hereditary, meniere disease, MS, trauma, ototoxic drugs, barotrauma

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23
Q

sinusitis

A

mucosal lining of sinuses/nasal cavity inflammation due to virus/bacteria

Sx: nasal discharge, cough, sneeze, congestion, fever, headache, pain, facial pressure
Tx: corticosteroids (flonase), nasal saline, etc

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24
Q

signs of bacterial sinusitis

A

double sickening - initially gets better then gets worse, purulent rhinorrhea, elevated ESR (from infection)

Tx: amoxicillin, augmentin

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25
Q

Croup

A

Laryngotracheitis due to viral infection in children 6 mos to 3 yrs old

Sx: barking cough, fever, nasal flaring, respiratory retractions, stridor
Tx: oxygen, dexamethasone, epi

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26
Q

epiglottitis

A

due to influenza/strep

Sx: rapid onset, sore thoat, muffled voice, drooling, fever, sitting/learning forward
Tx: must protect airway

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27
Q

vertigo

A

dizziness due to:

  • eustachian tube dysfunction (inflamed tube)
  • benign paroxysmal vertigo
  • vestibular neuritis (nerve inflammation)
  • labyrinthitis
  • meniere’s disease
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28
Q

inspection of chest/neck in URE?

A

lung disorders = sit forward w/ shoulders elevated

neck - SCM contraction

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29
Q

tactile fremitus

A

vibrations, Pt says (99 or 1-1-1)

  • decreased = COPD, effusions, fibrosis, pneumothorax, thick chest wall, tumor
  • increased = pneumonia
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30
Q

diaphragmatic excursion

A

change in level of diaphragm w/ inspiration/expiration

mark spot of full exhale then spot of full inhale

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31
Q

vesicular breathing sounds

A

over lesser bronchi, bronchioles, lobes; heard over most of the chest

soft/low, heard over most of lungs through all inspiration and 1/3 expiration

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32
Q

bronchovesicular breathing sounds

A

main bronchi, heard over 1-2 intercostal spaces

intermediate pitch/volume, equal in insp/exp

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33
Q

bronchial breathing sounds

A

distal trachea, heard over manubrium

loud and high pitched, heard longer in expiration

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34
Q

+ egophany lung test

A

3x likelihood of pneumonia

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35
Q

hypopnea/hyperpnea

A

hypopnea = bradypnea + shallow breathing

hyperpnea = tachypnea + deep breathing

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36
Q

hypoxia/hypoxemia

A

hypoxia = low O2 to tissues

hypoxemia = low O2 in arteries

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37
Q

atelectasis

A

collapse of lung tissue decreasing lung volume and affecting alveoli O2 absorption

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38
Q

needle thoracentesis space

A

2nd IC space at mid clavicular line

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39
Q

chest tube space

A

4-5 IC space at just anterior to mid-axillary line

5 IC space below nipple

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40
Q

pulse oximetry

A

measures peripheral arteriole O2 sat

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41
Q

end tidal CO2

A

concentration of CO2 at end of exhalation

measures ventilation, corresponds to PaCO2

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42
Q

common cause of post-surgery fever

A

atelectasis

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43
Q

tripoding?

A

Pt leaning forward w/ hands on knees and shoulders up to help them breath

44
Q

pectus excavatum

A

depression in lower sternum, can compress heart/vessels and cause mumurs

45
Q

pectus carinatum

A

anterior sternum

46
Q

barrel chest? seen in?

A

increased AP diameter of chest

COPD, normal in infants

47
Q

pink vs blue coloration?

A

pink = emphysema

  • often older, thin
  • enlargement/destruction of airspaces terminal to distal bronchiole
  • dyspnea, quiet chest

blue = chronic bronchitis

  • overweight, cyanotic, smokers, edema
  • wheezing
  • elevated Hb
48
Q

flail chest

A

rib fractures -> paradoxical movements of thorax in breathing

49
Q

hyperresonance heard in

A

COPD, asthma

50
Q

unilateral hyperresonance herad in

A

pneumothorax

51
Q

dullness replacing resonance suggests

A

hemothorax, emphysema, tumor

52
Q

bronchophony

A

spoken words louder in ausc

53
Q

whispered pectoriloquy

A

whispered words louder in ausc

54
Q

egophony

A

EE sounds like A in ausc

55
Q

CTAB?

A

lungs clear, auscultated bilaterally

56
Q

normal RR

A

12-20

57
Q

thoracic expansion test

A

thumbs at 10th ribs level and watch movement during deep inhalation

58
Q

adventitious breath sounds

A

added breath sounds

-stridor, wheezes, rhonchi (low wheezes), crackles (rales)

59
Q

absent or decreased breath sounds suggests

A

unilateral = pneumothorax, hemothorax/effusion

bilateral = COPD, asthma

60
Q

stridor common in

A

croup, epiglottitis, foreign body, anaphylaxis

61
Q

wheezing common in

A

RAD, asthma, COPD

62
Q

crackles common in

A

pneumonia, CHF, atelectasis, PF, bronchiectasis, COPD, asthma

63
Q

pertussis vs croup cough

A

pertussis - whoop

croup - bark

64
Q

SOB/cough -> what vitals needed

A

pulse oximetry

end tidal CO2

65
Q

five finger method of CV exams

A 
history (HPI, FH)
physical (inspect, palpate, perc/ausc, JVP)
ECG
imaging 
lab
66
Q

angle of louis?

