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312 Cards in this Set

  • Front
  • Back
What is the gold standard for taking blood pressure?
Mercury Sphygmomanometers.
What % of mercury sphygmomanometers are inaccurate?
21%.
What is the problem with mercury sphygmomanometers?
Potential toxicity during a spill.
What type of blood pressure system came with our doctor bags?
Aneroid sphygmomanometers.
How common are Aneroid sphygmomanometers found to be inaccurate in hospitals and private practices?
Hospitals- 44%. Private- 61%.
Of the aneroid sphygmomanometers that are inaccurate how inaccurate are they?
4-6 mm Hg- 32%. 7-12 mm Hg- 19%. More than 13 mm Hg- 7%.
Are finger monitors for measuring blood pressure recommened?
No.
What should the patient do before getting their blood pressure measured?
No tobacco or caffeine for 30 minutes and rest in a chair with their backs supported for five minutes with arm bared and supported at chest level.
What should a blood pressure cuff length be like?
The bladder should encircle at least 80% of the arms circumference.
What could happen if a short cuff is used for blood pressure?
Show a hypertension that doesn’t exist.
What is the first thing to do when measuring blood pressure?
Assess the palpatory systolic BP in one arm.
What is the second thing to do when measuring blood pressure?
Re-inflate the cuff to 20-30 mm Hg above the palpatory systolic BP and then deflate the cuff 2 mm Hg per second and record the Systolic and diastolic BP from auculateing the korotkoff sounds.
What is a common technique error when measuring blood pressure?
Too firm of pressure with the stethoscope.
How much can the systolic BP change from one arm the the other?
10 mm Hg.
If you get 2 different reading of BP from each arm which one should be used?
The higher of the two.
What will it mean when the BP between arms is 10 mm Hg or less?
Nothing it is clinically insignificant.
How many Korotkoff phase sounds are there?
five.
What are the 5 different Korotkoff phase sounds?
I- First consecutive sounds. II- Normal swishing sounds. III- Loud sounds well defined. IV- Sounds become abruptly muffled. V- No sound.
Which of these 5 Korotkoff phase sounds are not always present?
II, and IV.
What is the IV Korotkoff phase sound aka?
Mid-diastole.
What is the importance of the mid-diastole or IV Korotkoff phase sound?
Authorities argue over the significance of this sound.
What will represent the systolic BP?
Korotkoff Phase I sound.
What will represent the Diasolic BP?
Korotkoff Phase V better represents this.
What is the ausculatory gap?
Disappearnace of the korotkoff sounds.
With an ausculatory gap when will Korotkoff phase I sound occur?
At the onset systole.
If the Phase I sound occurs during onset of systole with an ausculatory gap then what sounds will disappear?
Sounds with other phases may fade in and fade out.
An ausculatory gap causes what problems?
It makes it hard to assess the pateints BP by ausculation alone.
What Risk is there with only doing an ausculatory BP measurment?
Under-estimation of systolic BP.
What clinical concern is there with an ausculatory gap?
The gap is a potential indiciator of increased arterial stiffness.
Besides arterial stiffness what can cause an ausculatory gap?
Venous congestion, obestiy, slow cuff inflation, back-to-back BP recordings.
How can problems from an ausculatory gap be prevented?
Assessing the patients palpatory systolic BP.
What is the normal BP?
Systolic- 120 or less. Diastolic- 80 or less.
What is the pre-hypertension BP?
Systolic- 120-139. Diastolic- 80-89.
What is the stage I Hypertenison BP?
Systolic- 140-159. Diastolic- 90-99.
What is the stage II hypertension BP?
Systolic- greater than or equal to 160. Diastolic greater than or equal to 100.
Classification of hypertension is based on what?
The mean of 2 or more properly measured seated blood pressure readings on each of 2 or more separate occasions.
What type of BP readings do not need to be done on 2 separate occasions to make a decision regarding intervention?
Systolic 180 or above. Diastolic 110 or above.
Risk of getting cardiovascular disease starts at what BP?
115/75 mm Hg.
Once your BP is 115/75 how much will the BP need to rise to double your risk of cardiovascular disease?
Each increment of 20/10 mm Hg will double the risk.
In people over 50 what is the more important part of BP with cardiovascular diseases?
Systolic BP more than 140 is more important than high diastolic BP.
The most effective therapy perscribed by the most carefull clinician will control hypertension only if the patient is what?
Motivated.
