Test 2: Heart & lungs Flashcards
(201 cards)
1
Q
hyperresonance of lungs can be heard in
A
asthma and COPD
2
Q
soft and low pitched; inspiratory sounds that last longer than expiratory sounds without pause
A
vesicular breath sounds
3
Q
inspiratory and expiratory sounds are about equal; heard often in the 1st and 2nd interspaces and b/t scapula
A
bronchovesicular breath sounds
4
Q
loud expiratory sounds last longer than inspiratory sound with a short silence between.
A
bronchial breath sounds
5
Q
discontinuous breath sounds
A
crackles or rales
6
Q
continuous breath sounds
A
wheezes or rhonchi
7
Q
discontinous, soft, high-pitched, and very brief breath sounds. Popping that sounds like wood in fireplace.
A
fine crackles
8
Q
discontinuous, brief, popping breath sounds. Most common during inspiration.
A
coarse crackles
9
Q
relatively high-pitched with hissing or shrill quality. mostly heard on expiration
A
wheezes
10
Q
when “ee” sounds like “a” that suggest pneumonia
A
egophony
11
Q
longer forced expiratory time is seen with
A
COPD
12
Q
creaking or grating sounds that have been described as being similar to walking on fresh snow
A
pleural rub
13
Q
continuous, low pitched sounds with a gurgling, snoring or rattle-like quality. More common during expiration.
A
rhonchi
14
Q
an S3 gallop indicates
A
a change in ventricular compliance
15
Q
mitral valve opens and rapid ventricular filling as blood flows early in diastole from atria into ventricle.
A
S3
16
Q
S4 relates to a
A
stiff ventricle and atrial contraction
17
Q
Stage I hypertension is
A
140-159/90-99mmHg
18
Q
Stage II hypertension is
A
> 160/100
19
Q
Prehypertension
A
129-139/80-89 mmHg
20
Q
the carotid upstroke always occurs
A
in systole after S1
21
Q
sounds or murmur coinciding with the carotid upstroke are
A
systolic
22
Q
sounds or murmurs coinciding after the carotid upstroke are
A
diastolic
23
Q
how to detect mitral stenosis
A
patient in left lateral decubitus and listen to apical pulse with bell of stethescope.
24
Q
how to detect aortic murmurs
A
ask the patient to lean forward, exhale, and hold breath. listen with diaphragm from left sternal border to apex.
25
aortic regurgitation is heard at
2nd - 4th left interspaces
26
timing of aortic regurgitation
early diastolic
27
quality of aortic regurgitation
descrescendo, blowing, high pitched
28
aortic regurgitation can cause
left ventricular hypertrophy
29
heard in the right 2nd interspace that radiates to the carotids
aortic stenosis
30
timing of aortic stenosis
mid systolic murmur
31
quality of aortic stenosis
harsh sounding, crescendo-decrescendo heard higher at apex
32
aortic stenosis murmur is heard best when
patient is leaning forward
33
aortic stenosis is heard mostly in
elderly patients
34
tricuspid regurgitation is best heard over
lower left sternal border over xiphoid
35
timing of tricuspid regurgitation
holosystolic
36
quality of tricuspid regurgitation
blowing, increases intensity during inspiration,
37
tricuspid stenosis is best heard at
4th-5th ICS left of sternal border
38
timing of tricuspid stenosis
diastolic
39
quality of tricuspid stenosis
descrescendo, soft, and low-pitched
40
murmur usually associated with rheumatic fever
mitral and tricuspid stenosis
41
tricuspid stenosis increases in intensity by
exercise, inspiration, sitting forward
42
consider atbx prophylaxis prior to dentist appts for pateints with
tricuspid stenosis
43
group most associated with tricuspid stenosis
children, pregnancy
44
pulmonic valve regurgitation is heard best at
2nd ICS at left sternal border and radiates to apex
45
timing of pulmonic valve regurgitation
diastolic
46
quality of pulmonic valve regurgitation
High-pitched decrescendo murmur
47
most common causes of pulmonic valve regurgitation
pulmonary HTN or tetrology of fallot
48
pulmonic valve regurgitation is usually
asymptomatic
49
pulmonic valve stenosis is best heard at
2nd and 3rd left ICS
50
timing of pulmonic valve stenosis
midsystolic to late systolic
51
quality of pulmonic valve stenosis
harsh, crescendo-decrescendo
52
pulmonic valve stenosis usually found in
children-congenital
53
VSD is heard best at
4th left ICS
54
timing of VSD
holosystolic (throughout s1 and s2)
55
quality of VSD
harsh and loud with thrill
56
venous hum is due to the rush of blood from the _____ to the ____
jugular veins, superior vena cava
57
in venous hum, this is louder
diastole
58
location of venous hum
under the medial third of right clavicle
59
continuous murmur without a silent interval
venous hum
60
Described as a humming, roaring, low-pitched sound best heard with the bell.
venous hum
61
age group most affected by venous hum
children
62
innocent murmur caused by low-frequency vibrations generated by normal pulmonary valve leaflets during systole or periodic vibrations generated by a left ventricular false tendon.
