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321 Cards in this Set
- Front
- Back
- 3rd side (hint)
Where do the lungs end?
A. Anteriorly B. Laterally C. Posteriorly |
A. 6th ICS
B. 8th ICS C. T10 |
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On which side is the diaphragm higher up?
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Right side d/t the liver
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What are the muscles of respiration?
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Diaphragm, Intercostal muscles, Trapezius, and Sternocleidomastoid muscles
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What is pectus carinatum?
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prominent sternal protrusion
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Does not cause many lung issues
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What is pectus excavatum?
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indentation of the lower sternum
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Can cause lung issues
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What is kyphosis?
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curvature of the spine
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In what people is kyphosis common?
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Women over the age of 52 (menopausal)
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What health promotion tips do we give for kyphosis?
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Take a Calcium supplement and do weight bearing exercises
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What is a normal AP:Transverse diameter in adults? in newborns?
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Adults- 1:2
Newborns- 1:1 |
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In what disorder will you have an increased AP ratio?
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Emphysema
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Where do the lung apices lie?
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2-4 cm above the clavicle
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Where does the Visceral pleura lie?
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over the lungs
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Where does the Parietal pleura lie?
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lining the chest wall
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Where does the Trachea bifurcate?
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High anteriorly and T4 posteriorly
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What is orthopnea?
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dyspnea when lying flat
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What is trepopnea?
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dyspnea when lying on one side
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common in CHF
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What is platypnea?
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dyspnea when sitting up
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common with liver failure or ascites
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If someone has a CC of lung origin, what other systems will you review?
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Cardiac, HEENT, GI
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What are some questions you may ask about a respiratory review of systems?
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Dyspnea, sputum production, cough, wheezing, history of...cancer, asthma, TB, chest pain, COPD/Emphysema
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What are some important social history questions to ask with a CC of respiratory origin
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Exposure to asbestos/chemicals in your work environment, history of smoking
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What are some important family history questions to ask with a CC of resp. origin?
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TB, cystic fibrosis, asthma, lung cancer
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What are some specific things related to infants and children that may be significant in a lung related history?
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low birth weight, assisted ventilation, difficult feeding, apneic periods, sibling SIDS death, recurrent spitting up
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What may it mean if a baby consistently spits up?
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they may have GERD
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When do babies develop surfactant?
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32 weeks
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Who has a higher risk of asthma?
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pacific islanders, filipinos, cubans, puerto ricans, those in inner cities
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Who have higher incidence of lung cancer?
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smokers, african americans, native americans
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What are some lung risks for immigrants?
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increased TB, poor housing (mold/lead)
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What will you inspect when examining respiratory?
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pattern of breathing, mode of breathing, is it audible?, pursed lips?, skin/mucous membrane color, posture with breathing? accessory muscle use, nasal flaring, cough, depth and rate and symmetry
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What will you inspect in the thorax?
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for the symmetry/bones (kyphosis, scoliosis), intercostal spaces, symmetry, skin (color, scars, venous patterns), shape (1:2)
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What may it mean if you see a venous pattern on the cest?
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it may be a tumor
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What will you palpate on a respiratory inspection/assessment?
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position of trachea, costal angle (should be less than 90 degrees), pulsations, asses, tenderness, thoracic expansion (anterior and posterior), tactile fremitus, spinal position, diaphragmatic excursion
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When might the costal angle widen?
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in pregnancy
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How do you assess tactile fremitus?
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have the patient say 99 repeatedly, feel vibrations, should be symmetrical
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When will tactile fremitus be increased?
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in pneumonia, due to mucous transmitting sound
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When will tactile fremitus be decreased unilaterally?
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pneumothorax, pleural effusion, bronchial obstruction, atelectasis
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When will tactile fremitus be decreased bilaterally?
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COPD, chest wall thickening d/t fat or muscle
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What is the sound of percussion over a solid organ?
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dull
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What is the sound of percussion over a structure with air inside the tissue?
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resonance
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What is the sound of percussion over hollow spaces?
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tympanic
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What is the sound of percussion over bone?
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flat
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What is the sound of percussion normally heard over the lungs?
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resonance
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What is the order of percussion in the lungs?
