H and P Exam II flascards.txt

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H and P Exam II flascards.txt
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  1. If you have an absent "x" decent and a prominent "v" wave you most likely have what?
    severe tricuspid regurgitation
  2. Name 2 conditions that cuase intermittent or prominent "a" waves (aka Cannon A waves)
    Atrial ventricular dissociation (complete heart block), Ventricular tachycardia
  3. Name 2 things that cuae absent "a" waves
    Atrial fibrillation and junctional or ventricular rhythms
  4. what are some disease processes that cause an increased "a" wave?
    Decreased ventricular compliance (right ventricular hypertrophy, pulmonary valve stenosis, COPD with pulmonary hypertension, restrictive cardiomyopathy), Tricuspid stenosis
  5. An increased "a" wave indicates what? (physiologically)
    that there is an increased resistance to right atrial emptying which could be due to decreased right ventricular compliance; for example tricuspid stenosis
  6. An "a" wave immediatly preceeds what heart sound in diastole?
    S1
  7. An "a" wave corresponts to ____
    atrial contraction
  8. How many cm to you add to JVP to accuratly reflect the distance to the right atrium?
    5cm
  9. A normal JVP should be ___cm
    less than 9cm
  10. Conditions that lower right atrial pressure (1)
    Dehydration
  11. Conditions that elevate right atrial pressured (4)
    Heart failure, tricuspid valve stenosis, pulmonic stenosis, pericardial disease
  12. Which ventricle sits most anterior to the sternum?
    Right ventricle
  13. Femoral inguinal lymph nodes drain what structures?
    abdominal cavity, lower extremity and genital tract (chlamydia is a big lyphadenopathy culpret in these nodes)
  14. When you have a hypovolemic patient who you want to measure JVD on you __ the head of the bed
    Lower the head of the bed
  15. When you have a hypervolemic patient who you want to measure JVD you ___ the head of the bed
    Elevate
  16. JVD levels above 9 cm reflect what in the right atria?
    increase in volume of the right atria which can be due to heart failure, tricuspid valve disases, pulmonic stenosis, pericardial disease
  17. Right atrial pressure during diastole should be __
    zERO
  18. What conditions increase the pressure in the right atria?
    Heart failure, Tricuspid valve disease, pulmonic stenosis, pericardial disease
  19. What conditions decrease the righ atrial pressure>?
    Dehydration
  20. An "a" wave corresponds to what in the heart cycle?
    atrial contraction
  21. "a" waves come immediatly before what part of the cardiac cycle?
    S1
  22. Increased "a" waves indicate what is happening in the right atria?
    there is increased resistance to emptying of the right atria, this is usually due to decresed right ventricular compliance or tricuspid stenosis
  23. What are some pathologica causes of increased "a" waves?
    right ventricular hypertrophy, pulmonary valve stenosis, chronic obstructive pulmnoary disease with associated pumonary hypertnesion, restrictive cardiomyopathy, tricuspid stenosis
  24. Absent "a" waves are caused by what?
    atrial fibrillation, Jugular/ventricular rhythms
  25. Intermittent or prominent "a" waves or "cannon a" are caused by what?
    • atrial ventricular dissociation
    • ventricular tachycardia
  26. An "x" decent corresponts to what?
    atrial relaxation
  27. A prominent "x" decent is due to what pathologies? (3)
    • constrictive pericarditis
    • restrictive pericarditis
    • pericardial tamponade
  28. Decreased or absent "x" decent is due to what pathologies?
    • severe tricuspid regurgitation
    • Atrial fibrillation
  29. the "C" wave represents what?
    bulging of the tricuspid valve during systolic contraction it may or may not be seen in every patient
  30. the "v" wave represents what?
    increased atrial pressure as venous return increases after systole
  31. What pathology can produce a prominent "V" wave?
    severe tricuspid regurgitation
  32. What is Kussmaul's sign?
    A jugular venous pressure that rises with inspiration
  33. What does a "y" decent represent?
    the reduced pressure observed with tricuspid valve opening and atrial emptying during diastole
  34. What causes a prominent or rapid y decent?
    • constrictive pericarditis
    • restrictive cardiomyopathy
    • RV infarctions
    • ASD
    • Tricuspid Regurgitation
  35. What causes a slow y decent?
    tricuspid stenosis
  36. What causes an absent y decent?
    pericardial tamponade
  37. why does JVD normally fall with inspiration?
