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220 Cards in this Set
- Front
- Back
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what is costocondritis?
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inflammation at costocondral junctions (musculoskeletal problem)
-can cause shortness of breath |
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what separates the thoracic cavity from the abdomen?
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the diaphragm
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what is a pulmonary embolism?
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blockage of a main artery of the lung
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in what disease process will you develop calcification in the top of the lungs?
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pulmonary TB
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what is the area called that separates the right and left lungs?
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middle mediastinum
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what is inside the middle mediastinum?
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heart, aorta, esophagus, and trachea
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if the costal angle is 90 degrees or greater what could that indicate?
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emphysema
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what are the three parts of the sternum?
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manubrium
body xiphoid process |
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what is the manubriosternal angle?
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"sternal angle, angle of Louis"
useful place to start counting ribs marks site of trachial bifurcation into right and left main bronchi |
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what is vertebra prominens?
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prominent bony spur protruding at the base of the neck (C7; and T1 if two bumps)
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where is the inferior border of the scapula?
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at 7th or 8th rib
-symmetrical in each hemothorax |
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what is hemothorax?
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condition that results in blood in the pleural cavity
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the patient has unequal scapula what should you think?
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scoliosis
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what are the functions of respiration?
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-supply oxygen to the body for energy production
-remove carbon dioxide as a waste product from energy reactions -maintain homeostasis of arterial blood -maintain heat exchange |
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what is hypoventilation?
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slow, shallow breathing
increased carbon dioxide in blood |
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what is hyperventilation?
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rapid, deep breathing
carbon dioxide blown off |
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where is the respiratory center?
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brainstem (pons/medulla)
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describe inspiration
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increase in size of thorax
major muscle responsible is diaphragm |
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describe expiration
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-primarily passive
-when diaphragm relaxes, elastic forces within lung, chest cage, and abdomen force it to dome up -creates positive pressure within alveoli, air flows out |
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what are the primary muscles of respiration?
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diaphragm
internal intercostal muscles external intercostal muscles sternocleidomastoid and trapezius (accessory muscles) |
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what is the function of the external intercostal muscles during respiration?
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increase anteroposterior chest diameter during inspiration
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what is the function of the internal intercostal muscles during respiration?
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decrease transverse chest diameter during expiration
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when are the accessory muscles of respiration brought into play?
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when there are pulmonary problems and compromise
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what controls breathing?
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the brain stem (medulla oblongata, pons)
chemoreceptors (central, peripheral) |
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what is the difference in the pediatric chest wall?
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chest wall is more flexible and ribs are softer
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are the lungs fully grown at birth?
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no
infants are pneumonically challenged |
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what is barrel chest?
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seen in older adults
increase in AP chest diameter loss of muscle strength in thorax and abdomen loss of lung resiliency stiffening, decrease expansion of chest wall dorsal curve of thoracic spine |
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how many lobes does the right lung have? left lung?
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three
two (and lingula) |
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what do the lobes contain?
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blood vessels
lymphatics nerves alveolar ducts alveoli |
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what are acini?
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terminal respiratory units
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what does the trachea divide into?
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right and left bronchi
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what are the bronchial functions?
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air transport
trap and dispose of foreign particles supply blood to lung parynchema and stroma |
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where do bronchial arteries branch from?
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anterior thoracic aorta and intercostal arteries
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** what are two reasons pulmonary diseases arise?
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lungs unable to provide adequate oxygenation
lungs unable to eliminate carbon dioxide |
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what is the primary cause of lung cancer?
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smoking
87% of people that are diagnosed with lung cancer are smokers or were previously smokers |
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what can cause lung cancer other than smoking?
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radon
radiation second hand smoke asbestos arsenic |
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which race experiences the highest incidence of lung cancer and death?
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african americans (especially males)
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what are the two main illnesses of COPD?
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chronic bronchitis
emphysema |
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what is chronic bronchitis?
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the lining of the bronchial tubes gets red and full of mucus, this blocks the tubes and makes it hard to breath
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what is emphysema?
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alveoli are irritated
they get stiff and cannot hold enough air, it makes it hard to get oxygen into and carbon dioxide out of your blood |
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what are the most common signs of COPD?
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chronic coughing
shortness of breath |
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what are the respiratory warning signs?
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anxious expression
SCM contractions nasal flaring circumoral cyanosis suprasternal and intercostal retractions hyperextended chest |
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what are the most common chief complaints?
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chest pain
hemoptysis cough sputum production dyspnea cyanosis wheezing |
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what is stridor?