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Right to left, apices to base (like a ladder)
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Where do you hear bronchial breath sounds?
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over the trachea
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Where do you hear bronchovesicular breath sounds?
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over the mainstem bronchi
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Where do you hear vesicular breath sounds?
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over the lung periphery
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What triggers respirations?
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the respiratory center in the brainstem, cellular demands, and mostly, carbon dioxide
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What occurs on inspiration?
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the diaphragm contracts and flattens, pulling the lungs down
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500-800 mL of air enters the lung
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What occurs on expiration?
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it is passive and the lungs and diaphragm recoil
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What do vesicular lung sounds sound like?
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soft, low-pitched, heard over fine airways/peripheral lung
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What do bronchial lung sounds sound like?
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loud, high-pitched, heard over trachea
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What is the mechanism and causes of crackles in the lungs?
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M: excess airway secretions and deflated small airways/alveoli
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C: bronchitis, respiratory infections, pulmonary edema, atelectasis, fibrosis, CHF
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What is the main mechanism and cause of wheezing in the lungs?
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M: rapid airflow through an obstructed airway (larger airways)
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C: asthma, P. edema, CHF, bronchitis
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What is the main mechanism and cause of rhonchi in the lungs?
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M: transient airway plugging
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C: pneumonia, bronchitis
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What is the main mechanism and cause of pleural rub in the lungs?
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M: inflammation of the pleura
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C: pleuritis
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What is the main mechanism and cause of stridor in the lungs?
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M: partial blockage of aiway from an object or inflammation; can be life threatening
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C: croup, aspiration, epiglottitis
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When should you ausculatate voice sounds?
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when tactile fremitus abnormal, when adventitious sounds present, or when dullness is percussed
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What are the 3 methods of voice sounds?
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A. Bronchophony (99)
B. Egophony (ee) c. Whispered pectoriloquy (123) |
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What are some Dx tests you might order for CC of resp. origin?
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CBC (WBC), ABG, CXR, V/Q scan, CT, Pulm. fxn tests, O2 sat
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How long is the newborn's chest?
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the same circumference as the head until age 2
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What occurs in the newborn's lungs with age?
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increase in the size of airway and number of alveoli
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What are some health promotion tips for a newborn lungs?
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use a bulb syringe for clearing nose/mouth, learn CPR
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What occurs in the geriatric lungs?
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loss of elasticity, atrophy of alveoli, decreased muscle tone, increased susceptibility to infection, and decrease in vital capacity/skeletal changes
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What are some health promotion tips for respiratory in the elderly?
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Pneumonia vaccine after age 65, maintain physical activity, health screenings for TB and CXR
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What is the infant chest look like?
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1:1 ratio with resps of 30/min at rest and 60/min with crying
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What babies are at high respiratory risk?
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premature, SGA, respiratory support
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What are signs of resp. distress in infants?
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nasal flaring, retractions, grunting (audible expiration)
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What is some health promotion for the babies at risk for lung issues?
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parents should stop smoking, learn signs of resp. distress, learn to clean infant's nose with bulb syringe, get immunizations, breast feed, back to sleep, and prevent suffocation
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What is the leading cause of death in the US
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cardiovascular disease
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What is the flow of blood through the body
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Through the sup. vena cava into the right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, lungs, pulmonary vein, left atrium, mitral valve, left ventricle, aortic valve, aorta, body
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What is the electric pathway through the heart?
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SA node, AV node, Bundle of His, Bundle Branches, Purkinje fibers
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Where is the aortic area?
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2nd ICS right sternal border
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Where is the pulmonic area?
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2nd ICS left sternal border
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Erbs point
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3rd ICS left sternal border
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Where is the tricuspid area?
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4th ICS left sternal border
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Where is the mitral area?
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5th ICS Left midclavicular line
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Where is the apex?
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down at the tricuspid and mitral valves; where you hear S1 loudest
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Where is the base?
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up towards aortic and pulmonic valves, where you hear S2 loudest
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What occurs at S1
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closure of tricupsid and mitral valves, loudest at apex
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What occurs at S2
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closure of the aortic and pulmonic valves; heard loudest at base
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When can the opening of heart valves be heard?
