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96 terms

Instruments & Vital Signs

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Atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries.
Leriche's syndrome

*causes radio-femoral delay
Patient presents with capillary pulsations in the nail bed.
Quincke's sign

*It is manifested as alternating flushing and blanching of the nail bed due to pulsations in the subpapillary arteriolar and venous plexuses. It can be encountered in aortic insufficiency.
Auscultation of the femoral artery reveals a bruit during systole and diastole.
Durozie's sign

*It is due to rapid "back and forth" flow of blood as seen in aortic insufficiency.
Patient presents with head nodding coinciding with the carotid pulse.
de Mussett's sign

*aortic regurgitation
Describe Osler's maneuver.
The blood pressure cuff is used to obliterate the radial pulse. In the normal situation, the vessel walls will not be palpable when there is no flow in the vessel. If it is still palpable and rigid, this is a positive sign of atherosclerotic disease.
Blood pressure if the radial pulse is present
at least 80 mmHg
Blood pressure if radial pulse is not palpable and the femoral pulse is present
at least 70 mmHg
Blood pressure if the radial and femoral pulses are absent, but the carotid pulse is present
at least 60 mmHg
The most common congenital deformity of the anterior wall of the chest, in which several ribs and the sternum grow abnormally.
pectus excavatum
List 2 accessory muscles of respiration.
sternocleidomastoid

scalene
List 3 causes of tachypnea (>24 BPM).
restrictive lung disease

pleuritic chest pain

bowel obstruction --> elevated diaphragm
What is the difference between tachypnea and hyperventilation?
tachypnea: rapid shallow breathing

hyperventilation: rapid deep breathing
List 3/4 causes of hyperventilation.
exercise

anxiety

metabolic acidosis

midbrain or pontine abnormalities (infection, hypoxia, hypoglycemia)
Deep breathing alternating with periods of apnea
Cheyne-Stokes breathing
List 3/4 causes of Cheyne-Stokes breathing.
brain damage (both sides of cerebral hemisphere)

heart failure

uremia

drug-induced respiratory depression
Damage to what part of the CNS causes Biot's ataxic breathing?
damage at medulla
What group of pulmonary disorders causes prolonged expiration?
COPD
Which part of the stethoscope is used for low frequency sounds?
bell
Which part of the stethoscope is used for high pitched sounds?
diaphragm
Describe the relationship between the length of the inflatable bladder and the circumference of the upper arm.
The length of the inflatable bladder should be about 80% of the upper arm circumference.
Describe the relationship between the width of the inflatable bladder and the circumference of the upper arm.
The width of the inflatable bladder should be about 40% of the upper arm circumference.
Which tuning fork is used for the hearing test?
512 Hz
What are the five vital signs?
pulse

blood pressure

respiration

temperature

pain
What is the most common site of pulse evaluation?
radial pulse
Which pulse is checked to assess contour?
right carotid artery
Name 4 characteristics that must be assessed when evaluating pulse.
rate & rhythm

symmetry of amplitude

contour (wave form)
Which 2 terms constitute the "character" of pulse?
amplitude

contour
What is the normal pulse rate?
60-100 beats/minute
Tachycardia pulse rate
>100 beats/minute
List 4 types of tachycardia and their associated pulse rates.
atrial flutter: 100-175 beats/minute

sinus tachycardia: 100-180 beats/minute

supraventricular tachycardia: 100-250 beats/minute (atrial or nodal)

ventricular tachycardia: 110-250 beats/minute
Sinus bradycardia pulse rate
<60 beats/minute
AV node normal intrinsic rate
40-60 beats/minute
Complete heart block pulse rate
<400 beats/minute
List the 2 types of irregular pulse rhythms.
regular irregular (sinus arrhythmia, atrial or nodal, ventricular premature beat)

irregular irregularity (atrial fibrillation)
Which pulse is assessed to determine a irregular irregularity of the pulse rhythm?
apex of the heart
Which characteristic of the pulse is determined by local conditions?
amplitude

*other characteristics are centrally generated; thus, there is no difference, for example, in the contour of the different blood vessels
Pulse amplitude 0
absent, not palpable
Pulse amplitude 1
diminished, barely palpable (heart failure)
Pulse amplitude 2
normal (expected)
Pulse amplitude 3
full and increased (aortic regurgitation)
Pulse amplitude 4
bounding
What is the contour of the pulse?
Contour refers to the speed of the upstroke, the duration of the summit, and the speed of the downstroke.
What pulse has a smooth and rounded wave pattern?
normal pulse
Patient presents with a weak and small pulse with a slow upstroke and prolonged peak.
hypovolemia

*decreased stroke volume, increased pressure; 1
Patient presents with a strong and bounding pulse with a rapid onset and fall (2).
fever

fistula

*increased stroke volume, decreased pressure; 1
What is a bisferiens pulse? List 3 causes.
pulse with double systolic peak

- aortic regurgitation
- aortic stenosis + aortic regurgitation
- hypertrophic cardiomyopathy (BUT often not palpable)
What is a pulsus alternans? Name an associated disorder.
regular rhythm but with alternating amplitude from beat to beat

left ventricular failure; 2
What is a bigeminal pulse?
normal beat alternating with premature beat; 2
What is a paradoxical pulse? List 4 causes.
exaggerated decreased amplitude on inspiration