    the reduced pressure from the expanding thoracic cavity
  38. What does kussmaul's sign indicate?
    impairment of filling of the right ventricle due to either fluid in the pericardial space or a poorly compliant myocardium or pericardium
  39. What happpens in a positive hepatojugular reflex?
    pressing on the liver augments the venous return to the right atrium with a right sided heart disease process the right atrium cannot accomodate for this increased flow of blood so the JVP rises and waveforms increasein intensity
  40. How do you tell the difference between the jugular vein and the carotid?
    • They both have a pulse but the jugular has a double pulse
    • the jugular is more easily stopped/occluded
    • The pulse in the jugular is not usually as strong as the pulse in the carotid
  41. If you have a patient with heart failure and their lungs are rapidly filling with fluid what should you give them and why?
    Nitroglycerine to dialate blood vessels and promote forward flow insted of backward flow
  42. Normal carotid upstroke follows ___ and preceeds ___ which is important for the timeing of murmers
    S1, S2
  43. What is the only way to measure the pressure in the right atria and ventricles
    swann-ganz catheter
  44. Can you hear a mitral stenosis with the diaphragm?
    No, the diaphragm only hears high pitched sounds and will not be able to pick up a mitral stenosis
  45. If upon chest exam you note that the patient is very tall and thin with a wingspan greater than their height, and they have a large chest scar what underlying disease do you expect they have and what heart problems may be corrolated with that?
    Stigmata of Marfan's syndrome, aortic route disese, dialation of the aortic route aortic insufficency and aortic dissection- this is due to the connective tissue imperfections that come with marfans
  46. When the sternum heaves it is a ____ ventricular problem when the sternum lifts it is a ___ ventricular problem
    Heaves- Right ventricle; Sternum lifts- left ventricle
  47. If the carotid has bruits or thrills use the ___ artery to time the cardiac cycle
    Brachial
  48. Where would you find the PMI (apical pulse)?
    5th intercostal space 1cm medial to the midclavicular line
  49. During percussion if the sternum is not the first and last dull note on the right then what is the most likely disease process?
    Right sided dialation
  50. S1 is loudest in the __ area
    mitral area
  51. S1 is loudest at the
    apex
  52. S2 is loudest in the __ area
    pulmonic area
  53. What murmurs do you hear in the Aortic space?
    aortic stenosis
  54. What murmurs do you hear in the pulmonic area?
    pulmonic insufficency, pulmonic stenosis and S2
  55. what murmurs do you hear in the tricuspid area?
  56. What murmurs do you hear in the mitral area?
    S1, S3, stenosis
  57. Where is the Tricuspid area located?
    4th intercostal space left sternal boarder
  58. Where is th mitral area located?
    5th intercostal space mid clavicular line
  59. What two areas have murmurs that are heard more clearly with the diaphragm?
    Aortic space, pulmonic area
  60. In what two areas is it crucial to listen for murmurs with the bell?
    Tricuspid and Mitral stenosis is a low sound is only heard with bell
  61. True or false aortic stenosis can radiate sound to the neck
    true
  62. What is the only murmur found in the aortic space?
    Aortic stenosis
  63. Where is the Aortic space?
    second intercostal right sternal boarder (below the sternal notch)
  64. Where is the pulmonic area?
    second intercostal space left sternal boarder
  65. What murmurs/heart sounds do you hear in the pulmonic area?
    pulmonic insufficency, pulmonic stenosis, S2
  66. What murmurs do you hear in the Tricuspid area?
    tricuspid insufficency, tricuspid stenosis,
  67. Where is the tricuspid area?
    4th intercostal left sternal boarder
  68. Where is the mitral area?
    5th intercostal mid clavicular line
  69. what murmurs do you hear in the mitral area?
    mitral stenosis, mitral insufficency, S1,S3, S4
  70. where is Erbs point?