Name 7 things the examiner can do to increase systolic BP?
cuff too narrow, cuff not centered, cuff over thick clothing, elbow a little too low, arm in dependent (down by side) position, back unsupported, arm unsupported.
Name 6 things that the patient can do to increase systolic BP?
white coat HTN, recent tobacco use, recent caffeine use, distended bladder, anyone talking during procedure, Crossing legs.
Primary hypertension is aka?
Essential.
What is the cause of primary "essential" hypertension?
No identifiable causes.
What % of hypertension cases are primary?
90-95%.
When will the onset of primary hypertension occur?
25-55 years of age.
What are BP levels like in early primary hypertension?
Usually transient.
What are some things that can exacerbate primary hypertension?
Obesity, lack of exercise, alcohol, and smoking.
What is the most common form of secondary hypertension?
Renal vascular hypertension.
Is it known what causes secondary hypertensions?
Yes an underlying cause is identified.
What type of hypertension is estrogen-induced hypertension?
Secondary because the cause is known.
What is osler's sign?
Seen in elderly patients when peripheral muscular arteries are rigid and non compressible so the radial artery is still palpable with a fully inflated blood pressure cuff.
What is osler's sign classified as?
Pseudohypertension.
Pseudohypertension remains a problem in BP measurments of what?
The legs.
What is pulse pressure?
Systole minus diastole.
What makes a pulse pressure a widened pulse pressure?
one that is greater than 50% of the sytolic BP.
A hyperkinetic heart syndrome and an increased pulse pressure is seen with what?
Excersie, fever, pregnancy, or anemia.
An isolated systolic hypertension of greater than or equal to 140 mm Hg and a disatolic BP less than or equal to 90 mm Hg causes what?
A widened pulse pressure.
ISH (isolated systolic hypertension) is a strong predictor of what?
Cardiovacular and all-cause mortality in the middle-aged and elderly populations.
What is the best predictory of cardiovascular mortality?
Pulse pressure.
What are the measurments for hypotension?
80/50 mm Hg.
What is orthostatic hypotension?
a drop in blood pressure, usually upon standing, that results in symptoms of dizziness, faintness or lightheadedness.
With hypertension what organs will be damaged?
Retina, left ventricular hypertorphy, Renal, CNS.
What is the mean normal body temperature?
98.2- 98.6 degrees F. 36.8-37 degrees C.
What temperature is an fever (measured oraly)?
99.9 degrees F. 37.7 degrees C. OR above 98.6 degrees F. 37 degrees C. OR some say true fever is greater than 100.2 degrees F which is 37.9 degrees C.
What area of temperature measurement is considered ideal by many?
Tympanic (infared) measurment.
What can lower typmainc measurments of temperature?
Cerumen (ear wax) accumulation.
What time of day is the temperature lowest and highest?
Lowest- 6 am. Highest- 4-6 PM.
Over 80% of people with bacterial infections have what?
A specific, focal sign or symptoms that points to a bacterial infection as the source of the fever.
What is extreme pyrexia (fever)?
106 f or 41.1 c.
What is a true hypothermia?
below 95 F, 35 C.
How reliable is inter-examiner agreement of determining elevated body temperature by palpating the skin?
0.09-0.23 which is not great, but shows a slight agreement.
To palpate a pulse what fingers should be used?
No thumb, but use 2 or 3 fingers.
What is a normal sinus (Channel for venous passage) rate?
60-100 per minute.
What will a sinus rate below 60 per minute be classified as?
Sinus bradycardia.
What will a sinus rate above 100 per minute be classified as?
Sinus tachycardia.
What is a pulse deficit?
When heart rate exceeds the pulse rate.
What is normal sinus Rhythm?
Regular and steady.
What is a normal variant in sinus rhythm?
The heart rate increases with inspiration and decreases with expiration.
What type of changes will the pulse amplitude usually have?
It will remain unchanged.
What type of people will have irregular heart rhythms?
All types since it can occur in normal healthy hearts.
What type of arrhythmia will not cause any symptoms?
Silent ones.
What is a palpitation?
Feeling of skipped heart beats, fluttering, flip-flop or feeling that your heart is running away.
What symptoms of arrhythmia are significant?
Dizziness or feeling light-headed, fainting.
What is needed to diagnose arrhythmias?
It is possible with a physical exam, but not that good so an electrocardiography is needed.
What would you call an arrhythmia with no pattern?
Irregularly-irregular rhythm.
