Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
28 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Which rib cannot be palpated?
|
1st rib
Question: Where is the landmark for thoracentesis? |
T7-8
Bates pg 285 |
|
|
Where is the location of the apex of the heart?
|
MCL 5th ICS
Question: which intercostal space is used for needle insertion for tension pneumothorax and insertion for chest tube? |
2nd ICS = needle insertion for tension pneumo
4th ICS = chest tube insertion |
|
|
A patient came in with a persistent sharp, knife-like pain across the chest and gets worsen when he takes a deep breath.
What are the two DD? |
1) Pericarditis
2) Pleuritic pain Question: What are the differences between pericarditis and pleuritic pain in terms of relieving factor? |
Pericarditis is relieved when sitting forward, but not pleuritic pain.
Bates pg 313 |
|
|
What is costochondritis?
|
Chest wall pain, often below the left breast or along the costal cartilages
Question: what factors aggravate the pain? |
Movement of chest, trunk, arms
Bates pg 312 |
|
|
A patient came in with a "ripping and tearing" chest pain that occurs abruptly.
What is your DD? |
Dissecting aortic aneurysm
Question: what are the associated symptoms? And what type of patients are at risk for aortic dissection? |
Syncope, hemiplegia, paraplegia
Marfan syndrome Dains pg 81 |
|
|
A patient reports persistent unilateral chest pain of pruritic, burning or stabbing quality. The pain will follow the distribution of a cervical or thoracic nerve root.
What is your DD? |
Herpes zoster.
Note: early in the course of the disease, no objective manifestations are present. Vesicular rash appears as herpes zoster progresses. |
|
|
|
A patient came in with intermittent, colicky epigastric or RUQ pain. The patient reported that the pain started after he ate lunch two hours ago, which consists of bacon and fried chicken. He tried antacids but it did not help.
What is your DD? |
Cholecystitis
Dains pg 94 Question: What kind of PE will show positive result for cholecystitis? How do you perform that PE? |
Murphy's sign
Inspiratory arrest with deep palpation of RUQ |
|
|
You suspect a patient has cholecystitis, what lab test would you order and why?
|
1) CBC - to determine leukocytosis
2) Bilirubin - to determine bile duct obstruction or liver involvement 3) Amylase - to dx pancreatitis 4) LFTs - to determine if liver is involved 5) ALP - to determine bile duct obstruction & liver involvement 6) GGT - to determine bile duct obstruction & liver involvement Hollier pg 270 Question: Where do ALP and GGT originate from? |
ALP (alkaline phosphatase) = liver and bones
GGT (Gamma glutamyl transpeptidase) = liver and bile duct |
|
|
What is tactile fremitus and how do you perform it?
|
Fremitus = palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the pt is speaking
Ask pt to repeat words of "ninety-nine" while palpating the chest. Bates pg 298 Question: what disease process show increased and decreased in fremitus? |
Increased = unilateral pneumonia (d/t consolidation)
Decreased = unilateral pleural effusion, pneumothorax, neoplasm |
|
|
What are the percussion notes and their characteristics?
|
1) Flatness = soft, high pitched (eg thigh)
2) Dullness = medium, medium pitched (eg. liver) 3) Resonance = loud, low pitched (eg healthy lung) 4) Hyperresonance = very loud, lower pitched 5) Tympany = loud and high pitched (eg gastric air bubble) Bates pg 300 Question: what disease process cause dullness, hyperresonance, and tympany? |
Dullness = lobar pneumonia, pleural effusion, hemothorax, empyema, fibrous tissue, or tumor
Hyperresonance = COPD, asthma, pneumothorax (unilateral) Tympany = large pneumothorax Note: Dullness = fluid or solid tissue Hyperresonance = hyperinflated lungs |
|
|
What are three common breath sounds and their characteristics?
|
1) Vesicular = I > E, soft, low piched
2) Broncho-vesicular = I = E, intermediate E sound, intermediate pitch 3) Bronchial = E > I, loud, high pitched Note: I = Inspiratory sounds E = expiratory sounds Bates pg 303 Question: when broncho-vesicular or bronchial sounds are heard in distant locations from medial lungs, what do you suspect? |
Fluid filled or solid lungs instead of air-filled.
Eg. Consolidation from lobar pneumonia; pulmonary edema or hemorrhage. Note: bronchial breath sounds usually correlate with an increase in tactile fremitus and transmitted voice sounds. |
|
|
What disease process cause crackles, wheezes, and rhonchi?
|
1) Crackles = pneumonia, fibrosis, early CHF, bronchitis, bronchiectasis
2) Wheezes = asthma, COPD, bronchitis (narrowed airway) 3) Rhonchi = secretions in large airways Bates pg 304. Question: Clearing of crackles, wheezes, or rhonchi after coughing or position change suggest_____? |
Inspissated secretions, as in bronchitis or atelectasis
|
|
|
What are the differences between tactile fremitius, bronchophony and egophony?
|
Tactile fremitus = "ninety-nine" while palpating the chest
Bronchophony = "ninety-nine" while ascultating the chest Egophony = "ee" is heard as "ay" while ascultating the chest (E-to-A) Bates pg 305 |
|
|
|
An 80 year old patient came in with c/o chest pain. He described the pain is aggravated with deep breaths. Upon PE, you discovered an increase in local pain while performing anteroposterior compression.
