Mod 3 Heart and Respiratory CH 6 and 7 Flashcards
A child has a systemic HTN, a murmur, and a weak pulses. Which cardiac defect is most likely associated?
a. Coarctation of the aorta
b. pulmonic stenosis
c. TOF
d. VSD
a. Coarctation of the aorta
Can go undetected in childhood and adult hood
key signs: systemic HTN with systemic murmur AND upper extremity pulses stronger than lower extremeity
Low calcium levels can result in EKG changes that include:
a. St segment elevation
b. ST segment depression
c. prolonged QT interval
d. Q waves
c. prolonged QT interval (asymptomatic or cause rapid heart rate, palpitations, dizzy, fainting)
certain medication (thiazides) can inc renal absorption and cause EKG changes Hypercalcemia = ventrical changes Hypocalcemia = prolonged qt
also high calcium can damage vessels = vascular calcification and turbulent blood flow
Patient is questioning the appropriate use of getting an US for a suspected Abdominal Aortic Aneurysm (AAA). How can the clinician reassure the patient that the US is necessary to diagnose an AAA?
a. Let the patient know that when used for suspected AAA it can decrease mortality
b. tell patient that it its the least invasive test and most accurate
c. Quickly change the subject
d. Ignore the question
a. Let the patient know that when used for suspected AAA it can decrease mortality
AAA- ballooning of the aortic wall predisposed to rupturing, need US to diagnosis
most commonly caused by atherosclerosis
**found by palpated mass on abdomen during exam, can be found to have a strong bounding pulse
if ruptured- pt will have severe pain followed by hypotension
When ausculating over the left second intercostal space, you hear S2 louder than S1. What should your response be?
a. Ask the patient to turn on left side to assess whether S2 sound changes
b. Consider this a normal finding and proceed with exam
c. continue the exam and refer the patient for additional cardiac evaluation
d. Expect that the S2 sound will muffle during inspiration
b. Consider this a normal finding and proceed with exam
S2 = indicates diastole, which requires closing of the semilunar valves (aortic and pulmonic). Which is typically heard at the base of the heart (top) where those valves are located
SIDE NOTE: S2 correlates with apical pulse
S1= indicates systole, which requires closing of the AV valves (mitral, tricuspid)
heard louder at the apex of the heart where those valves are located
Left lateral position where the left ventricle is closest to the chest wall where s3, s4 murmurs can be heard (mitral valve) s3, s4 ventricle problems
S3- ventricle gallop, heard at apex right after S2 does not vary with respiration consistent with volume overload problems
s4- right before s1 heard with bell atrial gallop and decrease ventricle and increase in after load.
A sound caused by turbulent blood flow that is heard over arteries is a?
a. bruit
b. Thrill
c. friction rub
d. heave
a. bruit (blowing or whooshing sound when listening)
Thrill-is vibratory sensation felt on the skin consistent with exaggerated murmur
heave- sign of left ventricle hypertrophy, pericardial movement found when palpating with heal of hand
this is abnormal should not feel movement
Where does S3 fall in the cardiac cycle?
a. throughout systole
b. throughout diastole
c. early diastole
d. late diastole
c. early diastole (s2)
s3 occurs early diastole r/t slow filling
Can be innocent (pregnancy, anemia and/or hyper volume states) or pathologic caused by decreased ventricle compliance. Sign of ischemia or HF *sounds like “kentucky”
does not vary with inspiration/expiration
innocent ones in children may change with positioning
s4 occurs late diastole caused by forceable atrial contraction in the presence of decreased ventricle compliance ( atrial gallop) sounds like a gallop
ventricle problem and problem with increased after load (LV hypertrophy)
s4 = almost always abnormal
s3 & s4 = heard best at apex of heart with bell (low pitch)
When during the the cardiac cycle is aortic regurgitation (AR) heard?
a. Throughout diastole
b. systole
c. neither systole nor diastole
d. diastole
d. diastole (relaxation)
diastolic murmurs = AR and mitral stenosis
systolic murmurs = Aortic stenosis, mitral and tricuspid regurgitation *heard between s1 and s2 during ventricle contraction
When is a split S2 sound considered normal?
a. Occurring with expiration and disappearing with inspiration
b. Occurring with inspiration and disappearing with expiration.