    3rd intercostal left sternal boarder
  71. What murmurs do you hear at Erbs point?
    Aortic insufficency, Hypertrophic cardiomyopathy, VSD, ASD
  72. What is a fixed splitting of S1 S2?
    ASD!!!
  73. When percussing what are the boarders of the heart?
    left anterior axillary line in the 3rd, 4th, 5th and 6th IC spaces and boarder should be the sternum on the right
  74. How would you possition a patient to listen to a diastolic murmur?
    • Have the patient sitting
    • put your stethoscope in the third intercostal space on the left sternal boarder
    • have the patient lean forward and exhale fully
  75. Where do you listen to a splitting of the S2 heart sound?
    2nd intercostal space left sternal boarder(pulmonic area)
  76. Where do you listen for Gallops?
    Mitral area 5th intercostal space mid axillary in the left lateral decubitus possition
  77. An S1 sound that is greater than the S2 sound can be caused by what?
    Tachycardia, Short PR interval, High output, MS
  78. A S2 sound that is greater than an S1 sound can be caused by what?
    1st degree AV heart block, Mitral regurgitation, CHF, ischemia
  79. A varying S1 sound can be caused by what?
    complete heart block, Afib
  80. What causes a split S1 heart sound?
    RBBB, PVC
  81. What organs are found in the RUQ?
    part of the pancrease, liver, gall baldder, kidney, adrenal gland, colon, pylorus, duodenum, portiosn of the ascending and transverse colon
  82. What organs are found in the RLQ?
    lower pole of the right kidney, cecum and appendix, portions of the ascending colon, right ovary and tube (if uterus is enlarged), right ureter (bladder if distended)
  83. What organs are found in the LUQ?
    • left lobe of liver
    • spleen
    • stomach
    • body of pancrease
    • left adrenal gland and upper aspect of the left kidney
    • splenic flexure of colon
    • portion of the transverse and decending colon
  84. What organs are found in the LLQ?
    • lower pole of the left kidney
    • sigmoid colon
    • portion of descending colon
    • left ureter (bladder if distended)
    • left ovary and tube (uterus if enlarged)
  85. What are some pathologies found in the Left upper quadrant?
    indigestion, gastroesophageal reflux, peptic ulcer disease, pancreatitis, splenic enlargement
  86. What is the main pathology to watch out for in the right lower quadrant?
    appendicitis
  87. what are some pathologies of the left lower quadrant?
    PCOS, menstural syndromes, ectopic pregnancies, diveraticular disease, renal lithiosis
  88. Where do the kidneys sit?
    behind the 11th and 12th rib part of it lies below the costovertebral angle
  89. Linear incision in the right lower quadrant is most likely a
    appendectomy
  90. midline linear scar over pubic symphysis is most likely a
    sessarian section
  91. contracture scars in the right upper quadrant are most likely a
    pyloric stenosis corrective surgery
  92. midline sternum to umbicular scares are what type of surgery
    laparotomy surgery
  93. What is the number one cause of small bowel obstruction?
    history of abdominal surgery
  94. Striae can be caused by
    steroids or stretches
  95. Caput medusa
    dialated veins around the umbilicus indicates liver disease
  96. Scaphoid stomach
    curves inward concave
  97. rounded stomach
    obesity
  98. flat stomach is..
    sexy!
  99. protuberant stomach is
    pregnant, acities
  100. Flanks are a good place to look for what three pathologies
    pooling blood, kidney pain, acites movement
  101. How many clicks and or gurgles should you hear in the abdomen?
    5-34
  102. How long must you listen to the abdomen before you can say that there are absent bowel sounds?
    5 minutes (book says 2 mins)
  103. Borborygmi
    • prolonged gurgles in the abdomen
    • aka hyperperistalsis
    • audible without stethescope or visible with the naked eye
  104. Do you listen to the abdomen with the bell or the diaphragm
    diaphram
  105. What are some conditions in which you deffinitly want to listen to the abdomen for aortic bruits?
    HTN, erectile dysfunction, carotid disaese, diabetics, kidney disease
  106. if you hear a bruit in the abdomen that is both systolic and diastolic what is it?