A

sternal angle, 2nd rib joins sternum here

67
Q

where to find PMI

A

upright - 5th ICS, 1 cm medial to MCL

supine at 45 degrees - 4-5th ICS at MCL

68
Q

thrills

A

turbulent blood flow causing murmurs

69
Q

aortic valve sound location

A

2nd ICS at RSB

70
Q

pulmonic valve sound location

A

2nd ICS at LSB

71
Q

tricuspid valve sound location

A

4th ICS at LSB

72
Q

mitral valve sound location

A

5th ICS at LMCL

73
Q

carotid auscultation

A

checks for bruits (turbulent flow)

74
Q

cardiac sound 1

A

“lub” due to bicuspid/tricuspid (L/R) closure, beginning of systole

loudest at apex

75
Q

cardiac sound 2

A

“dub” due to aortic and pulmonic closure, beginning of diastole

loudest at base

76
Q

physiologic splitting of cardiac sound 2

A

normal - occurs during inspiration b/c of increased venous return and more time for RV to deliver blood to lung (delayed pulmonic valve closure)

77
Q

cardiac sound 3

A

“Ken-Tuck-Y” due to Influx of blood during filling phase

normal in children/young adults

78
Q

cardiac sound 4

A

“Ten-Nes-See” due to atrial contraction, high P filling

normal in trained athletes

79
Q

murmur grading

A 
1 - barely audible
2- soft but easily heard 
3- loud w/o thrill
4- loud w/ thrill
5- loud w/ minimal contact b/w steth/chest + thrill
6- loud w/o stheth + thrill
80
Q

JVP/JVD

A

level of jugular vein visibility gives indications of CVP/RAP

IJ better estimate than EJ

81
Q

how to measure JVP

A

Pt supine, allow veins to engorge, then raise to 30-45 degrees and measure from JVP to sternal notch to RV

normal = 0-9 cm

82
Q

common causes of elevated JVP

A 
elevated RV diastolic P (top cause)
SVC obstruction 
heart failure
pericarditis, tamponade, RV infarction
restrictive cardiomyopathy
83
Q

artery vs vein waveform

A

vein varies, has A-C-V waveforms

artery constant, one single waveform

84
Q

pulses rating scale

A 
0 - absent
1 - barely palpable
2 - average
3 - stronger than average
4 - bounding
85
Q

normal cap refill time

A

< 2 secs

86
Q

edema rating scale

A 
0 - absent
1 - barely detectable, non-pitting
2 - slight indentation (4mm); 10-15 secs
3 - deeper indentation (6mm); can be >1 min
4 - marked indentation (8mm); 2-5 mins
87
Q

steps in CVE

A

inspect
palpate (PMI)
percuss (if cant find PMI)
auscultate

88
Q

allen test

A

occlude RA/UA while Pt makes a fist, release UA and observe for color return within 5-10 secs and repeated w/ RA

lack of dual supply = cant do radial catheter

89
Q

PR interval corresponds to

A

atrial diastole

90
Q

QRS/ST segment corresponds to

A

ventricular systole/late ventricular systole

91
Q

T wave corresponds to

A

ventricular diastole

92
Q

auscultation acronym

A

All (aortic)
Physicians (pulm)
Take (tricuspid)
Money (mitral)

93
Q

innocent murmurs

A 
grade < 2
softer when patient is sitting compared to supine
short systolic duration
minimal radiation
musical or vibratory quality
94
Q

causes of ventricular systole murmur

A

aortic/pulmonic stenosis

AV regurgitation

95
Q

causes of atrial systole murmur

A

bi/tri stenosis

A/P regurgitation

96
Q

what makes murmurs loud/soft

A

R louder in inspriation (RInspriation)(T/P)

L louder in experiation (LExpiration)(M/A)

increased preload = louder
decreased preload = softer

97
Q

exceptions to preload murmur rule

A

Hypertrophic Cardiomyopathy (HOCM) - increase in preload improves mumur

Mitral Valve Prolapse (MVP) - increase in preload improves click

98
Q

afterload effect on murmurs

A

increased = louder

besides w/ HOCM/MVP (increased = softer/decreased = louder)

99
Q

Crescendo-Decrescendo mumur

A

aortic stenosis

radiates up to carotids

100
Q

Rheu-mitral murmur

A

mitral regurgitation

radiates to axilla, best heard at apex

TRI some drugs

101
Q

tricuspid regurgitation often seen w/

A

history of IVDA (IV drugs)

102
Q

early blowing diastolic murmur

A

aortic regurgitation

Ct disorders, Marfan’s

AR there she BLOWS

103
Q

opening snap murmur

A

mitral stenosis

history of rheumatic fever

OS is MS

104
Q

HOCM

A

FH of sudden CV death at young age

murmur louder w/ decreased preload/afterload
murmur softer w/ increased preload/afterload

105
Q

MVP

A

midsystolic click

often young women w/ psych history or history of myxomatous valvular disease

PCM1 (2 decks)

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