c. Occurs during inspirations and continues during expiration
d. disappears with a change in position
b. occurring with inspiration and disappearing with expiration
split S2 is semilunar valves either (aortic or pulmonic) closing slightly before one another (a2 or p2) heard best at base (top) b/w 2nd/3rd left ICS
Fixed split s2 -occurs during inspirations and continue through expiration= may indicate valve disorder
paradoxical split- disappears with inspiration but appears with expiration may indicate left bundle branch block
A PMI that movs laterally away from the mid clavicular line is most likely the result of which of the following? a. LV hypertrophy b ASD c. Aortic stenosis d. Pulmonary HTN
a. LV hypertrophy
Point of Maximal Impulse (PMI) = location at which the cardiac impulse can best be palpated * Apex, 5th intercostal space in the left mid clavicular line*
- tells us about the size of the heart!*
- tells clinician where to auscultate the apical pulse*
Also important when evaluating patients with HTN and CHF (increased LV end diastolic volume)
You are conducting an exam of Mr. C’s heart and blood vessels and auscultate a grade 3 murmur. the intensity of the murmur is?
a. Very loud without a stethoscope
b. moderately loud
c. loud with palpable thrill
d. barely discernible
b. moderately loud
Heart murmurs are described by Timing in the cardiac cycle, intensity grad, pitch, pattern, quality, location, radiation, posture
intensity = 6 grades
1= barely audible
2=clear but faint
3. moderate loud
4= loud with palpable thrill
5= very loud with portion of stethoscope off of chest and with thrill
6 = loudest heard with stethoscope off of chest
The carotid pulse coincides with which heard sound?
a. s1
b. s2
c. s3
d. s4
a. s1 = beginning systole
S2 = indicates diastole S3 = indicating early diastole either abnormal (ventiricle gollop) or normal (innocent in children) S4 = indicating late diastole (atrial gallop) almost aleays abnormal
What segment/interval on a EKG reading signals Ventricle depolarization?
a. P wave
b. T wave
c. QRS complex
d. PR interval
c. QRS complex
P wave - atrial depolarization
T wave - Ventricle re-polarization
What disorder/diagnosis is consistent with pitting edema spider/varicose veins and medial/lateral ankle lesions?
a. Peripheral Artery Disease (PAD)
b. DVT
c. Coronary Artery Disease (CAD)
d. Chronic Venous Insufficiency (CVI)
d. Chronic Venous Insufficiency (CVI)
CVI-condition caused by stasis and reflux of venous blood flow (immobility)
Cardinal symptom = pitting edema and lesions on medial/ lateral ankle
non pitting edema is a sign of lymphedema
PAD- atherosclerosis of the lower extremities, affect blood flow to lower legs similar to CVI
Hallmark sign is Intermittent claudification (IC) = calf pain with exercise that is relieved by rest
Other sx: weak pulses lower pulses, painful ulcers on toes and feet
DVT- Blood clot
hallmark sign is unilateral leg edema
other sx: red, cool, tender extremities, decreased pulses, positive Homan’s sign
CAD- thickening and loss of elasticity of arterial wall r/t plaque build up (artheromas) blocking blood flow to heart causes ischemia
atherosclerosis causes CAD
common sx is chest pain can be transient attacks or lead to MI, aneurysm
All of the following are considered symptoms of Heart Failure except:
a. Cough and Dyspnea on exertion
b. Jugular vein distention
c. cool extremities
d. pick-tinged sputum
c. cool extremities
Other: wt gain, fatigue
In bronchovesicular breath sounds heard over the middle of the chest.
a. inspiration is equal to expiration
b. inspiration is longer than expiration
c. the high pitch of the sounds indicates pneumonia
d. the low pitch of the sounds indicates brochitits
a. inspiration is equal to expiration
bronchovesicular are intermediate intensity and pitch usually heard over the main stem bronchi in the mid chest anteriorly. The duration of inspiration almost equals expiration with a 1:1 ratio
Breath sounds auscultated over the most of the peripheral lung fields bilaterally are called.
a. bronchial
b. bronchovesicular
c. tubular
d. vesicular
d. vesicular
vesicular breath sounds are soft intensity, low pitched, with a rustling quality during inspiration and softer with expiration. Heard over most peripheral fields bilat.
Breath sounds beast auscultated over the lower manubruium are called.
a. Tracheal
b. Bronchial
c. vesicular
d. bronchovesicular
b. Bronchial
Bronchial sounds are louder and higher in pitch. Heard over the lower aspect of the trachea, best heard over the manubrium
High-pitched, discontinuous sounds heard over small airways that are fluid filled are called.
a. stridor
b. crackles
c. wheeze
d. rhonchi
b. crackles
can either have fine ( high pitched, popping sound) or course discontinuous low pitched sounds that are louder and longer
crackles indicated abnormalities of the lungs or airways such as pneumonia, CHF or bronchitis
Continuous musical sounds that can be high or low pitched, usually heard during expiration are called.
a. stridor
b. crackles
c. wheeze
d. rhonchi
c. wheeze
Wheezes are heard because of narrowing of the airways caused by asthma, COPD, or bronchitis
high pitched they will sound squeaky
low pitch will sound moaning
both can be heard throughout lung fields
Loud high pitched sound caused by disrupted airflow heard typically during inspiration are called.
