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Assessment test 2
thorax, lungs, cardiac, abd, peripheral vascular
| Question | Answer |
|---|---|
| Land marks for thoracentesis | T7-8 interspace |
| Which intercostal space used for insertion of needle for tension pneumothorax? | 2nd intercostal space |
| What is the lower margin of ET tube on chest x-ray? | T4 |
| This causes episodic dyspnea during rest and exercise, hyperventilation, and rapid shallow breathing. | Anxiety |
| Caused by partial airway obstruction r/t secretions, tissue inflammation of asthma, or foreign body. | Wheezing |
| Most common cause of acute cough | Viral URI |
| Acute bronchitis, pneumonia, L ventricular heart failure, asthma, or foreign body cause _______ cough. | acute |
| Post-infection, bacterial sinusitis, and asthma cause ________ cough. | subacute |
| Post-nasal drip, asthma, GERD, chronic bronchitis, bronchiectasis cause _______ cough. | chronic |
| causes large volumes of foul-smelling purulent sputum | anaerobic lung abcess |
| high pitched wheeze, ominous sign of upper airway obstruction in larynx or trachea | Stridor |
| causes of asymmetrical expansion: | pleural effusion, chronic fibrosis, lobar pneumonia |
| COPD, obstructed bronchus, effusions, fibrosis, pneumothorax, or infiltrating tumor _______ fremitus. | decrease |
| percussive dullness is normal over ______. it is heard over _____ abnormally when filled with fluid in disease states such as pneumonia, effusions, hemothorax, empyema, or tumor. | visceral organs, lungs |
| percussive sound of healthy lungs | Resonant |
| bilateral Hyper-resonance is typically heard in diseases such as: | COPD & asthma |
| unilateral hyper-resonance is possibly a: | pneumothorax or large air-filled bulla |
| Hair on the chest can cause false sounds of: | crackles |
| Breath sounds: hear over most of lung, inspiratory sounds are longer than expiratory, soft intensity, low pitch | vesicular |
| Breath sounds: heard over 1st and 2nd interspaces and between scapula, inspiratory and expiratory are equal duration, intermediate intensity and pitch | Broncho-vesicular |
| Breath sounds: heard over manubrium, expiratory sounds are longer than inspiratory, loud intensity and high pitch | Bronchial |
| Breath sounds: heard over trachea, equal inspiratory and expiratory, loud and high pitched | tracheal |
| fine late inspiratory crackles that persist suggest: | abnormal lung tissue |
| Rhonchi suggest secretions where: | large airways |
| Louder voice sounds when saying "ninety-nine" during auscultation | bronchophony |
| Louder, clear whispered sounds | whispered pectoriloquy |
| symmetrical lung expansion, resonant, vesicular breath sounds, diaphragm descends 4 cm bilaterally; indicates: | normal findings |
| thorax symmetrical moderate kyphosis, increased anteroposterior diameter, decresed expansion, hyper-resonant, breath sounds distant with delayed expiratory phase, scattered expiratory wheezes, decreased fremitus, diaphragm descends 2cm; this suggests: | COPD |
| productive cough, possible scattered crackles, may have wheezes or rhonchi; indicates | chronic bronchitis |
| edematous bronchial mucosa, late inspiratory crackles in dependent lungs, possible wheezing; indicates: | L-sided heart failure |
| Dull percussion, bronchial sounds over involved area, late inspiratory crackles of involved area, increased fremitus with bronchophony, egophony, and whispered pectoriloquy | Consolidation: alveoli fill with blood or fluid. ie pneumonia, pulmonary edema, pulmonary hemorrhage |
| dull percussion, trachea shifted to involved side, usually absent breath sounds and fremitus of affected side. | atelectasis |
| dull percussion, trachea shifted to opposite side, breath sounds and fremitus decreased or absent | effusion |
| hyper-resonant or tympanic percussion, trachea shifted to opposite side, breath sounds and fremitus decreased to absent | pneomothorax |
| resonant to diffusely hyper-resonant, breath sounds obscured by wheezes, possible crackles, decreased fremitius. | asthma |
| name that murmur: midsystolic, 2nd-4th intercostal, little radiation, soft/medium pitch, grade 1-3, disappears when sitting | innocent murmur |
| name that murmur: midsystolic, s2 possibly decreased, 2nd R intercostal, radiates to the carotid, soft or loud intensity, crescendo-decrescendo, harsh quality | aortic stenosis |
| name that murmur: mid-systolic, 3rd & 4th interspace, radiates LSB, variable intensity, harsh, medium pitch, decreased with squatting, presence of S4 | Hypertrophic cardiomyopathy |