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if they are damaged
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What is an opening snap?
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a sound heard when a narrowed/stenotic AV valve opens during diastole
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What is an ejection click?
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the opening of a narrowed/stenotic semilunar valve during systole
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Where is an ejection click heard?
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at the base/ aortic and pulmonic valves
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Where is an opening snap heard?
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at the apex; mitral and tricuspid valves
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What is arterial blood pressure
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the lateral pressure exerted by a column of blood against the arterial wall
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What is BP dependent on?
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volume of blood ejected, velocity of blood, distensibility of arterial wall, viscosity of blood, and pressure within the vessel after ejection
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What is normal BP
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Less then 120/80
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What is pre-hypertension
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120-130/80-89
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What is stage 1 hypertension?
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140-150/90-99
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What is stage 2 hypertension?
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>160/>100
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What are important s/s in a review of systems for Cardiac
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chest pain, palpitations, dyspnea, syncope, fatigue, dependent edema, hemoptysis, cyanosis
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What is the most important symptom of CV disease?
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chest pain
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What are some differential diagnoses for chest pain
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cardiac, pulmonary, intestinal, gallbladder, MSK
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Describe anginal chest pain?
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retrosternal, diffuse, left arm/jaw/back, aching, dull, pressing, squeezing, milkd to severe, lasts minutes, precipitated by effort, emotion, eating, or cold, relieved by rest and nitro
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If it is angina, it should never last longer than...
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20 minutes
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What are some common causes of cardiac related chest pain
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CAD, aortic valvular disease, pulm. htn, mitral valve prolapse, pericarditis
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What are some common causes of vascular chest pain
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dissection of the aorta
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What are some common causes of pulmonary chest pain
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PE, pneumonia, pleuritis, pneumothrorax
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What are some common causes of MSK related ches pain
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costochondroitis, arthritis, muscle spasm, bone tumor
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What are some common causes of neural related chest pain
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herpes zoster (pain may come before the rash)
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What are some common casess of GI related chest pain
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ulcer disease, bowel disease, GERD, pancreatitis, hiatal hernia, cholecystitis
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What are some common causes of emotional related chest pain
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anxiety or depression
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What are some common causes of palpitations
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thyrotoxicosis, hypoglycemia, fever, anemia, pheochromocytoma, anxiety, caffeine, tobacco, drugs, panic disorders
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What occurs with paroxysmal nocturnal dyspnea
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waking up from sleep in the supine position from SOB
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What is orthopnea
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the need to sleep with pillows; dyspnea when lying flat
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What do you ask if a patient has dyspnea?
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how many level of blocks or stairs can they walk
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What is trepopnea?
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SOB less while lying on side
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What are some cardiac causes of dyspnea
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LV failure, mitral stenosis
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What are some pulmonary causes of dyspnea?
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obstructive disease, asthma, restrictive diseases, PE, pulmonary hypertension
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What are some emotional causes of dyspnea
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anxiety
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What do you ask if a patient reports syncope
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Were you doing anything before this? What position were you in? Did you have any other symptoms? Do you see an aura?
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What is syncope
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fainting d/t inadequate cerebral perfusion
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What are some common causes of cardiac related syncope
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cardiac rhythm disturbance
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What are some common causes of metabolic related syncope
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hypoglycemia, hyperventilation, hypoxia
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What are some common causes of psych related syncope
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hysteria
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What are some common causes of neuro related syncope
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epilepsy, CVA
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What are some common causes of syncope d/t orthostatic hypotension
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low fluid volume, antidepressant meds, antihypertensive meds, BPH meds
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What are some common causes of cough related syncope
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chronic lung disease
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What is a common, vague complaint of cardiac issues
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fatigue
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What may be some causes of fatigue
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depression, anxiety, anemia, heart disease, chronic disease
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What occurs with edema in CHF patients?
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it is symmetrical and dependent and worsens as the day goes on
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What is hemoptysis
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coughing up blood
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What is a cardiac cause of hemoptysis
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mitral stenosis, d/t rupture of the bronchial veins d/t high pressure
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What may a dry, hacking cough be a side effect of?