a. stridor
b. crackles
c. wheeze
d. rhonchi
a. stridor
Stridor is associated with an upper airway obstruction, when airflow cannot flow through the larynx. Can be caused by swelling associated with infection (epiglottitis, croup), chemical irritation (aspiration), or trauma (mechanical ventilation)
Which assessment finding is most accurate for the individual with a barrel chest?
a. There is a decrease in the AP diameter
b. There is a decrease in the transverse diameter
c. There is an increase in the AP diameter
d. There is an increase in the transverse diameter
c. There is an increase in the AP diameter
Normally the AP diameter is 1/2 the diameter of the transverse diameter aka * thoracic cage is more wide than it is deep* = AP = 1:2
Barrel chest occurs when AP diameter is greater than transverse diameter means that there is hyperinflation of the lungs (air trapping) seen in COPD
A finding of bronchophony, clearly understanding the spoken word of “99” through the stethoscope indicates
a. air trapping, which is what happens in broncholitits
b. air trapping, which happens in emphysema
c. consolidation, which happens in asthma
d. consolidation, which happens in pneumonia
d. consolidation, which happens in pneumonia
Voice sounds will increase when the stethoscope is placed over denser areas of consolidation and can provide clue for dx pulmonary pathologies
Techniques include: Bronchophony, Egophony or whispered pectoriloquy.
If 99 is heard louder and more clear means that there is consolidation in the lung. Sound is heard better over dense tissue than air filled lunch tissue
egophony the sound eee will change to ayyy through a stethoscope means consolidation or fluid in lungs
Hyperrresonance on the percussion of the chest wall of an adult occurs with
a. COPD
b. community acquired pneumonia
c. lung tumor suggestive of cancer
d. pleural effusion
a. COPD
Hyperresonance is a very loud, slightly low pitch and longer duration than resonance. may be normal in children of very thin adult patients. but typically means the lungs are overinflated with as is diseases like asthma or COPD.
Resonance is a hollow sound typically heard over normal lung tissue that is filled with air. relatively loud with a low pitched
Tympany is a loud, high pitched, drum like sound that is longer in duration. It is considered a normal percussion sound heard over
a. The chest
b. The abdomen
c. Bone
d. Lung tissue
b. The abdomen
Typanic sounds in the chest are considered abnormal and can result when there is air in the chest caused by pneumothorax or collapsed lung
A dull sound percussed over lung tissue is considered a normal finding.
True or False
False
dullness is a medium pitched sound normally heard over solid organ or bone Not normal when heard over lung tissue can be related to fluid or consolidation associated with pneumonia, masses or tumors, pleural effusions
flatness can also be heard over solid bone areas typically short in duration
What is the most likely diagnosis for a 4-month- old who presents with intermittent spasms of coughing, intercostal retractions, and generalized wheezing?
a. Bronchitis
b. Bronchiolitis
c. Sleep apnea
d. TB
b. Bronchiolitis
Bronchiolitis is inflammation of the bronchioles typically affects children under 2 years old, the classic sx are cough, tachypnea and wheezing
caused by cold virus
watch for any signs of increasing respiratory effort
Which is essential to the diagnosis of COPD?
a. Chest X-ray shows a flattened diaphragm
b. Chest X-ray shows hyperinflation
c. Pulmonary function tests shows FEV1/FVC ratio of < 70%
d. Pulmonary function test shows FVC or < 30%
c. Pulmonary function tests shows FEV1/FVC ratio of 70%
The most important diagnostic test for COPD is spirometry -testing designed to detect the volume and capacity of the lungs to determine overall functioning of the respiratory system.
FEV= forced expiratory volume- how much air can be forced out of the lungs in a specific period ( one second = FEV1 )
FVC = total amount of air that can be forcibly exhaled
FEV and FVC used as a ratio used to diagnose lung diseases like COPD and asthma
The definition of air flow limitation is FEV/FVC less than 0.70
Which signs and symptoms can indicate CF?
a. recurrent lung infections and persistent cough
b. GI Problems, including small bowel obstruction
c. infertility and DM in an adult
d. all the above
d. all the above
CF= autosomal recessive disorder of the CFTR protein. affects disfunction of the transport of CH, NA and Bicarb which results in thick mucus within lungs, pancreas, liver, reproductive tract, inc sodium etc
Infants and children with CF may present with a meconium ileaus, and resp failure symptoms and FTT
adults usually present with GI symptoms, infertility and DM
Manifestations of CF include chronic sinus infections, pancreatic insufficiency SMO, Kyphosis, venous thrombosis, anemia
Resp sx: persistent cough, wheezes, dyspnea
hyperinflation of lungs on x-ray
PFT, impaired mucociliary clearance of the airway