What is most often associated with irregularly-irregular rhythms?
Atrial fibrillation.
What is the most common form of arrhythmia?
Atrial fibrillation.
Atrial fibrillation is associated with what?
High rates of morbidity and mortality.
Atrial fibrillation is responsible for 15 to 20 % of what?
All strokes.
Atrial fibrillatin is most common seen in what type of patients?
Those over 60, with coronary heart disease, high blood pressure, COPD.
Atrial fibrillation is like what in 11.4- 45% of patients?
Asymptomatic.
What is it called when the pulse rate or rhythm shows disturbance in a more commonly seen pattern?
Regularly-irregular.
What is pulse amplitude used to assess?
heart and peripheral arterial system.
Pulse amplitude is influenced by status of the aortic valve, the stroke volume, and what?
The amount of peripheral vascular resistance.
What is pulse amplitude?
The strength of the pulse correlates with pulse pressure (systole minus diastole).
What is the inter-observer agreement of pulse amplitude?
Present vs absent is ok, but normal vs diminished is bad.
What are the scales for grading pulse amplitude?
0- absent. 1- barely palpable. 2- normal. 3- full or increased. 4- bounding or hyperkinetic.
What is Pulsus alternans?
A regular rhythm, alternating strong and weak beats.
Pulsus alternans has a weak and then a strong pulse repeated this way and this strongly suggests what?
severe left ventricular dysfunciton when found in patients with a normal heart rate.
What is pulsus paradoxus?
An exaggerated decrease in systolic blood pressure and pulse amplitude during inspiration.
With Pulsus paradoxus systolic BP falls how much when?
12 mm Hg during inspiration.
Is it hard or easy to assess systolic BP in cases of Pulsus alternans and pulsus paradoxus?
Difficult.
What is commonly associated with aortic valve regurgitation?
Corrigan's pulse/ collapsing pulse/ water hammer pulse.
What is the normal respiration rate in adults?
12 to 20 per min.
What are the muscles of inspiration?
SCM, trapezius and scalenes.
What are the muscles of expiration?
Abdominal muscles.
What word is associated with respiration usually put on the end of other words?
PNEA.
What is tachypnea?
Increased respiratory rate.
What is Bradypnea?
Decreased respiratory rate.
What is hyperpnea?
Increased respiratory volume.
What is hypopnea?
Decreased respiratory volume.
What is dyspnea?
Difficulty breathing.
What is orthopnea?
Dyspnea when supine.
What is paroxysmal nocturnal dyspnea?
Fits of dyspnea when recumbent awaken the patient from sleep.
What is apnea?
Absence of breathing.
What is the older subjective approach to grading dyspnea?
grade I- breathlessness on mild exertion. Grade II- breathlessness while walking on a flat surface at a normal pace. Grade III- Dyspnea while doing routine activities. Grade IV- Breathlessness while at rest. Grade V- breathlessness begins when patient lies down. Orthopnea- the need to be upright in order to breath.
Chest pain associated with inspiration suggests what?
Musculoskeletal disorders.
A sensation of chest tightness or constriction with dyspnea suggests what?
Cardiac problems.
If you get out of breath with activity only and it is slowly preoressive this suggests what? What will it suggest if it progresses more rapidly?
Chronic bronchitis. Rapid= cardiac problems.
Difficulty breathing without exertion when associated with orthopnea is a classic finding in what?
Congestive heart failure, and pulmonary emphysema.
What would recurrent paroxysmal attacks of dyspnea suggest?
Asthma.
What type of arterial occlusion will be pale?
Chronic insufficency.
What type of arterial occlusion will acute look like?
Turns colors (blue and red).
What are some possible signs and symptoms of arterial occlusion in an extremity?
1. Numbness, tingling, pain, weakness, coldness, pallor or mottling of the skin. 2. Collapsed superficial vein. 3. Motor, sensory and or reflex alterations. 4. Decreased pulse amplitude distal to the occlusion. 5. Dusky cyanosis rubor of cyanosis.
Emboli are most often associated with what?
Ischemic heart disease.
Cardiogenic emboli tend to lodge where?
In the bifurcations of major arteries.
About 50-80% of cardiogenic emboli lodge where?
Aortic bifurcations / Large arteries of lower extremities.
About 20% of cardiogenic emobli lodge where?
In the carotid arteries.
The remainder of cardiogenic emboli (not in carotid arteries or aortic bifurcations) lodge where?