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ACE inhibitors
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When is cyanosis a common sign of heart disease
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in pediatrics
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What might you assess in inspection for cardiac
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general appearance, skin color, nails, face/eyes/mouth for cyanosis, neck, chest, extremities
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What is ortho hypotension
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drop in systolic BP of 20 mmHg or more in response to dizziness or syncope when standing
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How to rule out supraclavicular aortic stenosis
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increased BP in right arm but not same reading in left arm
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How to check for coarctation of the aorta
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if BP is elevated in arms, check in the legs. If the leg is lower than the arm, this is positive for possible coarc
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How to check for cardiac tamponade
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If pt has a low BP and a rapid pulse, look for pulsus paradoxus (a fall in systolic BP during inspiration that is greater than 10 mmHg)
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What is cardiac tamponade a s/e of
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pulling pacer wires
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What is pulsus paradoxus
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fall in systolic BP greater than 10 mmHg during inspiration
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What should you do before palpating carotid arteries?
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auscultate for bruits
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How should you assess JVD?
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check on the right internal jugular at a 30-45 degree angle with penlight or tangential lighting
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How do you check hepatojugular reflex?
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abdominal compression; place pressure over the liver and the neck will distend
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What may be the cause if the PMI is misplaced laterally, instead of the 5th ICS LMCL
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it may mean cardiomegaly
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How do you assess cardiac for thrills?
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with ulnar surface of hands
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How do you assess cardiac for heaves or lifts?
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with palm or fingers
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What are the four positions for cardiac auscultation?
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sitting, leaning forward, lying, and left lateral recumbent
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What do you listen to with the heart when patient is lying?
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All areas with bell and diaphragm
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What do you listen to with the heart when patient is in left lateral recumbent?
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listen to Tricuspid and mitral with the bell
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What do you listen to with the heart when patient is sitting up?
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all areas with bell and diaphragm
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What do you listen to with the heart when patient is leaning forward?
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Tricuspid and mitral with the diaphragm
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How do you describe murmurs?
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with timing, location, radiation, duration, intensity, pitch, quality, relationship to respiration, and relationship to body position
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What are some abnormalities of the first heart sound/ S1 (apex)?
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rate of rise of ventricular pressure, condition of valve, position of valve, distance of heart from chest wall
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What are some abnormalities of the second heart sound/ S2 (base)?
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changes in systolic pressure, condition of valve, splitting of S2 (associated with inspiration)
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What are some reasons for an S3 heart sound?
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pathologic, marker of ventricular overload or systemolic function; common with CHF; heard in early diastole, hooked onto end of S2
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When do you hear S3 sound?
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early diastole, hooked onto end of S2
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When do you hear S4
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late in diastole, hooked onto the beginning of S1
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What is S4
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pathologic; marker of poor diastolic function; most often in poorly controlled HTN or recurrent ischemia
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S3 is commonly due to...
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CHF
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S4 is commonly due to...
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HTN
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When do ejection clicks occur?
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early or middle of systole, at the aortic or pulmonic semilunar valves
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When do midsystolic clicks occur?
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with mitral valve prolapse at the Apex
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Where do ejection clicks occur?
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at the base (semilunar, A and P)
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Where do you hear opening snaps?
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AV valves; mitral stenosis; at the apex
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When do you hear a murmur?
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when there is turbulent energy in the walls of the heart and blood vessels; systole or diastole
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What is a stenotic murmur?
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due to valves not opening; hardened; likely from plaque
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What is a regurgitation murmur?
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valves not closing
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What is a grade 1 murmur?
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lowest intensity, often not heart by inexperienced; very faint
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What is grade 2 murmur?
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low intensity, usually audible by inexperienced
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What is grade 3 murmur
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medium intensity without thrill, as loud as S1 or S2
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What is grade 4 murmur?
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medium intensity WITH a thrill
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What is grade 5 murmur?
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loudest murmur that is audible with steth; associated WITH a thrill
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What is grade 6 murmur?
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loudest intensity, audible with steth is removed from chest; associated WITH a thrill
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When will you feel a thrill with a murmur?
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Grades IV-VI
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What are arteries?
