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157 Cards in this Set
- Front
- Back
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Which phase of heart contraction produces a pressure wave resulting in an arterial pulse?
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ventricular systole
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How much time does it take for an impulse from ventricular systole to be felt as the dorsalis pedis pulse?
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0.2 sec
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How long does it take for an RBC in the aorta to reach the dorsalis pedis?
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2.0 sec
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What are the 3 factors that influence systolic pressure?
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cardiac output, blood volume, and compliance of the arterial tree
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How is pulse affected when the aortic valve closes?
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There is a small upstroke in the descending part of the pulse called the dicrotic notch
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What factor influences diastolic pressure?
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peripheral vascular resistence
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systole - diastole =
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pulse pressure
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What 4 factors contribute to the characteristics of the pulses?
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stroke volume, distensibility of great vessels, blood viscosity, peripheral resistence
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Where are the external jugular veins most visible?
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above the clavicle, close to the insertion of SCM
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The activity of the right side of the heart is transmitted back through the _____ as a pulse.
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jugular veins
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What do the 3 peaks of the jugular vein pulse represent?
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a- brief backflow during R atrial contraction, c- backward push during R ventricular systole, v- increasing volume and pressure on right atrium
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What do the 2 descending slopes of the jugular vein pulse represent?
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x- passive atrial filling, y- open tricuspid ie rapid filling of right ventricle
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When does the ductus arteriosus close?
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12-14 hours after birth
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In the infant, what causes blood to flow into pulmonary arteries rather than across the foramen ovale?
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pulmonary resistance becomes lower than systemic resistance when the infant starts breathing
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What closes the foramen ovale?
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pressure in the left side of the heart becomes higher than the right
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How is systemic vascular resistance altered in pregnant women?
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systemic vascular resistance decreases causing peripheral vasodilation -> palmar erythema and spider telangietasias
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What changes are seen in the arterial walls of the elderly?
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calcification, dilation, and tortuousity
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What are the risk factors for preeclampsia? (high proteins in the urine and HBP in the 20th week)
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40+, 1st pregnancy, preexisting hypertension, obesity, renal Dx, or diabetes mellitus, family Hx
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What are the risk factors for varicose veins?
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Women 4x more likely than men, Irish & German descent, sedentary, age
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A healthy pulse contour should be _____.
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smooth, rounded, domed
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What is a possible cause of an alternating pulse (pulsus alternans)?
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left ventricular failure
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What is a possible cause of a pulsus bisiferans?
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aortic stenosis combined with aortic insufficiency
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What are possible causes of a large, bounding pulse?
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exercise, anxiety, fever, hyperthyroidism, aortic rigidity or atherosclerosis
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What is a possible cause of a bigeminal pulse?
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disorder of rhythm
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What are possible causes of a paradoxic pulse (pulsus paradoxus)?
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premature cardiac contraction, tracheobronchial obstrction, bronchial athsma, emphysema, pericardial effusion, constrictive pericarditis
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What are possible causesof a Water-hammer (Corrigan) pulse?
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patent ductus arteriosus, aortic regurgitation
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What is normal resting heart rate?
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60-100 BPM
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What is the pule rate of tachycardia?
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> 100 BPM
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What is the pulse rate of bradycardia?
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< 60 BPM
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A heart rate that is irregular but that occurs in a repeated pattern may indicate:
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sinus arrhythmia
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Lack of pulse symmetry between right and left may indicate:
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impaired ciculation
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What arteries can be auscultated for bruits?
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temporal, carotid, subclavian, abdominal aorta, renal, iliac, and femoral
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What is the venous hum?
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a clinically insignificant sound that can be auscultated at the medial clavicle anterior to SCM, can be confused with other pathologies
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What can cause carotid artery bruits?
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valvular aortic stenosis, mitral valve damage, aortic regurgitation, stenosis
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What is claudication?
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Pain brought on by exercise and relieved with rest, pain is distal to stenosis.
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What are the 5 P's of arterial occlusion?
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Pallor, Pain, Pulselessness, Paresthesia, Paralysis
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Where would pain present in an obstructed superficial femoral artery?
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calf muscle
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Where would pain present in an obstructed common femoral or external iliac artery artery?
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thigh
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Where would pain present in an obstructed common artery or distal aorta?
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aorta
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What sound is produced during a blood pressure reading?
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Korotkoff sounds
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What indicates the beginning of the Korotkoff sounds?
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2 consecutive systolic beats
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What is the term for when Korotkoff sounds appear, disappear, and reappear 10-15 mmHg lower?
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auscultory gap
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What can cause the auscultory gap to widen?
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systolic hypertension, chronic severe aortic regurgitation
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What can cause the auscultory gap to narrow?