stills murmur
63
stills murmur heard best at
2nd to 4th left ICS
64
timing of stills murmur
early and mid systolic
65
quality of stills murmur
musical
66
linked with a remarkably rapid ejection of blood from the left ventricle during systole
hypertrophic obstructive cardiomyopathy (HOCM)
67
HOCM best heard at
lower left sternal border
68
timing of HOCM
late systolic
69
Typically develops during a puberty growth spurt as an adolescent
HOCM
70
timing of coarctation of aorta
continous
71
congenital narrowing of aorta
coarctation of aorta
72
Patent ductus arteriosis is caused by
failure of closure of hole that connects pulmonary artery and aorta
73
assessment of PDA reveals
bounding pulses
74
timing of PDA
continuous
75
higher risk of PDA with
premature infants
76
grade of murmur that is loud with thrill
Grade 4
77
grade of murmur where it is audible without a stethoscope and thrill is palpable
grade 6
78
risk factors for PE
age > 60, pulmonary HTN, CHF, lung disease, stroke, cancer, trauma, DVT, oral contraceptives
79
s/s of PE
pleuritic chest pain, hemoptysis, dyspnea, pleural friction rub, fever
80
virchow's triad with DVT
venous stasis, hypercoagulability, endothelial injury.
81
sharp tearing chest pain with pain radiating to ipsilateral shoulder,
pneumothorax
82
pneumothorax will have ___ tactile fremitus and _____ of lungs
decreased; hyperresonance
83
tracheal shift seen in
pneumothorax, pleural effusion, atelectasis
84
in pneumothorax, the trachea is deviated toward the _____ during exhalation and toward the _____ during inhalation.
opposite side; the side of pneumothroax
85
s/s of croup
barking cough, stridor, hoarseness
86
cause of croup
parainfluenza type 1
87
AP radiograph reveals this with croup
steeple or thumb sign
88
in COPD there is ____ tactile fremitus and _____ lungs
decreased; hyperresonance
89
s/s of COPD
cough worse in morning, increased sputum, barrel chest, fatigue
90
asthma is characterized as
reversible airway obstruction, inflammation, and airway hyperresonsiveness.
91
GERD can be a risk factor for
asthma, acute bronchitis
92
hallmark of asthma is
coughing at night
93
children with asthma have respirations that are
slow and deep
94
bacterial causes of PNA
Mycoplasma, Streptococcus, Haemophilus influenza
95
incubation period for Mycoplasma pneumonia
21 days
96
s/s of PNA in adults
pleuritic chest pain, dyspnea, green sputum, fever, chills
97
this is usually absent in elderly with PNA
fever
98
these conditions increase tactile fremitus
PNA, HF, and tumors
99
trx for outpatient with bacterial PNA
macrolide (azithromycin or clarithromycin)
100
PNA in children is mostly caused by
RSV, adenovirus, parainfluenza
101
3 clinical findings with acute COPD exacerbation
worsening dyspnea, increased sputum purulence, and increased sputum production
102
causes of acute bronchitis
adenovirus, rhinovirus, influenza A&B, parainfluenza
103
s/s of acute bronchitis
rhonchi on expiration, hacking cough, low-grade fever, burning chest
104
in acute bronchitis, the chest xray is
normal
105
avoid this with bronchitis
antihistamines and decongestants
106
typical trx for acute bronchitis
cough suppressants
107
chronic bronchitis is the production of sputum for at least
3 months for 2 years
108
chronic bronchitis is usually
irreversible and progressive
109
secondary polycythemia is seen with
chronic bronchitis
110
In chronic bronchitis, the FEV1/FVC ratio is
< 70%
111
bronchiolitis is an infection of lower respiratory tract caused by
RSV
112
risk factor for bronchiolitis
daycare centers
113
This commonly accompanies bronchiolitis
otitis media
114
S/S of bronchiolitis
URI for 1-3 days, fever, cough, crackles, purulent rhinorrhea
115
s/s of TB
night sweats, hemoptysis, brassy cough
116
PPD can cause a false negative with
steroid use
117
positive PPD test for a regular person is induration greater than
15 mm
118
positive PPD test for immigrant, healthcare worker, or drug user is when induration is greater than
10 mm
119
in sputum smear, this suggests TB
acid-fast bacilli (AFB)
120
monitoring this when on TB meds
LFTs
121
in adults, a URI is viral when there is a
temp less than 101, small amounts of clear-yellow sputum, nasal congesiton, malaise
122
In adults, a URI is bacterial when there is
temp greater than 101, chest pain, purulent sputum
123
in children, a bacterial URI is when there is
fever, loss of appetite
124
often people with GERD are
smokers, overuse alcohol, and are overweight
125
inflammation of the pleural lining of the lung after a URI
pleurisy
126
pain with pleurisy is lessened when
lying on the affected side
127
pericarditis pain is described as
sharp, stabbing pain that radiates to left shoulder
128
in pericarditis, pain is worse when
supine or sitting, better when sitting forward
129
labs indicative of pericarditis
elevated WBC and ESR and ST elevation
130
s/s of aortic aneurysm
diaphoresis, hypotension, asymmetrial pulses & BP
131
size of aortic aneurysm
aortic diameter > 3 mm
132
meds that can cause syncope
antidepressants, antiarrhythmics, beta blockers, diuretics
133
diagnostic tests for syncope
carotid ascultation, Holter monitor, stress test, ECG, tilt table test
134
normal ABI
0.90-1.30
135
severe PAD
< 0.39
136
s/s of PAD
claudication, no hair on legs, thick toenails, cool extremities
137
in PAD, the legs feel better when ____ and feel worse when _____
dependent; elevated
138
gold standard for diagnosing PAD
contrast angiography
139
varicose veins are when veins are
incompetent and allow reverse blood flow.