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high pressure and receive blood
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What are veins?
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low pressure, have valves, return blood to heart
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What are common s/s with per. vascular issues?
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pain, change in skin temperature and color, edema, ulceration, emboli, stroke, dizziness
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What is a common issue in men with peripheral vascular?
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erectile dysfunction; may be d/t blockage of femoral artery
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What is intermittent claudication
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pain in lower extremity during exercise (calf, arch of foot, thighs, hips, buttocks); site of pain distal to occlusion
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What is Leriche syndrome
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chronic aortoiliac obstruction that causes intermittent claudication and erectile dysfunction
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What will skin be like with arterial insufficiency?
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cool and pale; nonhealing ulcers
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What will skin be like with venous insufficiency
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warmer than usual; blood pooling
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What is DVT
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red, swelling, warm; 2cm difference in extremities at ankle or midcalf
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When is lymphedema common
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after breast surgery or lymphedema
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What is ulceration
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persisent ichemia of a limb that can lead to gangrene
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What is the most important cause of a thrombus formation?
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venous stasis
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What are secondary s/s to emboli
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SOB (with PE), abd pain (splenic, intestinal or renal artery), neuro symptoms (if carotid or vertebrobasilar artery), pain and parethesias (if per. artery)
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Where is the epitrochlear node and how do you feel lit?
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in the groove of the elbow; have pt flex elbow 90 degrees and feel in groove; should NOT be palpable
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What does it likely mean if epitrochlear node is palpable?
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acute infections or non-hodgkins lymphoma
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What are the 5 "P" signs of arterial occlusion?
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pain, pallor, paresthesia, paralysis, pulselessness
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What is DVT s/s
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unilateral, marked swelling of lower extremity with redness, pain, warmth and tenderness (change in calf size to baseline)
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What are the 3 color changes of Raynauds?
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1. Pallor/White- artiospasm and decreased blood supply
2. Cyanosis/ Blue- increased peripheral extraction of oxygen 3. Rubor/Red- return of blood supply |
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What is gangrene
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necrosis of deep tissues resulting from decreased blood supply
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What occurs in cardio and peripheral vascular with age?
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Decreased elasticity of aorta; regurgitant or stenotic valves; degeneration of conduction system; arrthymias (afib), hypertension, risk in systolic pressure w/o diastolic rise
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What may cause angina, MI, or fatigue in elderly
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coronary atherosclerosis
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What are some CV labs you might draw?
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Troponin, CPK-MB, CBC w/ diff, CMP, O2, PT/INR, Mg, lipid
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What are some diagnostic CV tests?
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echo, EKG, CXR, carotid doppler, periperal doppler, tilt study, CT abdomen, sleep study, 24 hour BP monitor. 24 hour Holter, 30 day event recorder, angio
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What are some CV drugs
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antihypertensives, beta blockers, nitrates, ARBs, ACE inhibitors, antiarrythmics, coumadin, pradaxa, plavix, aspirin, statins, fenofibrates, niacin
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Who can NOT have pradaxa?
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those with a valve issue
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What are some educational topics about CV disease
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low sodium cardiac diet, aerobic exercise, BP management, side effects of meds, cardiac rehab
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What should you do if taking Beta blocker?
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sit up slowly
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What are some health maintenance tips for cardiac
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weigh loss/BMI (decrease in 5 pounds lowers BP by 10 points), stop smoking
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What organs are located in the LUQ
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spleen, stomach, body of pancreas, kidney, transverse and descending colon
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What organs are located in the LLQ
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kidney, sigmoid colon, ovary/fallopian tube
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What organs are located in the RUQ
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liver, gallbladder, duodenum, head of the pancreas, kidney, ascending and transverse colon
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What organs are located in the RLQ
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kidney, cecum, appendix, ascending colon, ovary/fallopian tube
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What is the #1 abdominal complaint?
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gastritis (LUQ)
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Where will you feel pain with cholecystitis?
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RUQ and referred scapula pain
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Where will you feel pain with pancreatitis?
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Upper quadrants and shoulders
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If they have lower quadrant pain, what should you ask?
|
LMP? Any pregnancies? It may be pregnancy related, ovary torsion/twisting, dysmenorrhea
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What should you ask if a male patient has abdominal pain and is older?