Upper extremities or the mesenteric arteries.
What are small emboli?
Splinter hemorrhages.
Thrombi usually occur where?
Site narrowed by atherosclerotic plaque.
Acute arterial thrombosis may be precipitated by what?
Inflammation of the arterial wall.
What is another name for a chronic arterial occlusion?
Peripheral arterial disease.
The term PAD refers to what?
Arterial insufficiency in the lower extremities.
PAD is most often due to what?
Atherosclerotic plaque.
PAD is much more common with who?
Diabetics.
Patients with chronic PAD may also experience episodes of what?
Acute occlusion due to thrombus formation and or the discharged emboli.
Major cardiovascular risk factors predict the occurrence of what better than they perdict coronary heart disease?
Intermittent claudication.
What is an essential component of treating PAD?
Risk factor modifications.
PAD affects 12 million people in the US and is most commonly associated with what?
Atherosclerosis.
PAD indicates a high risk for what?
Cardiovascular morbidity and mortality.
Name a non-modifiable risk factor of PAD that are the "traditional activators".
Being over the age of 60.
Name 3 modifiable risk factors of PAD?
1. Smoking. 2. Hypertension. 3. Diabetes.
Of the 3 modifiable risk factors of PAD which one is a strong predictor of PAD?
Hypertension.
Diabetic PAD patients are more likely to have what?
Foot ulcerations.
Name a modifiable PAD risk factor that is a "non-traditional activator.
Arterial inflammation, ulceration of exisiting plaque and increased clotting.
50% of PAD patients will present how?
Aysmptomatic or previously-unrecognized PAD.
PAD patients tend to have decreased exercise capacity relateive to what?
The leg or other non-claudication types of leg pain on exertion.
What is Essential to treatment of PAD?
Rick factor modifications.
What are the risk factor modifications that can decrease the morbidity and mortality of PAD patients?
Stop smoking, exercise, Reduce elevated Lipid levels, control hypertension.
40% of PAD patients have what disease?
Peripheral arterial occlusive disease (PAOD) and claudication.
What is a "Classic" indicator or symptomatic PAD?
Intermittent claudication.
What is intermittent claudication?
Exercise-induced ischemic leg pain, calssically in the calf.
What are the symptoms of intermittent claudication?
They vary from patient to patient, but they are fatigue, aching, pain, cramping.
The distribution of the symptoms with intermittent claudication depend on what?
The level of the occlusion.
Intermittent claudication and (PAOD) symptoms can occur where?
Buttock, and or thighs and or calves.
What is a typical history of intermittent claudication and (PAOD)?
Asymptomatic before walking and asymptomatic after a brief rest.
What are the three parts to intermittent claudication patients walking patterns?
1. Fixed threshold distance. 2. Short tolerance distance. 3. Brief refractory period.
What is the fixed threshold distance?
Onset after walking a short perdicatble distance.
What is the short tolerance distance?
Patient can't continue walking due to pain.
What is Brief refractory period?
Pain decreases almost as soon as the patient rests.
Intermittent claudication indicates what?
A high risk of atherosclerosis.
10% of intermittent claudication have what?
Critical leg ishcemia.
What are the signs of a advanced intermittent claudication?
Rest pain, ulcers, gangrene.
What is the most compelling indicators of PAD/ PAOD?
Absence of both dorsal pedal and posterior tibial pulses.
What are some other indicators of PAD/ PAOD?
presence of any limb bruit, presence of wounds or sores on foot, absence of a femoral pulse, presence of asymmetric foot coolness.
What is the positive LR of PAD with wounds/ sores on foot?
LR=7.0
What is the Positive LR of PAD with absence of both pulses?
Lr14.9
What is the positive LR of PAD with presence of any limb bruit?
LR=7.3
What is the inter-observer agreement like for PAD?
Good when checking if pulse is present versus absent, but bad when checking if pulse is normal or diminished.
What is the Positive LR of PAD when venous filling time is over 20 seconds?
Lr=3.6
A patient without PAD would have what type of capillary refill time?
5 seconds or less.
With a PAD where would site of claudication be with calf muscles and usually the thighs and buttocks showing symptoms?
Aorticoiliac segments.
With a PAD where would site of claudication be with calf muscles and foot symptoms?
Femoropopliteal segment.
What would pallor (extreme paleness), and trophic changes be like for PAD of the aortoiliac segment and femoropopliteal segement?