    Arterial insufficency
  107. large areas of dullness to percussion in the abdomen may indicate
    acites, mass, splenomegally, impaction
  108. dullness at flanks
    acites
  109. A protuberant belly that has increased tympany
    free air in abdomen
  110. How many cm vertically should the kidney be on percussion of an adult patient?
    6-12cm its less if you go midstenal and more if you go midaxillary
  111. an abnormally large liver can be part of portal hypertension name some conditions that cause portal hypertension
    right heart failure, tricuspid stenosis, pulsitile liver, liver disease, hepatitis, early cirrhosis, fatty liver disease
  112. If the liver is lower than normal but no increased in size what is on your differential?
    tumor in the lungs, COPD, diaphragmatic depression
  113. Percussion of the liver reveals a dender liver what are 2 disease processes that can cause this?
    hepatic inflammation, portal hypertension
  114. While you are percussing traubs space and you have the patient inhail what finding is indicative of splenomegally?
    if traubs space is displaced (if you can percuss to the axillary line then no splenomegally) or if there is dullness without inspiration in traubs space or just to the side of it
  115. What is the only test besides biopsy to tell if a patient has a kidney infection or a bad URI?
    CVA tenderness test
  116. What are some causes of visceral pain?
    organ pain, hollow organ pain, kidney stone pain,
  117. can the patient localize viceral pain?
    no
  118. The patient has tenderness with movement, pain that they can localize to the RUQ hyperasthesis, skin tenderness and rebound tenderness. does this patient have viceral or peritoneal pain?
    peritoneal
  119. Rebound tenderness indicates (peritoneal or visceral) tenderness?
    Peritoneal
  120. bleed in abdomen pain refers to
    the scapula
  121. ectopic pregnancy pain refers to
    the shoulder
  122. pancreatitis pain refers to
    the back
  123. aortic anyrism refers to
    radiating pain up the back
  124. where pain shows up when you palpate is that referred pain or the area of pathology?
    area of pathology
  125. You feel an organ on your exam in the left upper quadrant and you cant tell if its the spleen or the kidney you move upward and feel the superior aspect of the organ what do you expect it is?
    kidney
  126. you are having trouble deciding if you are feeling the kidney or the spleen the organ in question has a notch that you can sink a finger into which organ is it?
    spleen
  127. If the abdominal aorta is more than 3cm or really pulsitile what do you expect it is?
    aortic anerysim
  128. what is the gold standard for checking for aortic aneryism?
    ultrasound
  129. Central tympany tests for what?
    acites
  130. fluid wave test for what? it is a sensitive test?
    acites, no
  131. Ballottment
    a brief jab to the organ like the liver in a patient with acites the organ will shift downward then rapdily float back up in the abdominal fluid hitting your hand works on liver not spleen
  132. What is under McBurney's point?
    appendix
  133. What does rovsing's sign test for?
    appendicitis
  134. You have rebound tenderness in the left lower quadrant when pushing on the right lower quadrant this is a positive __ sign and suggests peritonitis where?
    Rovsing's sign, RLQ peritonitis ie appendicitis
  135. Psoas sign
    extention of the psoas muscle aggravates an appendicitis so if you stretch or flex the psoas then the appendix will be aggravated
  136. Obdurator sign
    tests for appendicitis, stretches the internal obdurator muscle hip rotate leg internally
  137. Cutaneous hyperethesia
    when you have pain response by just touching the skin in the area of peritoneal pain
  138. Heal tap
    tests for appendicitis can also have patient jump off the gurney
  139. Murphy's sign tests for what
    cholecystitis
  140. What is murphy's sign
    when you are palpating the liver using the hooking method and you have the patient breath in, if they stop inhailing suddenly then they may have cholecystitis
  141. what will a ventral hernia do as the patient does a crunch?