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noisy breathing
harsh type of breathing obstruction of a major bronchus that occurs with aspiration (a kid swallowed something; anaphylactic shock) |
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what could cause voice changes?
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inflammation of vocal cords
interference with recurrent laryngeal nerve |
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what is dependent edema?
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swelling in the ankles
could be cardiac or pulmonary, liver disease, obstruction of venous flow |
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what is weeping edema?
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wet legs; so much fluid it starts coming out of the pores
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what is bronchiectasis?
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inability to clear mucus
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what is empyema?
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build up or collection of pus in the lungs; typically in patients with a lung abscess; can occur in patients with a bad case of pneumonia; typically seen in older patients
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what is atopic dermatitis?
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eczema
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what is pack year?
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number of years smoking times the number of packs per day
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what is pleuritic pain?
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inflammation of parietal pleura
sharp, stabbing pain felt during inspiration localized to one side splint to avoid pain |
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what is hemoptysis?
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coughing up blood
frothy color bright red mixed with pus dyspnea |
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what are some possible causes of hemoptysis?
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bacterial infection
tuberculosis PE lung cancer fungal infection |
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what is the most common cause of hemoptysis?
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bronchitis
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what is hematemsis?
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vomiting blood
not frothy dark red, brown ("coffee grounds") mixed with food nausea |
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what is the most common symptom of lung disease?
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cough
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what is a cough?
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normal defense mechanism
clean airway of extraneous material by producing a sudden, forceful, noisy expulsion of air from the lungs |
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what could coughing after exercise indicate?
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exercise induced asthma
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what could wheezing indicate?
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asthma
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what could a chronic cough, usually in the morning indicate?
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cigarette smoking
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what could a chronic, productive cough indicate?
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carcinoma
bronchitis |
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what could a dry, hacking cough indicate?
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allergies
environmental exposure |
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what could a cough that is associated with eating or drinking indicate?
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gastrointestinal disease
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what could a barking cough indicate?
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epiglottal disease
ex: croup |
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what could a nocturnal cough indicate?
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viral illness
heart failure |
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what is sputum?
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substance produced by respiratory tract, can be expectorated or swallowed mucus, blood, purulent
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what is mucoid?
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sputum that is uninfected, odorless, transparent, and whitish-grey resembling mucus
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what is purulent sputum?
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infected sputum, pus, yellow, greenish, or red
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what does a foul odor in sputum indicate?
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lung abscess
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what does bloody sputum indicate?
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PE
TB tumor cardiac disease bleeding disorder |
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what is dyspnea?
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shortness of breath
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what is pillow orthopnea?
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alleviation of shortness of breath (ie: sleeping on two pillows)
indication of cardiac disease |
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what are some possible causes of dyspnea?
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COPD
aspiration anaphylatic reaction heart failure PE pneumonia collagen vascular pulmonary neoplasms |
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what is wheezing?
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musical high-pitched sound due to airway inflammation/obstruction
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what are some possible causes of wheezing?
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asthma
pulmonary edema pneumonia reaction to medication |
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a "silent" chest with acute asthma attack can mean what?
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worsening of the obstruction
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what is pectus excavatum?
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funnel chest
depression in lower portion of sternum -compression of the heart and great vessels may cause murmurs |
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what is barrel chest?
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increased anteroposterior diameter
accompanies aging and COPD |
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what is pectus carinatum?
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anteriorly displaced sternum
increased AP diameter costal cartilage adjacent to the protruding sternum are depressed |
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what is traumatic flail chest?
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multiple rib fractures may result in paradoxical movements of the thorax
on inspiration-caves inward on expiration-moves outward |
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what is kyphoscoliosis?
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abnormal spinal curvatures and vertebral rotation that deform the chest
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what are the two accessory muscles for breathing?
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SCM
trapezius |
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what is the purpose of the neck?
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provide structural support and movement
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what is the function of atlas?
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support and balance the head
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what is the function of axis?
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allows atlas to pivot as the head is turned side to side
-allows us to touch our chin to our shoulder |
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what is bruit?
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turbulence in the blood vessels
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distended jugular veins could indicate?
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right sided heart disease and failure
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when assessing the vessels in the neck what do you always do first?
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auscultate and then palpate
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what is the anterior triangle of the neck formed by?
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SCM
mandible trachea |
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what does the anterior triangle of the neck contain?
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anterior cervical lymph nodes
trachea thyroid gland |
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what is the posterior triangle of the neck formed by?
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SCM
trapezius clavicle |
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what does the posterior triangle of the neck contain?