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pulsus paradoxis with cardiac tamponade or other cardiac constrictions
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Define phases 1 of Korotkoff sounds.
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First 2 consecutive beats = systolic pressure
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Define phases 2 of Korotkoff sounds.
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reappearance of sounds after auscultory gap
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Define phases 3 of Korotkoff sounds.
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point as which sounds are first crisp
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Define phases 4 of Korotkoff sounds.
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point at which crisp sounds become muffled: 1st diastole
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Define phases 5 of Korotkoff sounds.
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disappearance of sound: 2nd disatole
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What is optimal blood pressure?
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<120/80
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What is the range of prehypertension?
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120-139/ 80-89
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What is the range of stage 1 hypertension?
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140-159/ 90-99
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What is stage 2 hypertension?
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> 160/100
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What is considered an exaggerated paradoxical pulse?
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>10 mHg difference in systolic pressures between inhalation ans exhalation
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What can cause an exaggerated paradoxical pulse?
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cardiac tamponade, pericarditis, emphysema
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How is postural hypertension defined?
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Drop in systolic (>15mmHg) and diastolic pressures when the patient stands after being supine
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What can cause portal hypertension?
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blood loss, drugs, ANS disease
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What can undermine the accuracy of blood pressure readings?
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cardiac dysrhythmias, aortic regurgitation, venous congestion, valve replacement
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What is the expected value for jugular venous pressure?
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9 cm H2O (divide by 1.3 for mmHg
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What is the quality and character of a jugular vs carotid pulse?
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3 undulating waves / one brisk wave
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What is the effect of respiration of a jugular vs carotid pulse?
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decreased on inspiration and increased on expiration/ no effect
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What is the effect of venous compression on a jugular vs carotid pulse?
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easily eliminates pulse wave/ no effect
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What is effect of abdominal pressure on a jugular vs carotid pulse?
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increased prominence/ no effect
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What can the hepatojugular reflex measure?
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right-sided heart failure is suspected when JVP elevates after the hepatojugular reflex is tested
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How do you perform the hepatojugular reflex?
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While measuring JVP, apply firm sustained pressure over the midepigastric region
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What measurement taken in the hands is equivalent to mean JVP?
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elevate hand, measure from midaxillary line at nipple to the level of collapsed hand veins
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What are the signs of acute venous obstruction?
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constant pain with swelling & tenderness, enorgement of superficial veins, erythema & cyanosis
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What is a Homan sign?
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Flex patient's knee and dorsiflex foot. Calf pain may indicate venous thrombosis
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Edema with skin thickening and ulceration indicates:
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deep vein thrombosis
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Unilateral edema indicates:
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occlusion of a major vein
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Bilateral pitting edema indicates
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congestive heart failure
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Nonpitting edema indicates
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arterial insufficiency or lymphedema
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Describe Grade 1 Edema
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slight pitting that disappears rapidly, can be felt not seen
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Describe Grade 2 Edema
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deeper pit that disappears in 10-15 sec
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Describe Grade 3 Edema
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deep pit that lasts 1 min+, the tested extremity appears swollen
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Describe Grade 4 Edema
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very deep pit that lasts 2-5 min, tested extremity is grossly distorted
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How can the presence of varicose veins in the leg be tested?
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Have patient stand on their toes 10 times in succession to build leg pressure. Pressure disappears in competent veins and persists in incompetent veins.
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How can the presence of collateral veins be tested?
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Compress the vein with one hand and strip it of blood moving towards the heart with the other hand. If stripped veins fills, there are collaterals.
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How can the competency of venous valves be tested?
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Compress the vein with one hand and strip it of blood moving towards the heart with the other hand, then release cephalad hand. If the entire column fills, the valves are incompetent.
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What should also be tested with blood pressure in the infant?
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capillary refill
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What does a bounding infant pulse indicate?
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patent ductus arteriosus
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What type of specialized sphygmomanometer can be used for infants and children?
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one that includes Doppler or other oscillometric technique
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What is usual newborn blood pressure?
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60-96/ 30-62 mmHg
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What can capillary refill time > 2sec in an infant or your child indicate?
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dehydration or hypovolemic shock
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What can newborn hypertension indicate?
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thrombosis from umbilical catheter, stenosis, kidney disease, neuroblastoma, Wilms tumor, hydronephrosis, adrenal hyperplasia, or CNS disease
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Which phase of the Korotkoff sound is the appropriate measurement for diastole for ages 3-adolescence?
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Phase 4, after which use phase 5
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In children, radial artery BP will read ____ less that brachial artery BP?
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10 mmHg
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50% of the time, hypertension in adolescents is ___.