    it will sink back into the abdomen
  142. What are some things you are looking for during a rectal exam
    blood, polyps, hemmorroids, retrocecal appendix, prostate
  143. Where do you listen for illiac bruits?
    2-3 cm from the midline at the level of the belly button
  144. do you try to catch a kidney at maximum exhailation or maximum inhailation?
    maximum inhailation
  145. Where is the anterior base of the lung?
    6th rib midclavicular line to the 8th rib mid axillary line
  146. Where is the posterior base of the lung?
    T 10
  147. Where is the right oblique fissure of the lung anteriorly?
    Right 3rd anterior axillary line to the right 6th midclavicular line
  148. Where is the right horizontal fissure?
    4th rib to 5th rib mid axillary line
  149. What Spinal number separates upper from lower lobes of the lung posteriorly?
    T3
  150. Where is the left horizontal fissure located?
    there is none! the left lung has only two lobes separated by an oblique fissure
  151. Sweet or fruity breath
    diabetic ketoacicosis, starvation or positive trident fruit chew sign
  152. fishy or stale breath
    uremia
  153. ammonia breath
    uremia
  154. musty or clover breath
    hepatic failure
  155. foul or feculant breath
    gi obstruction
  156. putrid breath
    sinusitis, GABHS, abcess
  157. Cinnamon breath
    Gum or TB or mycobacterium
  158. Normal breathing is __-__ breaths per minute
    14-20
  159. Bradypnea
    • slow breathing
    • Pathology: hypothermia, cerebral issues increased intracranial pressuer, diabetic coma, drug induced respiratory infection
  160. Sighing
    Pathology: sad people, hyperventilation syndrome
  161. Obstructive breathing:
    • inspiration with prolonged expiration due to narrowed airways or increased resistance to flow
    • Pathology: asthma, COPD, chronic bronchitis
  162. Cheyne-stokes
    • periods of deep breathing alternated with periods of apnea
    • Pathology: heart failure, uremia, drug induced respiratory depression, brain damage (specifically bilateral cerebral hemisphere damage or bilateral diencephalon damage)
  163. Tachypnea-
    • rapid shallow breathing
    • Pathology: restrictive lung disease, pleuritic chest pain, elevated diaphragm
  164. Hyperpnea/hyperventilation
    • rapid deep breathing
    • pathology: exercise, anxiety, metabolic acidosis
    • in a comatose patient: infarction, hypoxia, hypoglycemia
  165. Kussmaul Breathing
    • fast normal or slow deep breathing
    • due to metabolic acidosis
  166. Ataxic breathing/biots breathing
    • unpredictable irregularity
    • Pathology: respiratory depression, brain damage
  167. Air Trapping
    • pregressive inflation of the lungs with breathing
    • pathology: COPD
  168. Pursed lips can suggest what pathology?
    emphysema
  169. A fixed and matted trachea suggests what?
    cancer
  170. Central cyanosis suggests what?
    ARDS, COPD, disseminated blood issues, congenital heart problems, cyanide poisoning
  171. peripheral cyanosis suggests what?
    asthma, peripheral artery disease, congestive heart failure, COPD
  172. Where do you look for peripheral cyanosis?
    lips eyes fingers toes
  173. Clubbing is NOT caused by what?
    COPD
  174. What causes stridor?
    obstruction, upper airway sound caused by croup epiglottitis, FB and tumors
  175. Pectus excavatum
    concave chest, displaces heart
  176. pectus caronotum
    convex chest displaces lungs
  177. Scoliosis or khyphosis
    abnormal curvatures of the spine at the thoracic level khyphosis is hyper curvature, and scoliosis is a side to side curvature
  178. What patients have Harrison's sulcus?
    patients who have COPD as a portion of their diaphragm becomes fixed
  179. Hoover's sign
    when the thumbs lift off the chest when palpating for chest expansion
  180. Increased vibration with tactile fremitus means what>?
    pneumonia or tumor some kind of consolidating solid mass
  181. Decreased vibration with tactile fremitus means what?
    increased fluid or air, indicating pulmonary edema or pneumothorax, airtrapping, etc.