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posterior cervical lymph nodes
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what is the largest endocrine gland in the body?
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thyroid gland
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a scar of past thyroid surgery is a clue to?
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unsuspected thyroid disease
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what is the function of the thyroid gland?
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controls metabolism
production of calcitonin |
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what is hyperthyroidism?
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over active
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what is hypothyroidism?
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under active in terms of hormone production
-the most common reason it is under active is because it was over active |
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what is the function of the lymph system?
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to detect and eliminate foreign substances from the body
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where are the lymph nodes accessible during examination?
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head and neck (cervical)
arms (epitrochlear-by elbow) axillary inguinal region (groin) |
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what do tonsillar, submental, and submandibular lymph nodes drain?
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portions of the mouth and throat as well as the face
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what do anterior cervical lymph nodes drain?
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internal structures of the throat, posterior pharynx, tonsils, thyroid gland
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what do posterior cervical lymph nodes drain?
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skin on back of head
-enlarge during URI (mono) |
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what do tonsillar lymph nodes drain?
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tonsillar and posterior pharyngeal regions
-enlarge with strep throat |
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what do submandibular lymph nodes drain?
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structures in the floor of the mouth
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what do the submental lymph nodes drain?
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teeth and intra-oral cavity
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what do supraclavicular/infraclavicular lymph nodes drain?
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part of thoracic cavity, abdomen, and breast
-if enlarged, need to think metastatic disease coming from the chest or abdominal cavity |
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what do preauricular/postauricular lymph nodes drain?
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external canal of the ear (otitis externa)
scalp and auditory canal (viral conjunctivitis) |
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what do occipital lymph nodes drain?
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anterior and posterior scalp
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what is pectus carinatum?
|
anteriorly displaced sternum
increased AP diameter costal cartilage adjacent to the protruding sternum are depressed |
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what is traumatic flail chest?
|
multiple rib fractures may result in paradoxical movements of the thorax
on inspiration-caves inward on expiration-moves outward |
|
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what is kyphoscoliosis?
|
abnormal spinal curvatures and vertebral rotation that deform the chest
|
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what are the two accessory muscles for breathing?
|
SCM
trapezius |
|
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what is the purpose of the neck?
|
provide structural support and movement
|
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what is the function of atlas?
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support and balance the head
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what is the function of axis?
|
allows atlas to pivot as the head is turned side to side
-allows us to touch our chin to our shoulder |
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what is bruit?
|
turbulence in the blood vessels
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distended jugular veins could indicate?
|
right sided heart disease and failure
|
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when assessing the vessels in the neck what do you always do first?
|
auscultate and then palpate
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what is nuchal rigidity?
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is the inability to flex the head forward due to rigidity of the neck muscles; may be associated with bacterial meningitis in 70% of patients
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if there is an enlarged lymph node what do you need to note?
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Size, shape
consistency (hard/soft) Delineation (Discrete or matted together) mobility tenderness temperature location |
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if a lymph node is hard or they are matted together what should you think?
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malignancy
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if a lymph node is tender and warm to touch what should you think?
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infection
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what is lymphadenopathy?
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Enlargement of lymph node (>1 cm) due to infection, allergy, or neoplasm
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diffuse lymphadenopathy raises suspicion of what?
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HIV or AIDS
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what is lymphadenitis?
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firm, tender, enlarged and warm
affected node is site of the inflammation w/ local spread to overlying skin, If untreated: center becomes necrotic, abscess formation (fluctuance |
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what is infectious mononucleosis?
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anterior/posterior cervical chains
enlarged, tender nodes, fever (102°F), splenomegaly, extreme malaise Looks & presents like strep pharyngitis |
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** what is Virchow's node?
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Single, enlarged, nontender, hard node in the left supraclavicular area
Abdominal or thoracic malignancy |
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what are the 9 S's for features of a lump?
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Size
Shape Surface Site Sensations Symptoms Softness or fluctuance Squeezability Spread |
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patients with neck tumors also have what kinds of problems due to disfiguration and distortion?
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psychological problems
depression and suicide |
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a rheumatological etiology for neck stiffness and pain is?
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fibromyalgia
-complain about exquisite tenderness |
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what could a lateral, painless neck mass that is near the anterior upper 3rd border of the SCM?
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brachial cleft cyst
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hoarseness associated with a thyroid nodule could be because of?
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vocal cord paralysis due to impingement of the recurrent laryngeal nerve by the tumor
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when would you call something a congenital mass?
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if a patient has had it since they were born but it didn't become a problem until they had a cold
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acute onset of a mass in a person over the age of 40, what should you think?