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primary
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Hypertension in children younger that 10 is ______.
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secondary due to kidney disease, renal artery disease, coarctation of the aorta, or pheochromocytoma
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Hypotension in pregnant women peaks at ____.
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16-20 weeks gestation
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What is considered elevated blood pressure in a 2nd trimester pregnant woman?
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>125/ 75 mmHg
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What is considered elevated blood pressure in a 3rd trimester pregnant woman?
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>130/ 85 mmHg
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During pregnancy, a rise in ____ above the 1st trimester baseline should be monitored, and sustained pressure of _____ indicates a BP disorder.
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30/ 15 mmHg, >140/ 90 mmHg or
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Hypertension in older adults is defined as:
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> 140/ 90 mmHg
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What is temporal aka giant cell arteritis?
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inflammatory disease of he branches of the aortic arch including temporal arteries
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How is an arterial aneurism defined?
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1.5x the diameter of the normal artery
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What is peripheral artery disease?
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stenosis of the extremities caused by atherosclerotic plaques
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What is Raynaud's Disease?
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Exaggerated spasm of the digital arterioles and sometimes nose and ears due to cold exposure.
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What is arterial embolic disease?
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atrial fibrillation that leads to clot formation within the atrium, may lead to dispersed emboli
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What causes venous thrombosis?
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Trauma or prolonged immobilization
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What can hypertension cause?
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stroke, renal failure, congestive heart failure
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How does constrictive pericarditis arise?
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chronic inflammation and subsequent scarring of the pericardium
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Where is coarctation of the aorta most commonly seen?
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stenosis is seen in descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum
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What is Kawasaki disease?
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acute vasculitis unknown ETO affecting the young, may be due to cardiac involvement leading to aneurisms of coronary artery
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What is preeclampsia?
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hypertesion that occurs after the 20th week of pregnancy with proteinuria
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What is eclampsia?
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preeclampsia with seizures when no other cause for seizures can be found
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What causes venous ulcers?
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Chronic venous insufficiency in which lack of venous flow leads to lower extremity venous hypertension
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What is the only useful information for ruling in DVT?
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malignancy, previous DVT, recent immobilization, difference in calf diameter, and recent surgury
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What is useful information for ruling out DVT?
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absence of calf swelling or diameter difference
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What is the pathophysiology of temporal arteritis?
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unknown ETO, inflammatory infiltrates develop of thoracic aorta, arterial intimal thickening can affect structures in the head.
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What are the subjective findings of temporal arteritis?
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age 50+, flu-like, headache esp temporal region, occular symptoms, ischemia of jaw and tongue
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What are the objective findings of temporal arteritis aka giant cell arteritis?
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Area over temporal area red, swollen, tender, nodular. Temporal pulse varies.
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What is the pathophysiology of arterial aneurism?
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result of atherosclerosis + tobacco and hypertension, 4x more common in men
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What are the subjective findings of arterial aneurism?
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asymptomatic until dissection causes ripping pain
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What are the objective findings of arterial aneurism?
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pulsatile swelling, thrill or bruit may be present over aneurism
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What is the pathophysiology of arteriovenous fistula?
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congenital or caused by catheterization
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What are the subjective findings of arteriovenous fistula?
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low extremity edema, varicose veins, claudication, high cardiac output
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What are the objective findings of arteriovenous fistula?
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weak or absent pulses, foot or leg is painful at rest, cold and numb, and dry with poor hair growth. Ulceration, muscle atrophy, no edema.
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What is the pathophysiology of peripheral arterial disease?
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peripheral atherosclerosis, diabetes, hypertension, dyslipidemia, tobacco use, vascular trauma, radiation, vasculitis
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What are the subjective findings of peripheral arterial disease?
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predictable anount of exercise produces pain, ache, or cramp in exercised muscle
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What are the objective findings of peripheral arterial disease peripheral arterial disease?
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severe ischemia, leg or foot is painful at rest, cold and numb, and skin is scaling with poor hair growth. Ulceration and muscle atrophy, no edema.
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What is the pathophysiology of Reynaud phenomenon?
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primary: young, healthy women, unknown ETO. Secondary: CT disease such as sclerodoma or systemic lupus erythematosus
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What are the subjective findings of Reynaud phenomenon?
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Involved areas feel cold and achy, which improves when warmed. Secondary Renaud: intense pain with digital ischemia and necrosis.
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What are the objective findings of Reynaud phenomenon?
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Primary: red white and blue extremities, vasospasm lasts < 1 hr. Secondary: fingertip ulcers or skin over digits appears smooth, shiny, tight
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What is the pathophysiology of arterial embolic disease?