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his voiding history
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Which quadrants of the abdomen are flexible and may change with eating?
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lower quadrants
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What are the 3 savlivary glands?
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Parotid- empties into Stenson duct
Sublingual- empties into Wharton's duct Submandibular- |
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What occurs in the mouth?
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mechanical digestion, carbohydrates are broken down
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What does saliva do?
|
lubricates for speech and swallowing and cleans teeth and breaks down food
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What is the pH of the esophagus?
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alkaline; pH 6-8
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What is a large issue with the esophagus?
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GERD
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What occurs in the stomach?
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chemical digestion
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What are some problems with the stomach?
|
peptic ulcer, gastritis, reflux, stomach CA
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Who is at higher risk for stomach cancer?
|
Asians
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What is the pH of the stomach?
|
acid, 2-4
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How much gastric juice does your stomach make each day?
|
2-3 liters
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When does food move into the duodenum?
|
about 2-4 hours after eating
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How long does it take for the stomach to empty?
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6 hours
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What occurs mainly in the small intestine?
|
absorption of nutrients
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What is the order of the small intestine?
|
Duodenum, Jejunum, Ileum, Ileoceccal valve
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What happens when food enters the duodenum from the stomach?
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pancreatic enzymres are stimulated and the gallbladder contracts to release bile
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What occurs in the large intestine?
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water and electrolytes are absorbed and stool is formed
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Where is the liver located?
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RUQ
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What is the largest solid organ in the body?
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liver
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Where is the liver normally?
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from the 5th rib to 1-2 cm below the right costal margin
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What are the functions of the liver?
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glucose storage, metabolism of proteins, lipids and carbs, production/secretion of bile, production of clotting factors, and detoxification
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What are the 3 ways to assess the size of the liver?
|
1. to feel for percussion of the liver span
2. Scratch test 3. Hook the liver |
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What do you do to assess liver span?
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Start at MCL, percuss for resonance and move down til turns dull. Then begin at umbilicus and percuss upward until dull
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Where is the pancreas located?
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RUQ & LUQ
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What is the exocrine function of the pancreas?
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secrete bicabonate and pancreatic enzymes
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What is the endocrine function of the pancreas?
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to secrete hormones of insulin and glucagon
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Where is the spleen located?
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LUQ
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What is the largest lymph organ in the body?
|
spleen
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What does the spleen do?
|
act as a reservoir for red blood cells and filters old RBCs and platelets
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What happens with mono?
|
the spleen gets enlarged
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Where is the appendix?
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RLQ
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What does the appendix do?
|
fill with digestive material from the cecum
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What happens if the appendix does not empty completely?
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it becomes obstructed of infected
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Who most commonly gets appendicitis?
|
those under age 20 or the elderly
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What does the gallbladder do?
|
stores and concentrates bile produced by the liver and releases it into the duodenum when stimulated
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Where are the kidneys?
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T4-L3
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What will help tell if kidneys are inflamed?
|
testing for CVA tenderness
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Some questions to ask in abdominal health history:
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medications, bowel habits, enema use, stool color and consistency, hemorrhoids, bleeding, N/V/D
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What is description of GERD
|
gastric secretions emptying into the esophagus
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What is the etiology of GERD
|
increased intra-abdominal pressure
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What are clinical findings with GERD?
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heartburn
regurgitation dyphagia |
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What is the description of a hiatal hernia?
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Protrusion of the stomach through the esophagus
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What is the etiology of a hiatal hernia?
|
weekend abdominal muscles
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What are clinical findings with hiatal hernia?