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malignancy
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what is serous otitis?
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Fluid in the middle ear (in setting of neck mass) of an adult should be regarded as a potentially ominous sign of a nasopharyngeal tumor
-should be sent to ENT |
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why do you assess the trachea?
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to make sure it is midline
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if the trachea is pushed to the unaffected side what could be the cause?
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Aortic aneurysm, tumor, unilateral thyroid lobe enlargement, pneumothorax
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if the trachea is pulled towards the affected side what could be the cause?
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Large atelectasis, pleural adhesions, or fibrosis
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what is tracheal tug?
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rhythmic downward pull that is synchronous with systole and occurs with aortic arch aneurysm
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what is Grave's disease?
|
hyperthyroidism
autoimmune disorder associated with increase in T3 and T4 -thin face, sharply defined features, prominent eyes (exophthalmos-cartilage build up behind the eye) |
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what is the purpose of valves in the heart?
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to prevent back flow (regurgitation)
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where does the inferior border of the right ventricle lie?
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below the junction of the sternum and xiphoid process
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what is the epicardium?
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the innermost layer of the pericardium
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what is the pericardium?
|
double layered walled sac that covers the heart
-consists of fibrous and serous layers |
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what is the serous pericardium made up of?
|
parietal pericardium (fused to fibrous pericardium)
visceral pericardium (part of epicardium) |
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what is the pericarditis??
|
inflammation of the pericardium
-will sound like two pieces of paper rubbing together (friction rub), usually secondary to some sort of infection |
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what is pancarditis?
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inflammation of the entire heart
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what is the flow of blood through the heart?
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into the right atria from superior and inferior vena cava
into the right ventricle out through pulmonary arteries in through pulmonary veins into left atria into left ventricle out through aorta and aortic arch |
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what is the SA node and the normal rate?
|
pacemaker
60-100 bpm (most people 75-85 bpm) |
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how do you rate a pulse?
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0-3
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what does 0 mean in rating a pulse?
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absent pulse (not palpable, does not mean blood isn't flowing)
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what does +1 mean in rating a pulse?
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diminished, weak pulse (have a hard time feeling it)
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what does +2 mean in rating a pulse?
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brisk, normal pulse
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what does +3 mean in rating a pulse?
|
bounding (beating so hard you can slightly touch and feel it)
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what is cardiac output?
|
stroke volume times heart rate
or mean arterial pressure times total peripheral resistance |
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what is preload?
|
ventricular end diastolic pressure
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what is afterload?
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the pressure the ventricles pump against
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if heart rate decreases, how are you going to maintain stable cardiac output?
|
increase stroke volume
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how do you calculate blood pressure?
|
cardiac output times systemic vascular resistance
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what happens during systole?
|
the ventricles contract
-right ventricle pumps blood into the pulmonary arteries (pulmonic valve is open) -left ventricle pumps blood into the aorta (aortic valve is open) |
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what happens during diastole?
|
the ventricles relax
-blood flows from the right atrium to the right ventricle (tricuspid valve is open) -blood flows from the left atria to the left ventricle (mitral valve is open) |
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when do coronary arteries perfuse?
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during diastole
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how do you palpate for heaves/lifts?
thrills? |
finger pads
ball of hand |
|
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what areas do you palpate the chest?
|
the chest wall in aortic, pulmonic, left parasternal, and apical areas
|
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where do you hear the aorta?
pulmonic valve? |
upper right
upper left |
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where do you feel the point of maximal impulse?
|
midclavicular line
|
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what is the first heart sound you hear?
|
S1
closure of atrioventricular valves: mitral and tricuspid |
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what is the second heart sound you hear?
|
S2
closure of semilunar valves: pulmonic and aortic |
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what are cardiac murmurs?
|
abnormal heart sounds (turbulent flow)
graded on scale 1-6 |
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what does leaning forward accentuate in a murmur?
|
aortic regurgitation
|
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what does left lateral decubitus (laying on left side) accentuate?
|
mitral stenosis
|
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what is the diaphragm of the stethoscope best for detecting?
|
high-pitched sounds
S1, S2, murmurs |
|
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what is the bell best for detecting?
|
low pitch sounds
S3 and S4, rumble of mitral stenosis |
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what is S3 most commonly associated with and what causes it?
|
left ventricular failure
-blood from the left atrium slamming into an already overfilled ventricle during early diastolic filling |
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what is S4 most commonly associated with and what causes it?