  182. An increased AP ratio happens in what disese?
    COPD
  183. What causes clubbing?
    cystic fibrosis, asbestosis, fibrotic lung disease
  184. yellow fingers tell you what
    smoking history
  185. If the chest wall does not move easily with inspiration what might you have?
    disesed chest, adhesions, tumor, pneumonia
  186. If the chest wall shows unilateral expansion with inspiration...
    chronic fibrosis, pleural effusion, lobar pneumonia, pleural pain, unilateral bronchial obstruction, tension pneumothorax
  187. Asymetrical Fremitus that is increased
    unilateral pneumonia
  188. asymmetrical fremitus that is decreased
    pleural effusion, pneumothorax, neoplasm
  189. normal diaphragmatic excursion is __ to __ cm
    3-5
  190. Decreased diaphragmatic excursion occurs in
    pneumothorax, emphysema, acites, mass, pain
  191. Abnormally increased diaphragmatic excursion occurs in
    atelectasis or diaphragmatic paralysis
  192. Absent diaphragmatic excursion in
    phrenic nerve damage
  193. Flat percussion
    soft intensity sound that is high pitched and short in duration on chest is indicative of pleural effusion
  194. Dull percussion
    medium intensity sound that is medium pitched and medium duration the liver will make this sound normally but in the chest it is suggestive of fluid or solid mass in the chest replacing normal air spaces
  195. Resonant percussion
    Loud, low sound with a long duration indicative of healthy lung tissue
  196. Hyperresonant percussion
    very loud and lower tahn ressonance with a longer duration indicative of emphysema or pneumothorax
  197. Tympany
    loud high pitched nois indicating gass bubble under the area of tympany in the chest it suggests absense of lung tissue or could be the gastric bubble
  198. 579 rule
    the upper boarder of the liver is located in the 5th intercostal space midclavicular, 7th intercostal space midaxillary, and 9th intercostal space scapular line
  199. If there is no cardiac dullness then what might the patient have?
    emphysema
  200. Intrapulmonary pressure is a mean pulmonary pressure of
    • >25mmHg at rest
    • >30mmHg during exercise
    • must be confirmed with a right heart catheter!
  201. A patient presenting with dyspnea on exertion shoudl recieve what type of ultrasound?
    ultrasound of the aorta
  202. Axillary nodes are __ until proven otherwise
    cancer
  203. Vesicular sounds
    • soft low pitches breath sounds
    • heard through inspiration and continue through expiration
    • fade away at 1/3 of expiration
  204. Bronchovesicular
    • Heart in equal amounts during inspiration and expiration
    • can be separated by a silent interval
    • can be heard in the first and second interspaces anteriorly and between the scapula
  205. Bronchial
    • louder and higher pitched
    • short silence between inspiratory and expiratory
    • expiratory can last longer than inspiratory
    • can be heard over the manubrium
  206. Rhonchi
    • course lung sounds caused by increased disturbance in the normal lung fields
    • relatively low pitched snoring sound
  207. Wheezing
    • constrictive issue that is rarely found on its own
    • continurous musical prolonged like dashes in time
    • relatively high pitches with hissing or shrill quality
  208. Crackles (rales)
    distinct continuous intermittent notn musical like brief dots in time
  209. Pulmonary functioning tests
    • differentiate sfrom obstructive and restrictive lung diseases
    • FEV1 is most important in asthma and COPD pts
  210. Decreased FEV1
    Obstructive
  211. Increased FEV1
    Restrictive
  212. In right heart failure if your patient has a pressure of 25-30mmHg what would you expect to see in the lungs?
    batwings, an hear crackles/rales indicating fluid
  213. On a chest X ray A + B should be what of T?
    less than T
  214. A patient with a right heart cath pressure of 18 or over is in what?
    Heart failure
  215. Right heart pressure of 30mmHg or more =
    pink frothy sputum and death from heart failure
  216. What is the only EKG arrhythmia to stem entirely from lung pathology?
    multifocal atrial tachycardia
  217. Multifocal atrial tachycardia + Rt heart hypertrophy =
    cor pulmonale
  218. A decrease in V1 and V2 and right axis deviation=
    right ventricular hypertrophy

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