|
heartburn, regurgitation, dysphagia
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What is the description of peptic ulcer disease
|
ulcer in the esophagus, stomach, or duodenum
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What is the etiology of peptic ulcer disease
|
H. pylori, stress, or medications
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What are clinical findings with peptic ulcer disease
|
Pain 1-4 hours after eating; relieved by antacids
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What is a description of crohn's disease
|
chronic bowel inflammation; narrowing of the lumen; mucosa ulcerated and forming fistulas
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What is the etiology of Crohn's Disease
|
Unknown
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What are clinical findings with Crohn's Disease
|
Severe CRAMPING abdominal pain, diarrhea, weight loss, can affect ANY area of GI
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What is the description of ulcerative colitis
|
chronic inflammatory bowel disease that starts in the rectum to the large intestines
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What is the etiology of ulcerative colitis
|
unknown
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What are clinical findings with ulcerative colitis
|
severe abdominal pain, fever, chills, anemia, weight loss, bloody stools
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What is the description of diverticulitis?
|
herniations in the muscular wall of the colon with inflammation and abscesses
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What is the etiology of diverticulitis
|
unknown
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What are clinical findings with diverticulitis?
|
LLQ crampy pain, N/V, constipation, distended abdomen, decreased bowel sounds, fever
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How can you diagnose divertilicutis
|
CT scan or colonoscopy
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What are signs of hepatitis?
|
N/V, anorexia, jaundice, clay colored stools, fatigue
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How do you get Hep. A?
|
bathrooms, dirty food/water, travel
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How do you get Hep. B
|
drugs, sex
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How do you get Hep C
|
usually healthcare related or drug users
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What is the description of hepatitis
|
inflammation of the liver
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What is the etiology of hepatitis
|
viral
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What are s/s of hepatitis?
|
Anorexia, vague abdominal pain, N/V, enlarged liver, jaundice, clay-colored stool, dark amber urine
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What is the description of cirrhosis?
|
chronic degenerative disease of the liver; lobes become infiltrated with fat
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What is etiology of cirrhosis?
|
usually alcoholism, biliary obstruction, or hepatitis
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What are clinical findings with cirrhosis?
|
liver hardening, ascites, jaundice, clay colored stools, dark amber urine
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What is the description of cholecystitis?
|
inflammation of the gallbladder, chloelithiasis (gallstones)
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What is the etiology of cholecystitis?
|
gallstone obstruction
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What are clinical findings with cholecystitis?
|
RUQ colicky/spasming pain that radiates to the right scapula, indigestion
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What is the description of pancreatitis?
|
inflammation of the pancreas from autodigestion
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What is the etiology of pancreatitis?
|
untreated gallstone obstruction or alcoholism
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What are clinical findings associated with pancreatitis?
|
steady boring, sharp pain that radiates to the back, N/V, weight loss, glucose intolerance, epigastric pain that radiates; feels better when sitting up and forward
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What makes pancreatitis pain better?
|
sitting up and forward
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What hurts the most with pancreatitis pain?
|
lying down
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What is the description of a UTI
|
inflammation of the bladder
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What is etiology of UTI
|
gram negative organisms
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What are clinical findings with an UTI
|
frequency, urgency, dysuria
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|
When should you begin screening for colorectal cancer?
|
at age 50 (or 45 if African American)
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What is the preferred screening for colorectal cancer detection?
|
colonoscopy
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|
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What are alternate screenings for colorectal cancer?
|
fecal immunohistochemical testing yearly, CT colonography every 5 years, or flex sig every 5 years
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|
Who is at highest risk for GI cancers?
|
Males, over the ages of 50-60, those who smoke and drink alochol
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|
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What are risk factors for esophageal cancer?
|
males, ages 70-80, African American, smoking, alcohol, deficiencies of fruits and veggies, Barrett's esophagus
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What are risk factors for stomach cancer?
|
Males, over age 65, Asians, Hispanics, African-Americans, smoking, alcohol, diets high in smoked foods, and those with H. pylori
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What are risk factors for colon cancer
|
males, age over 50, Jewish, smoking, alcohol, diets high in animal fat, those with diabetes
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Who are at high risk for liver cancer?
|
males, over age 65, smoking, alcohol, and hepatits or cirrhosis
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|
|
Who are at risk for pancreatic cancer?
|
males, ages 60-80, smoking, diet high in meat and fats, those with diabetes
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|
|
Who are at risk for bladder cancer?
|
males, age over 68, caucasians, smoking, diet with contaminates in fluids, chronic bladder inflammation
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|
What is a description of parietal pain?
|
steady aching, worsened by position change or cough and rebound tenderness
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|
Describe pain in the visceral peritoneum?