Aortoiliac segment- minimal. Femoropopliteal segment- Distinct.
What is the essential component of treatment for PAD?
Risk factor modifications.
What are the risk factors of PAD?
Smoking, exercise, elevated Lipid levels, hypertension and diabetes.
What is the most important risk factor of PAD?
Smoking.
What type of excersice is best for PAD?
Graded ambulation. Walk just less than the threshold and then rest and repeat.
AAA is seen in what % of people over the age of 60?
5-8%.
What are the strong risk factors for AAA?
Smoking and male gender.
What are some modifiable risk factors for AAA?
smoking, lipid disorders, atherosclerosism, coronary artery disease.
What are some non-modifiable risk factors for AAA?
Male gender, family history of AAA, advanving age, ethnicity: more common in caucasuans.
What is the only physical exam procedure that can be done to screen for AAA?
Palpation.
How is a AAA palpatory exam done?
Mainly bimanual palpatin.
What would a normal and abnormal AAA palpation be like?
Normal- pulsatation, brief and succinct. Abnormal- an expansile and pulsatile mass.
What is the positive LR for AAA with an expansile pulsatile mass found during palpation?
LR=7.6
What makes an abdominal aorta an AAA?
At least 1.5 times normal diameter.
What would the normal diameter of the aorta be?
Normal supraumbilical portion- 1.66- 2.0 cm. Normal infraumbilical portion- 2.0-2.39 cm. In older men- 1.4- 3.0 cm.
Will AAA patients feel ill?
No most wont unless they have an impending or frank rupture.
What causes AAA? Name 2 things.
Atherosclerotic weakening of the tunica media, and Inflammation/ degeneration first, aneurysm later.
An aortic diameter above ____ cm usually indicates an AAA?
3.0 cm.
Ruptured AAA's are the ____ leading cause of death in the USA.
13th.
AAA is diagnosed in only about ____ of patients prior to rupture.
1/3.
The rate of AAA rupture increases with what?
Size.
AAA's less than ___cm. in diameter rarely rupture?
4.0 cm.
Aneurysms that are ____ cm. in diameter carry the peak incidence of rupture.
7.0 cm.
What 2 things effect the ability to palpate an AAA?
1. Size of patient. 2. size of aneurysm.
On average an AAA grows how much a year?
0.2-0.8 cm.
What are 3 complications that come with AAA?
1. Arterial insufficiency in lower extremity: thrombi/ emboli. 2. Impending rupture: expansion or a controlled bleed. 3. Overt rupture: hemorage, shock, death.
What is an impending rupture of an AAA?
Flank pain and or back painand or abdominal pain of sudden onset may indicate that an overt ruture may occur within minutes, hours, days, or weeks.
What is a frank rupture of an AAA?
intraperitoneal rupture into the abdominal cavity almost always follows the slow bleed, causing shock and death.
What type of rupture mimics a kidney stone?
Impending rupture.
What type of rupture mimics a herniated disk?
Impending rupture.
Pain with an impending rupture is unrelieved by what?
Changing positions.
Acute rupture almost always follows what?
A slow bleed/ impending rupture.
What % of AAA ruptures are impending and what % are frank?
Impending- 80%. Frank-20%.
What can mimic raynauds syndrome?
Carpal tunnel or thoracic outlet syndromes.
What is the difference between raynauds syndrome and carpal tunnel or thoracic outlet syndromes?
CT or TOS rarely lead to physical signs such as nail fold changes.
What is Raynauds phenomenon?
A reversible vasospastic ischemia of the peripheral arterioles, most often seen in the fingers.
Raynauds most often involves what?
The fingers.
Raynauds effects toes in what % of patients?
40%.
What is the "classic" tri-phasic color change?
Seen in raynauds it is Pallor, cyanosis, rubor.
What is the common presentation of raynauds?
Having at least two of the color changes.
What are the areas effected by raynauds like?
Discrete, well defined, well demarcated. Demarcation usually stops at joint lines.
With raynauds besides color change what else happens?
Numbness, tingling.
Rubor indicates what with Raynauds?
The arteriolar circulation has been restored.
What are the 2 types of raynauds?
Primary or secondary.
Primary raynauds has what type of vasospasm?
Idiopathic (cause unknown).
When will primary raynauds occur at usually?
In second or third decade of life.
Primary raynauds almost always dose what?
affects both hands.
What are some common triggers of primary raynauds?
Cold, mental stress, smoking.