|
left ventricular hypertrophy that is a result of long standing hypertension
-blood trying to enter a stiff, non-compliant left ventricle during atrial contraction |
|
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what is important in describing heart murmurs?
|
intensity
timing duration |
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an increase in pulse pressure can be a result of what?
|
-increase in systolic pressure (usually secondary to arterosclerosis in older adults and increased blood volume in younger adults)
decrease in diastolic pressure |
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what is arterosclerosis?
|
stiffening of the aorta
|
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how do you calculate pulse pressure?
|
systolic minus diastolic
normal is about 40 above 40-wide below 40-narrow |
|
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what is a normal blood pressure?
|
120/80 mm Hg
|
|
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what is the range for prehypertension?
|
120-139 over
80-89 |
|
|
what is the range for stage 1 hypertension?
|
140-159 over
90-99 |
|
|
what is the blood pressure target for patients with diabetes and chronic kidney disease?
|
less than 130/80
|
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substernal chest pain is associated with what?
|
heart disease
|
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what is orthopnea?
|
trouble sleeping because you can't breath when you lay down
|
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what is paraxysmal nocturnal?
|
wake up multiple time
|
|
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what is claudication?
|
pain in muscles (calves) after output
resting helps feel better |
|
|
what dependent edema?
|
fluid accumulation only when their legs are down
|
|
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what is TIA?
|
transient ischemic attack
manifestation of neurological symptoms that last less than 24 hours (right hand felt numb but slowly started going away) indicative of stroke risk |
|
|
pertinent history in cardiac?
|
timing of symptoms
severity improvement |
|
|
what is angina pectoris?
|
-chest pain
myocardial ischemia the most common manifestation of coronary artery disease |
|
|
what are some qualities of chest pain?
|
substernal, crushing feeling
may radiate to jaw/left arm exacerbated by stress/exercise relieved by rest, nitroglycerine may not be perceived as "pain" |
|
|
how would you describe pericarditis pain?
|
sharp, knife-like, sustained, worse in supine position
|
|
|
how would you describe dissecting aortic aneurysm?
|
acute onset
tearing anterior chest pain |
|
|
how would you describe costachondritis pain?
|
dull
worse with movement and breathing tender to palpation |
|
|
how would you describe anxiety pain?
|
dull
across anterior chest lasts minutes to hours then gets better |
|
|
how would you describe GERD pain?
|
dull
recurring substernal pain |
|
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what is sinus tachycardia?
|
heart rate increases unexpectedly, unknown cause, beta receptors blocked
|
|
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what is PSVT?
|
paroxysmal supraventricular tachycardia
conduction problem have to breath rapidly to make it feel better |
|
|
what is syncope?
|
dizziness, fainting
transient loss of consciousness |
|
|
what is the biggest cardiac consideration with syncope?
|
aortic stenosis
|
|
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what are some cardiac considerations with syncope?
|
aortic stenosis
IHSS pulmonary hypertension perfusion problems valve problems (conduction problems) |
|
|
what are some non-cardiac considerations with syncope?
|
vasovagal
orthostatic |
|
|
what does claudication suggest?
|
peripheral arterial occlusive disease
-likely to have coronary ischemia |
|
|
what is the more common cause of hemoptysis?
|
pulmonary disease (bronchitis)
|
|
|
what is cyanosis usually indicative of?
|
congenital or valvular heart abnormality
|
|
|
**what is amaurosis faux?
|
loss of vision in one eye due to temporary loss of blood flow to the retina
|
|
|
what is xanthomata?
|
cholesterol deposits
patients with metabolic syndrome, insulin resistance, obese, at risk of having thromboembolic events |
|
|
what are trophic skin changes?
|
skin has become thick or too thin (can be result of cortisol)
|
|
|
what is xanthoma (xanthalasma)?
|
build up of fat underneath the skin
|
|
|
what is the most common physical finding with ischemic heart disease?
|
nothing
-history is key to diagnosis |
|
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what are some risks for cardiovascular disease?
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hyperlipidemia
hypertension diabetes gender race age family history lifestyle issues |
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ischemic heart disease is what type of process?
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inflammatory
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how does cardiovascular disease compare to the leading causes of death?
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higher mortality than the next six leading causes of death combined
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what is the optimal BMI?
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18.5-24.9 kg/m
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salt intake should be?
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less than 6 g of sodium chloride or 2.4 g of sodium per day
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alcohol intake for men? women?
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2 drinks per day
1 drink per day |
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how much potassium intake should you have in your diet?
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3,500 mg
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men and women risk factors with waist circumference?
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men- greater than 44 in
women- not having a shape |