- severe asthma
- emphysema
- pericardial tamponade
- constrictive pericarditis

*This is because the intrathoracic pressure becomes more negative relative to atmospheric pressure. This increases systemic venous return, so more blood flows into the right side of the heart. However, the decrease in intrathoracic pressure also expands the compliant pulmonary vasculature. This increase in pulmonary blood capacity pools the blood in the lungs, and decreases pulmonary venous return, so flow is reduced to the left side of the heart. Also the increased systemic venous return to the right side of the heart expands the right heart and directly compromises filling of the left side of the heart. Reduced left-heart filling leads to a reduced stroke volume which manifests as a decrease in systolic blood pressure. The decrease in systolic blood pressure leads to a faster heart rate due to the baroreceptor reflex, which stimulates sympathetic outflow to the heart.
What normally happens to systolic pressure upon inspiration?
slight drop

*paradoxical pulse is associated with an exaggerated drop
What disorder is associated with an irregular irregular apex beat?
atrial fibrillation
Pulse deficit
The difference between the heart rate by auscultation and peripheral rate by palpation.
Is the normal transmission of the pulse wave faster to the radial or femoral artery?
femoral artery

*a delay to the femoral artery would signify obstruction of flow to the lower extremities
Normal blood pressure
<120 / <80
Pre-hypertension blood pressure
120-39 / 80-89
Stage 1 hypertension blood pressure
140-159 / 90-99
Stage 2 hypertension blood pressure
>160 / >100
Isolated systolic hypertension blood pressure
>140 / <80
Describe the findings in orthostatic hypotension. How much does systolic and diastolic blood pressure fall--and after how much time has elapsed? List 2 causes.
After lying down, there is a fall of 20 mmHg systolic and 10 mmHg diastolic within 3 minutes of standing. Some associated conditions include diabetes and spinal cord injuries.
What is the value of normal pulse pressure?
30-40 mmHg
What could be the cause of a pressure difference of greater than 10-15 mmHg (comparing one arm to the other)?
stenosis
Pulsus paradoxus
In certain conditions such as severe asthma, emphysema and cardiac tamponade, there is a drop of greater than 10 mmHg during inspiration

*respiratory variation
The interval of pressure where Korotkoff sounds indicating the true systolic pressure fade away and reappear at a lower pressure point during blood pressure measurement.
Auscultatory gap

- can be obviated by first determining pressure by palpation.
Normal respiratory rate for adults
14-20 breaths/minute
Normal respiratory rate for children
<44 breaths/minute
What are the 4 characteristics of respiration?
rate

rhythm

depth

effort of breathing
A patient presents with deep breathing alternating with periods of apnea.
Cheyne-Stokes breathing
Describe Biot's/ataxic breathing. Identify 2 possible locations for the causative lesion.
unpredictable irregularity

- lower pons or upper medulla
What type of respiratory rhythm is associated with hyperventilation?
frequent sighing

*every now and then taking a deep breath; 4
What type of respiratory rhythm is associated with asthma?
obstructive breathing

*prolonged expiration because asthmatics are trying to get the air out (bronchoconstriction)
Normal oral temperature
37 C

98.6 F (morning 96.4, evening 99.1)
Rectal temperature
+0.4-0.5 C

+0.7-0.9 F

*oral temperature
Axillary temperature
-1 C/F
Hyperpyrexia temperature
>41.1 C

106 F

*oral temperature

*septicemia
Hypothermia temperature
<35 C

<95 F

*oral temperature

*hypothyroidism
List 4 patterns of temperature variation.
continuous

intermittent: diurnal variation--temperature fluctuates between normal and elevated over 24 hours, e.g. malaria

remittent: abating and relapsing in cycles

relapsing: alternative periods of fever and apyrexia lasting 5-7 days each
List 2 causes of an amplitude of 0 or 1 for the radial pulse.
heart failure

increased peripheral resistance
Pulse with a greater than normal amplitude, rapid rise, normal summit, and sudden descent. Name the pulse and give 2 causes.
Water Hammer/Corrigan pulse

- aortic regurgitation
- patent ductus arteriosus
Maximal blood pressure in the aorta DURING left ventricular contraction
systolic pressure
Minimal blood pressure in the aorta BEFORE left ventricular contraction
diastolic pressure
Mean arterial pressure =
DP + 1/3 (SP - DP)
What will happen to a blood pressure reading if the patient's arm is not at the level of the heart?
false ELEVATION
List a metabolic disorder and cranial disorder that can cause bradypnea (<10 breaths per minute).
diabetic coma

raised ICP
Lesion to what part of the brain stem causes inspiratory cramps?
upper pons
Increased curvature of the upper spine
kyphosis
What is another name for pigeon chest?
pectus carinatum
What are the 3 centers located in the pons and medulla that control respiration? Comment briefly on their functions.
medullary rhythmicity center: quiet respiratory rhythm

apneustic center: depth of inspiration

pneumotaxic center: duration of inspiration
What 2 neurogenic centers are controlled by the pneumotaxic center?
medullary rhythmicity center

apneustic center
What cranial nerve terminates inspiration when a certain lung volume is achieved?
vagus nerve

- stretch receptors act in concert with the pneumotaxic center to achieve the desired rate and depth of respiration
What is the most important trigger for the peripheral chemoreceptors?
low PaO2

- less than 60 mmHg
Carotid body afferent limb
glossopharyngeal nerve
Aortic body afferent limb
vagus nerve
Normal respiratory rate in infants (up to 1 year)
25-50 breaths per minute
Normal respiratory rate in children (1-12 years)
15-30 breaths per minute
Fever temperature in adults
>99F
Fever temperature in infants less than 3 months of age
>101F