| name that murmur: mid-systolic, 3rd & 4th interspace, radiates when loud to L shoulder/neck, harsh quality, medium crescendo-decrescendo pitch | pulmonic stenosis (RARE) |
| name that murmur: pansystolic, heard at apex, radiates to axilla, apical thrill, medium high pitch, harsh | Mitral regurgitation |
| name that murmur: lower LSB, radiates to right of sternum, variable intensity, medium pitch, blowing, increased intensity with inspiration. | tricuspid regurgitation |
| name that murmur:diastolic, 2nd to 4th intercostal, radiates if loud, no thrill, high pitched, grade 1-3, best heard while pt sitting leaning forward, and holding breath after exhalation | aortic regurgitation |
| name that murmur: diastolic, apex, no radiation, grade 1-4, decrescendo, low pitch, turn pt left lateral, heard best during exhalation, opening snap preceding s2 | mitral stenosis |
| unpleasant awareness of breathing | dyspnea |
| unpleasant awareness of heart beating | palpitations |
| Sounds like "Tennessee" | S4 |
| Sounds like "Kentucky" | S3 |
| Pain: occurs when hollow organs contract forcefully or are distended, stretching of capsule of solid organs, difficult to localize, stimulated by ischemia, described as gnawing, burning, cramping. can be associated with sweating, pallor, n/v, and restles | Visceral |
| Pain: occurs r/t inflammation, steady aching pain, aggravated by movements esp. coughing, precisely located over involved structures | parietal |
| Pain: occurs in distant sites that are innervated by the same spinal level, develops as initial pain increases, can be superficial or deep | referred |
| visceral pain in the RUQ may result from liver distention against its capsule in | alcoholic hepatitis |
| _______ is a subjective negative feeling that is nonpainful and can include bloating nausea upper abd fullness adn heartburn | discomfort |
| burning pain/sensation in epigastric chest, after fatty meals, worse when lying down or being physically active. Antacids, theophylline, and CCB releive. may have wheezing and cough | GERD |
| epigastric pain that radiates to the back, gnawing burning aching, wakes pt up at night, present for weeks disappears for months reappears. Relieved by food. sx: n/v bloating heart burn weight loss | peptic ulcer and dyspepsia |
| pain in "cardia" and GE junction, slow persistent, aggravated by food, not relieved by food or antacids. sx: anorexia, nausea, early satiety, weight loss, bleeding | Stomach Ca |
| periumbilical pain followed by RLQ pain mild to severe w/ cramping, aggravated by movement or cough, low fever, n/v anorexia | acute appendicitis |
| epigastric or RUQ radiates to R scapula, steady achy, not colichy, rapid onset last several hours resolves gradually, recurrent, SX: anorexia, n/v, restlessness | biliary colic |
| RUQ or upper abd, radia to right scapula, steady aching, gradual onset, aggravated by deep breathing and jarring, SX: anorexia n/v, fever | acute cholecystitis |
| steady pain in epigastric radiating to back or other abd areas, poorly localized, acute onset, persistent, aggravated by lying supine, relieved by flexing truck and leaning forward, SX: n/v abd dist, hx etoh abuse | acute pancreatitis |
| steady deep pain in the epigastric area radiating to the back, chronic, aggravated by etoh or heavy fatty meals. lessened by flexing trunk but usually intractable. SX: steatorrhea, DM | chronic pancreatitis |
| deep epigastric pain radiates to back, persistent relentlessly progressive, pt flex trunk for relief, usually unretractable, sx: anorexia, n/v, jaundice depression | pancreatic CA |
| crampy steady LLQ pain, gradual onset, "left sided appendix", sx: fever constipation | diverticulitis |
| cramping of periumbilical or upper abd, sx: vomiting of bile and mucus or fecal material | small bowel obstruction |
| cramping of periumbilical or generalized abd, Sx: ob stipation, vomiting late in disease | colon obstruction |
| cramping then steady pain of periumbilical or diffuse abd, abrupt onset, persistent pain Sx: vomiting, diarrhea sometimes bloody, constipation, shock | mesenteric ischemia |
| chronic or recurrent discomfort or pain centered in the upper abd | dyspepsia |
| difficulty with solid foods r/t mechanical narrowing ex: mucosal rings and webs, esophogeal strictures, esophogeal CA | esophageal dysphagia |
| difficulty swallowing r/t motor disorders affecting the pharyngeal muscles | oropharyngeal dysphagia |
| difficulty swallowing solids and/or liquids ex: diffuse esophageal spasm, scleroderma, achalasia | motor disorders |