What is your DD? |
Fractured rib
Bates pg 309 Question: what dx study would you order? |
CXR
|
|
|
What is the difference between murmur and bruit?
|
Murmur = originate from the heart
Bruit = originate from the vessel Bates pg 329 Question: what are two important things to determine when you listen to a murmur? |
1) Grading of the murmur (Grade 1 to 6)
2) Physiologic vs pathologic murmur |
|
|
How do you grade murmur?
|
Grade 1 = very faint
Grade 2 = Quiet but heard immediately after place stethoscope Grade 3 = Moderately loud Grade 4 = Loud, with palpable thrill Grade 5 = Very loud, with thrill. May be heard when stethoscope is partly off the chest. Grade 6 = Very loud, with thrill. May be heard with stethoscope entirely off the chest. Bates pg 368 Question: How do you document the murmur? |
Murmur 4/6 at apical.
Note: 1) grade and 2) location |
|
|
Which chamber is the most anterior part of the heart hitting the sternum?
|
Right ventricle
Bates pg 324 Question: where is the point of maximal impulse (PMI)? |
Left ventricle
|
|
|
What are "normal" blood pressure, "pre-hypertension," and "stage 1 hypertension?"
|
Normal = < 120/80 mm Hg
Pre-hypertension = 120 to 139 mm Hg systolic; 80 to 89 mm Hg diastolic; or both Stage 1 HTN = 140 to 159 mm Hg systolic; 90 to 99 mm Hg diastolic; or both. Bates pg 340 Question: For stage 1 HTN, what class of drug can be ordered in addition to lifestyle modification? |
Thiazide diuretic
Note: Thiazide is recommended as the first line anti HTN drug. Use with caution in patients with severe renal disease and impaired hepatic function. |
|
|
Where are the locations for aortic, pulmonic, tricuspid, and mitral valves?
|
Aortic = Right 2nd ICS
Pulmonic = Left 2nd ICS Tricuspid = Right Vent = Left (sternal border) 3rd and 4th ICS Mitral = PMI (apical) = MCL 5th ICS Bates pg 356 Question: what position is best to ascultate for murmur? |
Patient lying on the left side or sitting up and leaning forward.
|
|
|
How do you determine whether a splitting is physiologic or pathologic?
|
Physiologic = normal splitting is accentuated by inspiration and disappear on expiration.
Pathologic = wide splitting persists throughout the respiratory cycle Bates pg 380 Question: What causes pathologic splitting? |
Pulmonic stenosis, RBBB, Mitral Regurgitation
|
|
|
What causes systolic clicks?
|
Mitral valve prolapse
Bates pg 381 |
|
|
|
What are innocent, physiologic, and pathologic murmurs?
|
Innocent = no physiologic or structural abnormality
Physiologic = physiologic changes in body metabolism Pathologic = structural abnormality in the heart or great vessels Bates pg 384 Question: what are the common causes of physiologic murmurs? When do you refer a patient to a cardiologist? |
Physiologic murmur causes include anemia, pregnancy, fever, and hyperthyroidism
Pathologic murmur = cardiologist referral Bates pg 385 |
|
|
You are going to palpate a patient's breast for mass and your patient reported that she has breast reconstruction done in the past. What additional question should you ask the patient?
|
Whether the implants are "upper" or "under?"
Question: How do you teach your patient to do BSE to prevent missing a potential mass? |
Palpate the whole breast including below the clavicles and near the arm pit.
Note: 75% of the breast cancer occurs above the breast. |
|
|
How can you differentiate between cysts and breast cancer?
|
Cyst = round shape
Breast CA = Irregular or stellate (shape like a star) C = soft to firm, usually elastic BCA = firm or hard C = well delineated BCA = not clearly delineated C = mobile BCA = fixed to skin or underlying tissues C = often tender BCA = nontender, painless C = no retraction signs BCA = retraction signs may present (dimpling, retraction or deviation of nipple) C = superficial BCA = deep Bates pg 413 |
|
|
|
What is the cause of edema of the skin in breast and peau d'orange (orange peel)?
|
Lymphatic blockade
Bates pg 414 |
|
|
|
What is a Paget's disease of the nipple?
|
A type of breast CA with a scaly, eczema-like lesion that may weep, crust, or erode.
Bates pg 414. |
|
|
|
A patient came in with dull pain, hyperventilation, and lasted for few minutes. Denies hx and family hx of CVD. Pt recently broke up with his spouse. All cardiac diagnostic tests were normal.
What is your DD? |
Acute anxiety (psychogenic origin)
Dains pg 97 |
|
|
|
What are the common causes of emergent chest pain?
|
1) AMI
2) aortic dissection 3) acute coronary artery insufficiency 4) PE 5) pneumothorax 6) arrhythmias 7) congenital coronary anomalies Dains pg 95 |
|