140
venous ulcers appear more on
lateral ankle
141
ulcer borders are irregular, flat, and painful
venous ulcers
142
arterial ulcers appear more on
toes and feet
143
gangrene may be associated with
arterial ulcers
144
murmurs that can be best heard with a bell
tricuspid and mitral stenosis
145
rumbing sounds are with these murmurs
tricuspid and mitral stenosis
146
S3 and S4 are heard when patient has
heart failure
147
best to hear S3 and S4 when
using bell and patient in left lateral recumbent
148
ways to identify murmurs
timing, location, radiation, intensity, pitch, quality
149
timing of mitral valve prolapse
late systolic
150
three heart sounds of pericardial friction rub
atrial systole, ventricular systole, and ventricular diastole
151
location for pericardial friction rub
3rd ICS to left of sternum
152
when you hear a pediatric murmur, next step is to
check H&H
153
Class I heart failure
physical activity does not cause symptoms
154
class II HF
slight limitations with physical activity
155
Class III HF
symptoms with less than ordinary activity
156
Class IV HF
symptoms at rest
157
GOLD 1
FEV1 > 80%
158
GOLD 2
FEV1 50-80%
159
GOLD 3
FEV1 30-50%
160
GOLD 4
FEV1 <30%
161
gold standard for diagnosing COPD
spirometry
162
3 measurements of spirometry
FVC, FEV1, ratio
163
the amount of air that can be taken into the lungs.
forced vital capacity (FVC)
164
reveals how freely the air moves within the lungs.
forced expiratory volume in one second (FEV1)
165
when to give pna shots
> 65, prevnar 13 then pneumovax 23 6-12 months later
166
components of intermittent asthma
symptoms < 2days/week, nighttime awakenings <2x/week
167
components of mild persistent asthma
symptoms > 2days/week, nighttime awakenings 3-4x/month, SABA use >2x/week
168
components of moderate persistent asthma
symptoms daily, nighttime awakenings >1x/week, SABA use daily
169
components of severe persistent asthma
symptoms throughout day, nighttime awakenings 7x/week, SABA use several times/day
170
lung function for severe persistent asthma
FEV1 <60%
171
problem with SCDS
they prevent but don't treat existing DVT
172
activity with DVT
ambulate ASAP
173
compression stockings with DVT
put on before getting out of bed, start after anticoagulation therapy
174
when patient with DVT should be hospitalized
high bleeding risk, iliofemoral DVT, renal failure
175
S1 is louder than S2 at the
apex
176
S2 is louder than S1 at the
base
177
maneuver to listen for HOCM
valsalva maneuver increases intensity, squatting decreases intensity
178
helpful acronym to listen for S3
kentucky
179
helpful acronym to listen for S4
tennessee
180
a stiffening of aortic valve d/t aging
aortic sclerosis
181
mitral regurgitation location
apex and can radiate to left axilla
182
opening snap occurs in
mitral stenosis
183
superficial thrombophlebitis occurs mostly in
saphenous vein
184
s/s of renal artery disease
HTN < 30, malignant HTN, worsening renal function after use of ACE or ARB
185
trendelenberg test for PVD
elevate leg 90 degrees, compress saphenous vein and ask pt to stand up. If blood flow quickly then valves are incompetent.
186
raynaud's disease
episodic spasm of small arteries and arterioles
187
things that aggravate raynaud's disease
cold, emotional upset, smokinG
188
BNP value that indicates HF
> 100
189
D-Dimer for DVT is
highly sensitive but not specific
190
exercise training for PAD
exercise, stop when hurting, then start again when relieved.
191
test that is more sensitive and rapidly responding indicator of ESR.
CRP
192
CRP correlates with these levels
CKMB
193
failure of CRP to normalize may indicate
damage to heart tissue.
194
CRP levels are not elevated in patients with
angina
195
CRP may be a stronger predictor of cardiovascular events than
LDL
196
preferred study to diagnose PE
CT angiography
197
ESR can detect
MI and severe anemia
198
In HF, the ECG may show this which indicates loss of viable myocardium
Q waves
199
BP goal for those >60 who don't have diabetes or CKD.
150/90
200
BP goal for patients 18 to 59 years of age without major comorbidities, and in patients 60 years of age or older who have diabetes or chronic kidney disease.
140/90
201
hypertensive therapy for blacks
CCB and thiazide