|
covers organs, described as diffuse, gnawing, crampy, aching, sharp, throbbing, can be pointed to
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What is obturator muscle test?
|
test for appendicitis; patient lying supine, flex R knee and internally rotate the hip, causes pain
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|
What is the ileopsoas sign?
|
Have patient lay supine, raise the Right leg against resistance or roll on the Left side and extend the Right leg back/hyperextend and it will cause increased RLQ pain
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|
What is rebound tenderness?
|
test for appendicitis or parietal pain- press the abdomen and let go, pain on release
|
|
|
What is Rovsings sign?
|
test for appendicits; press into the LLQ and pain will increase in the RLQ
|
|
|
What is Kehr's sign?
|
test for spleen problems; lift arm above the head, you will feel LUQ pain
|
|
|
What is the order for the abdominal assessment?
|
inspect, auscultate, percuss, palpate
|
|
|
What is murphy's sign?
|
test for gallbladder problems, push on the gallbladder while the patient is taking deep breath and pain will cause breathing to stop
|
|
|
What are some reasons, starting with "F", that the abdomen will be rounded?
|
fat, flatulence, fetus, fluid, fibroid tumor, feces
|
|
|
What may a venous pattern on the abdomen mean?
|
portal hypertension
|
|
|
What should you do if you suspect a hernia?
|
ask the patient to raise his/her head and shoulders off the table and cough; the bulge of a hernia will usually appear with this action
|
|
|
What is a sign of internal bleeding on the abdomen?
|
Cullen's sign; blue umbilicus
|
|
|
How long must you listen before you make bowel sounds as absent?
|
5 minutes
|
|
|
Where will you listen to the abdomen with the bell and what are you listening for?
|
bruit- abdominal aorta, renal arteries, iliac arteries, femoral arteries
venous hum- umbilicus |
|
|
Where will you listen for a friction rub?
|
over the liver and spleen
|
|
|
What is Ballance sign?
|
You should hear tympany over the LUQ. If you percuss and hear a dull sound, it may be that the spleen is enlarged, and this is a positive Ballance sign
|
|
|
What sounds do you normally hear with percussion over the stomach and intestines?
|
tympany
|
|
|
Where do you normally percuss dullness in the abdomen?
|
in the abdominal organs and a distended bladder
|
|
|
How do you do the liver scratch test?
|
place steth diaphragm over the RUQ liver, start to scratch in RLQ and move upward. Make when sound becomes louder. Mark all areas of the liver to determine size.
|
|
|
How do you test liver span?
|
start at R MCL 3rd ICS and assess when it changes from resonance to dull and mark it.
Then start at R MCL at umbilicus moving up, check when it changes from tympany to dull and mark it. Measure the spaces, and this is liver span. Should be 6-12 cm |
|
|
What is normal liver span?
|
6-12 cm
|
|
|
What do you percuss the kidneys for?
|
pain/CVA tenderness
|
|
|
When is a pulsation in the abdomen okay?
|
2 cm is okay, 4 cm is still sometimes okay, 5 cm we intervene
|
|
|
How do you check rebound tenderness?
|
press hand firmly into abdomen and then release
|
|
|
How do you check McBurney's point?
|
rebound tenderness at the RLQ 1/3 distance from the iliac crest to the umbilicus
|
|
|
How do you test cutaneous hypersensitivity?
|
gasp a fold of skin or touch the abdomen with an open safety pin
|
|
|
What occurs in the abdomen with age?
|
abdominal muscles diminish in mass and tone, fat increases, GI motility slows and absorption is altered, decreased acid, increased malignancy, changes in bowel habits
|
|
|
What is a healthy waist circumference?
|
women less than 35 inches; men less than 40 inches
|
|
|
What are some tests/labs you would do for abdominal assessment?
|
CBC with dif (any -itis)
Chem panel (kidneys) Amylase/lipase (pancreas) UA/HCG (if preg/female) Stool culture (diarrhea, travel) EKG- UQ/epi pain Films- Xray to r/o air in the bowel US Abdominal CT- highest diagnostic yield Colonoscopy- lower bowel |
|