Term
In order of importance, what are the most influential factors on the magnitude of the systolic blood pressure? |
|
Definition
1st- Stroke volume
2nd- Aortic compliance (inversely proportional)
3rd- Velocity of ejection |
|
|
Term
A 84-yr old man presents with an abnormal blood pressure. Which part of the BP is most likely to be abnormal and why? |
|
Definition
The systolic BP will probably be higher than normal, even if the diastolic BP is normal. This is caused by a loss of compliance in the large elastic arteries (aorta) caused by arteriosclerosis. |
|
|
Term
If a patient presents with aortic noncompliance, describe the energy distribution of a normal ventricular ejection: |
|
Definition
If the aorta is noncompliant, the elastic recoil will be low or insignificant and nearly all the energy of ejection will be contributed by systolic BP (usually results in an increase). |
|
|
Term
| When measuring the magnitude of diastolic BP, which two factors are directly related? |
|
Definition
HR and systemic vascular resistance |
|
|
Term
(Using a normal healthy BP of 120/80)
If systolic BP increased by 20 mm Hg, with no change in the diastolic BP, what would the increase in mean arterial pressure be? |
|
Definition
Mean arterial pressure formula
(BPsyst + (2 x BPdias)) / 3
120 + (2 x 80) / 3 = 90.3 mm Hg
140 + (2 x 80) / 3 = 100 mm Hg
100 - 90.3 mm Hg = ~10 mm Hg |
|
|
Term
A 22-year old n(m)urse with a FHx of hypertension and subsequent heart disease decided to take his BP while he was having some breakfast before his 6 AM shift. It revealed higher than normal results. Should he be worried and why? |
|
Definition
No, a healthy 22-yr old man will have a higher BP in the morning due to normal diurnal variation of BP. (high in the morning, low at night) |
|
|
Term
A health conscious weight lifter knows his regular BP is somewhere around 110/75. After his normal "lifting" sessions his BP rises to about 136/90. When his triathlon enthusiast little brother finally convinced him to go on a 35-mile training ride with him, what would be the weightlifter's most likely BP after the ride?
A. 110/75
B. 136/90
C. 150/110
D. 136/70
E. 110/90 |
|
Definition
D. 136/70
(Diastolic BP decreases during dynamic exercise versus a normal increase in diastolic BP during isometric exercise) |
|
|
Term
A wide pulse pressure is indicated by a BP difference (sys - dias) of greater than what values? |
|
Definition
Either 60 mm Hg or 50% of systolic BP |
|
|
Term
A severely hypertensive 42-yr old obese woman would most likely have a BP of:
A. 140/100
B. 180/125
C. 178/110
D. 150/95
E. 130/80 |
|
Definition
C. 178/110
Essential hypertension is the most common cause of a wide pulse pressure (sys/dias BP difference of 60 or more). |
|
|
Term
| Holding peripheral resistance constant and increasing cardiac output necessarily increases stroke volume. What are some causes of increased stroke volume? |
|
Definition
Anemia, hyperthyroidism, pregnancy, and fever
(all create a wide pulse pressure) |
|
|
Term
A patient presents with an aortic valve disorder that allows significant blood regurgitation into the left ventricle. Which of the following would be most representative of their probable BP?
A. 180/150
B. 160/88
C. 110/70
D. 150/95
E. 90/60 |
|
Definition
B. 160/88
Chronic aortic regurgitation (insuffiency) causes a wide pulse pressure when severe. EDV and SV are both larger than normal. |
|
|
Term
A CT scan with contrast reveals a narrowed aortic valve in a 16 year old female. Which of the following BP's would be most indicative of her condition?
A. 120/80
B. 95/55
C. 150/75
D. 180/110
E. 110/90 |
|
Definition
E. 110/90
A narrow pulse pressure is found in patients with aortic stenosis (narrowing of the aortic valve). |
|
|
Term
A 52-yr old CEO is rushed to the ER with shortness of breath and moderate left-sided chest pain. He also complains of feeling like he's drowning. The 4th year medical student indicates on his write-up that his abnormal BP is:
A. 180/100
B. 100/84
C. 95/55
D. 120/80
E. 150/115 |
|
Definition
B. 100/84
Congestive Heart Failure (CHF) has presenting symptoms of shortness of breath and pulmonary edema and is accompanied by a narrow pulse pressure. |
|
|
Term
A BP of 138/80 would be identified as being in what category?