What should be monitored for with primary raynauds?
Connective tissue disease.
What type of care will 90% of primary raynauds patients respond to?
conservative care.
What are some signs of secondary raynauds?
capillary nailfod changes, telangectasia, rashes.
What may be associated with reducing the number of raynauds attacks in patients?
Ginkgo biloba.
Secondary raynauds is different from primary how?
Secondary is more often unilateral.
Secondary raynauds is associated with what?
Autoimmune disorders.
What are the autoimmune disorders that are associated with secondary raynauds?
progressive systemic sclerosis/ scleroderma. Mixed CT disease.
Secondary raynauds may be associated with what else?
Frost bite, and vibration injury.
When evaluating for raynauds what type of palpation should be done?
Palpate for scerodactyly or calcinosis.
Vasospasms are seen with raynauds, but can vasospasms without anyother disease cause digital ulcers or gangrene?
No vasospasm alone can never cause digital ulcers or gangrene.
What is the third most common cardiovascular disease in the US?
Deep vein thrombosis.
Deep vein thrombosis left untreated can lead to what?
Pulmonary emboli.
59% of deep vein thrombosis will be attributed to what?
Current hospitalization or recent nursing home stay. Because of venous stasis.
What is Virchow' triad?
Thrombosis in veins is triggered by 1. venous stasis. 2. Hypercoagulability. 3. vessel wall inflammation. All clinical risk factors for DVT and pulmonary emboli have their basis in one or more of the virchow' triad.
What will cause deformation to the venous valves?
Venous thrombophlebitis (secondary inflammation changes to the vein).
What are the symptoms of early stage DVT?
Often asymptomatic.
What is seen in 80% of symptomatic DVT patients?
Proximal deep vein thrombosis.
Proximal deep vein thrombosis has a much higher incidnce of what?
Pulomonary embolism
What are 3 inspections for Deep vein thrombosis examination?
thigh swelling, asymmetric calf swelling, superficial venous dilation.
What is a palpation test for DVT?
Asymmetric skin warmth.
What is wells decision-making tool?
DVT pre-test probability can you assign one point for each clinical characterisitc that matches and deduct 2 points if there is an alternative diagnosis that is as likely as DVT. If the score is less than 2 then DVT is unlikely.
what is the inter-observe agreement like with Well's test?
0.75 so substantial agreement.
What are the top 2 causes of sudden unexpected death at any age?
1. Coronary artery disease. 2. Pulmonary embolism (a complication found with DVT).
What are the classic signs and symptoms of Pulmonary embolism? How good are these calssic signs at predicting Pulmonary embolsims?
Hemoptysis, dyspnea, chest pain. These signs are not sensitive or specific.
What is Homan's sign?
A test for DVT that is passive dorsiflexion of the foot. If painful or shows increased muscular resistance then test is positive.
What is Mose's sign?
A classic but not reliable exam for DVT.
What are 4 signs of respiratory distress?
1. Increased respiratory rate (30 or more per minute). 2. Increased heart rate (120 or more per minute). 3. Diaphoresis (Sweating). 4. Excessive use of accessory muscles of respiration.
What are 2 red flags of respiratory distress?
1. Excessive use of the accessory muscles of inspiration. 2. Excessive use of accessory muscles of expiration.
What will excessive use of accessory inspiration and expiration muscles imply?
Severe obstructive disease.
What will increased work of breathing cause?
Fatigue of the diaphragm and can lead to respiratory failure.
Fatigue of the diaphragm is a red flag for respiratory distress and is seen how?
Decreased diaphragmatic movement during inspiration. The abdomen retracts while the thorax expands.
What is orthopnea?
The need to be upright to breathe.
Orthopnea is classically seen with what?
Heart failure.
What is a classic posture of Chronic obstructive pulmonary disorder?
Tripod posture.
What might be the only symptom of asthma?
A cough.
What would a cough caused by asthma be like?
Nonproductive and nonparoxysmal. May be present with wheezing.
What should always be considered when dealing with a chronic cough, especially in cases of nocturnal asthma?
Gastroesophageal reflux disease (GERD).
Yellow or green sputum from a cough indicates what?
Presence of a large number of WBC.
What will red or brown sputum from a cough indicate?
Presence of RBCs.
IN primary care settings acute bronchitis is considered the most common cause of what?
Hemoptysis (coughing up blood).
What should be considered in any pateint over 40 with hemoptysis?