| increased abd pressure causes bladder pressure to exceed urethral resistance, poor urethral tone, momentary leakage of small amount of urine with coughing, laughing, and sneezing | stress incontinence |
| 4 drugs that cause constipation | anticholinergics, Ca++ channel blockers, iron, opiates |
| 6 disease states associated with constipation | diabetes, hypothyroidism, hypercalcemia, MS, parkinson's, systemic sclerosis |
| incontinence: urgency is followed by immediate involuntary leakage due to uncontrolled detrusor contractions that overcome normal urethral resistance | urge incontinence |
| incontinence: detrusor contractions are insufficient to overcome urethral resistance, neurological disorders or anatomical obstruction limit bladder emptying until bladder overdistedned | overflow incontinence |
| incontinence: inability to get to the toilet | functional incontinence |
| kidney pain, fever, chills= | acute pyelonephritis |
| a sharp increase in tenderness when stopping inspiration is a positive | murphy's sign |
| functional change in frequency or form of stool, unknow pathology; diarrhea predominant, constipation predominant, mixed. >3mo of abd pain, improvement with defecation, onset with change in stool frequency, onset with change of stool form/appearance | IBS |
| progressive narrowing of bowel lumen, associated with diarhea, abd pain, bleeding, occult blood in stool, weight loss, pencil shaped stools | Rectal CA |
| watery stool w/o blood, pus, or mucus. lasting a few days associated w/ n/v, periumbilical cramping pain, slight fever, often travel related, food source, or epidemic | secretory infection acute diarrhea |
| loose watery stool w/ blood, pus, or mucus, varying duration, associated with lower abd pain/cramping, rectal urgency, tenesmus, and fever | inflammatory infection acute diarrhea |
| inflammation of mucosa of rectum and colon with ulceration, soft/ watery stools often contain blood, may awaken at night mild cramping, lower or generalized abd cramping, anorexia, weakness, often in young people, increases risk of colon CA | ulcerative colitis |
| inflammation of bowel wall in skip pattern, small, soft, watery stools, little to no blood, diarrhea may wake pt at night, crampy periumbilical or RLQ pain, anorexia, low fever, wight loss, rectal abcesses, may lead to bowel obstructions, colon CA risk | crohn's |
| bulky soft, light yellow/grey stools, possibly mushy, oily, greasy, or frothy, floats in toilet, anorexia wight loss fatigue abd distention, crampy lower abd pain, nutritional deficiency sx | malalbsorption syndrome |
| black, tarry, shiny stools, occult pos. blood from esophagus, stomach, or duodenum (transit time 7-10 days)possibly r/t GERD, peptic ulcers, Mallory-Weiss tear, esophageal varices | melena |
| red blood in stools, originates in colon, rectum, or anus. | hematochezia |
| prolonged gurgles of hyper-peristalsis | borborygmi |
| these nodes drain the ulnar surface of the forearm and hand, little and ring fingers, and adjacent surfaces of hte middle finger | epitrochlear nodes |
| ankle brachial index of 0.60-0.89 | mild PAD |
| ankle-brachial index of <0.39 | severe PAD |
| Edema: soft, bilateral, pitting after 1-2 seconds of pressure. w/o skin thickening, ulcerations, or pigmentation. r/t dependent legs, prolonged sitting or standing, heart failure, nephrotic syndrome, cirrhosis | pitting edema |
| edema: soft, pitting on pressure, occasionally bilateral. brawny skin thickening, ulcerations, brownish pigment, r/t incompetent valves | chronic venous insufficiency |
| edema: soft then indurated hard and non-pitting. thickened skin w/o ulcerations or pigment changes | lymphedema |
| insufficiency: intermittent claudication, r/t tissue ischemia, decrease pulses, pale skin on elevation, dusky red when dependent, cool, mild edema, thin shiny atrophic skin with loss of hair/nails, may develop gangrene | arterial insufficency |
| insufficiency: painful, r/t venous htn, normal pulses but difficult to palpate, brown pigmentation in chronic state, normal temp, edema, thickened skin | venous insufficiency |
| kidney or spleen? notch is palpated on medial border, edge extends beyond midline dull percussion, finger can probe deep bwetween the medial and lateral borders, but not between the mass and costal margin | SPLENOMEGALY |
| preservation of normal tympany in LUQ, fingers can probe between the mass and costal margin but not deep in to its medial and lover borders | ENLARGED KIDNEY |
Created by:
kaFoster
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