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emboli caused by atherosclerotic plaques, infectious material from fungal and bacterial endocarditis, or atrial myxomas
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What are the subjective findings of arterial embolic disease?
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pain, parasthesias
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What are the objective findings of arterial embolic disease?
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occlusion of small arteries and necrosis of their tissues. endocarditis leads to splinter hemmorhages in nail beds
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What is the pathophysiology of venous thrombosis?
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prolonged immobilization, malignancy, birth control meds, trauma, or previous DVT
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What are the subjective findings of venous thrombosis?
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tenderness along iliac vessels or femoral canal, popliteal space, or deep calf veins, pulmonary embolism may occur without warning,
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What are the objective findings of venous thrombosis?
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difference in circumference of upper and lower legs, mininal ankle edema, high-grade fever, and tachycardia, Howman sign useful
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What is the pathophysiology of hypertension?
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BP consistently at 140/ 90 mmHg or higher
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What are the subjective findings of hypertension?
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Essential hypertension is asymptomatic, malignant hypertension has headache, visual symptoms, and encephalopathy
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What are the objective findings of hypertension?
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In addition to BP, end organ damage, papilledema, or heart failure may be present
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What is the pathophysiology of tricuspid regurgitation?
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due to conditions that lead to dilation of the right ventricle such as hypertension and pulmonary thrombosis, can also result from primary valvular disease
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What are the subjective findings of tricuspid regurgitation?
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no symptoms if mild-medium, severe shows right-sides heart failure with ascites or peripheral edema
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What are the objective findings of tricuspid regurgitation?
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v wave is early, prominent, and often merges with c wave, holocystolic murmur in tricuspid, pulsatile liver, peripheral edema
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What is the pathophysiology of atrial fibrillation?
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heart disease leading to enlargement or elevated pressures
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What are the subjective findings of atrial fibrillation?
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asymptomatic then palpations, lightheadedness, or dyspnea
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What are the objective findings of atrial fibrillation?
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absent wave withan irregularly irregular pulse: 2 venous pulsations for each arterial pulsation, variable interval between v waves
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What is the pathophysiology of cardiac tamponade?
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pericardial fluid from infection, malignancy, or autoimmune disease impairs cardiac ooutput
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What are the subjective findings of cardiac tamponade?
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acute sudden onset chest pain and dyspnea or chronic heart failure symptoms
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What are the objective findings of cardiac tamponade?
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Y-descent is abolished and JVP is elevated 15-25cm of H2O, JVP falls with inspiration, pulsus paradoxus (decrease in systolic >10mm Hg)
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What is the pathophysiology of constrictive pericarditis?
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pericardial thickening and inelasticity, diminished cardiac filling and output
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What are the subjective findings of constrictive pericarditis?
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progressive cardiac insufficiency such as worsening of lower extremity edema or dyspnea
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What are the objective findings of constrictive pericarditis?
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Elevated JVP with prominent Y descent, peripheral edema and ascites due to right-sided heart failure
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What is the pathophysiology of coarctation of the aorta?
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congenital defect of vascular wall or acquired inflammatory aortic disease or severe atherosclerosis
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What are the subjective findings of coarctation of the aorta?
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asymptomatic unless severe hypertension or vascular insufficiency develops
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What are the objective findings of coarctation of the aorta?
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differences in systolic BP when radial and femoral pulses are palpated simultaneously
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What is the pathophysiology of Kawasaki Disease?
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ETO of vasculitis is unknown, immune-mediated blood vessel damage can result in both vascular stenosis and aneurism formation
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What are the subjective findings of Kawasaki Disease?
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diffuse symptoms of varied duration, wieght loss, fatique, myalgias, or arthritis
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What are the objective findings of Kawasaki Disease?
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Conjunctival injection, strawberry tongue, edema of hands and feet, lymphadenopathy and polymorphous nonvesicular rashes
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What is the pathophysiology of preeclampsia-eclampsia?
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vascular and immunologic abnormalities within uteroplacental circulation
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What are the subjective findings of preeclampsia-eclampsia?
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may be diagnosed without proteinuria if visual changes, headache, abdominal pain, and pulmonary edema are present
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What are the objective findings of preeclampsia-eclampsia?
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sustained elevation of blood pressure > 160/ 110 mmHg
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What is the pathophysiology of venous ulcers?
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incompetent valves, obstruction of blood flow, or loss of pumping effect of blood vessels
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What are the subjective findings of venous ulcers?
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asymptomatic then leg heaviness and discomfort progressing to edema and ulceration
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What are the objective findings of venous ulcers?
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ulcers on medial and lateral aspects of lower limbs, induration, edema, and hyperpigmentation
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