Lung cancer.
What % of patients with hemoptysis can no cause be found?
34%.
Almost any pulmonary lesion can result in what?
Hemoptysis.
What will influence dyspnea?
The patients reaction to it since anxiety plays a significant role in patients.
Dyspnea of heart failure is more likely to be provoked by what?
Lying down flat.
What is DOE?
Dyspnea on exertion.
The majority of patients with heart and lung diseases what grades of DOE?
Grades I and II. I- mild exertion. II- while walking on a flat surface at a normal pace.
Paroxysmal nocturnal dyspnea (PND) tends to indicate what?
Heart disease.
Can alveoli sense pain?
No.
The central tendon can refer pain to where?
Ipsilateral shoulder.
What is pleuritic pain like?
It is localized and follows the distriution of the intercostal nerves and could therefore be considered dermatomal in nature.
What happens to pain when a direct pleuritc pain is palpated?
It is not made worse.
What makes the pain worse with direct pleuritic pain?
Taking a deep breath or coughing.
What might be a cause of direct pleuritic pain?
Infection/ systemic diseases: alarm findings are present.
What happens to pain when a indirect pleuritc pain is palpated?
Pain is harder to describe, but the pain is not made worse by palpation.
What makes the pain worse with indirect pleuritic pain?
It MIGHT be worse by a deep breath and coughing.
Alarm findings are more common with Direct or indirect pleuritic pain?
Indirect.
What is a common symptom of lung disease (a sound)?
Noisy breathing.
Where should normal bronchial breath sounds be heard at?
Larynx, trachea, larger bronchi, and SHOULD NOT BE HEARD IN ANY OTHER LUNG AREAS.
When would bronchovesicular sounds be considered abnormal?
When they are heard in the lower lung fields.
What needs to happen for vibrations to be transmitted from the airways to the chest wall?
1. Airways must be at least partially open, and the pleurae must be intact and in normal proximity to the parietal pleura.
What is a physical factor that might increase the transmission of vibrations to the chest wall?
Lobar pneumonia and consolidation.
Wheezes / rhonchi tend to be associated with what?
Expiration.
Fine crackles / fine rales tend to be associated with what?
Inspiration.
What are fine crackles/ fine rales heard on inspiration like?
Discontinuous.
What is the big clinical question that should be asked with fine crackles?
Will they clear with a cough.
What will the intensity of a wheeze and the presence of polyphonic sounds correlate with?
NOT with the degree of obstruction as measured by spirometry.
Bronchial sounds heard in areas other than normal implies what?
Larger airways are open but they are surrounded by consolidated tissue.
Abnormal bronchial sounds are classically associated with what?
Pneumonia.
Abnormal pleural friction rubs with creaking sounds are accompanied by what?
Well-localized pain.
Barrel chest is associated with what?
COPD.
Digital clubbing is associated with what?
Chronic bronchitis.
What is costochondritis / Teitze's syndrome?
Inflammation of the costochondral or costosternal junctions. Involving ribs 1-7.
Will swelling happen with costochondritis / teitze's syndrome?
Yes with Tietze's but no with costochondritis.
What happens to pain along the course of an intercostal nerve (intercostal neuralgia, intercostal neuritis) with palpation?
Might not be made worse by palpation.
What will be considered abnormal with a palpation exam to assess vocal tactile fremitus?
Only aysmmetric tactile fremitus is considered abnormal.
When will fremitus by asymmetrically increased?
When there is consolidation of the underlying lung: unilateral/ lobar pneumonia.
When might palpation to assess respiratory excursion be reduced unilaterally?
In pleural diseases and pneumonia with consolidation.
What test should be done first percussion or auscultation?
Percussion.
What is a percussion abnormalitiy?
unusual dullness or hyper- resonance over one side indicates disease in that area.
Percussion of the thorax has ____ diagnostic value.
Limited.
What is tapotement?
Tapping therapy used to clear thickened secretions from airways of COPD patients.
Where should Tympanitic (hollow) sounds be found at with percussion?
Stomach, colon.
Where should hyper-resonant sounds be found at with percussion?
Abdomen.
Where should resonant sounds be found at with percussion?
Normal lung.
Where should dull sounds be found at with percussion?
Heart, liver.
Where should flat sounds be found at with percussion?
Bone.
What is murphy's percussion?
Indirect percussion over the kidney elicits an intense, sharp, focal pain in conditions that inflame and / or distend the kidney capsule.