A. Normal
B. Prehypertensive
C. Hypertensive Stage 1
D. Hypertensive Stage 2 |
|
Definition
B. Prehypertensive
Normal- <120/80
Prehypertension- 120-139/80-89
Hypertension Stage 1- 140-159/90-99
Hypertension Stage 2- >160/>100 |
|
|
Term
| In order to accurately and effectively diagnose hypertension, how many BP readings should be taken over how many visits? |
|
Definition
Elevated BP must be recorded twice (at least 5 minutes apart), on two separate visits over the course of a week in order to diagnose hypertension. |
|
|
Term
| Primary (essential) hypertension is most often found in what age group? |
|
Definition
35-55 yr/o
This age range is so consistent that if hypertension is found outside of this age range, secondary hypertension is suspected before primary. |
|
|
Term
Which of the following is NOT a secondary cause of hypertension?
A. obesity
B. kidney failure
C. adrenal tumor
D. caffeine abuse
E. sleep apnea |
|
Definition
A. obesity
Although kidney failure can occur because of the complications of obesity, the last 4 are all secondary causes of hypertension. |
|
|
Term
| What is the least invasive way of identifying indicators for dangerous complications of hypertension? |
|
Definition
Examining the eye during a physical exam to see if there is retinopathy (arteriolar sclerosis, neuroretinitis, AV nicking). |
|
|
Term
Which of the following is NOT a direct complication of chronic (essential) hypertension?
A. LV hypertrophy
B. Arterial aneurysms
C. Pedal edema
D. Stroke
E. Proteinuria |
|
Definition
C. Pedal edema
Although pedal edema is a symptom of right ventricular problems, it is not a direct complication (disorder) relating to chronic essential hypertension as are the other four (Heart disease, Peripheral vascular disease, Cerebral vascular disease, kidney disease). |
|
|
Term
| A 19-yr old girl sets up an appointment with her primary care physician because of a lingering common head cold. While acquiring her vital signs the attending nurse finds that her BP is 95/65. What does this BP indicate? |
|
Definition
This young woman could be classified as hypotensive, but some normal young woman do have healthy BP's in that range.
(*Remember, BP norms need to be referenced to the age, physicality, and overall health of the patient) |
|
|
Term
A 49-yr old airplane pilot is rushed to the emergency room following a cross-Atlantic (polar) flight and presents with decreased cardiac output and severe chest pain. His BP is most likely to be:
A: 180/110
B. 140/75
C. 116/82
D. 108/52
E. 121/71 |
|
Definition
D. 102/52
The pilot's recent history most likely indicates a pulmonary embolus that is decreasing cardiac output and end-systolic pressure thus lowering his diastolic BP. |
|
|
Term
| On her arrival at the hospital, a 31-yr old female was rushed to the OR for emergency surgery to fix a punctured left lung due to an anterior rib fracture. Two days later, a 4th year medical student doing rounds in the ICU notices severe hypotension on her vital signs. What is a probable cause of this finding? |
|
Definition
Cardiac tamponade
Because of the trauma to the left side of her thoracic cavity, it is probable to deduce that there could be pericardial fluid build up following her surgical procedure. |
|
|
Term
| After returning home from a disasterous honeymoon in Costa Rica, newlyweds both go to an urgent care to try and get some nausea and diarrhea medication to ease the discomfort from drinking bad water on their trip. Other than a fluid/electrolyte imbalance, what other basic finding would the doctor find after preliminary tests? |
|
Definition
Hypotension due to water loss from the diarrhea and vomiting. |
|
|
Term
Which of the following conditions/diseases would most probably NOT cause serious hypotension?
A. bacterial infection in the abdomen
B. Heart attack
C. Anaphylaxis
D. Stroke
E. Influenza |
|
Definition
D. Stroke
This is a complication of chronic severe hypertension, not a cause of hypotension. |
|
|
Term
| Paradoxical pulse (an inspiratory decrease in systolic BP of more than 12 mm Hg) is found in nearly all patients who present with what? And why is this? |
|
Definition
Patients with cardiac tamponade (fluid in the paricardial sac) experience a greater change in intrathoracic pressure during expiration and inspiration due to the fact that each side of the heart is competing for space because of the fluid. |
|
|
Term
Many patients with asthma present with more than a 12 mm Hg decrease in systolic BP during inspiration. This phenomenon is called what and why does it occur in asthmatic patients? |
|
Definition
Paradoxical Pulse
It occurs in asthmatic patients because asthma is characterized by increased resistance to airflow during expiration. A higher intrathoracic pressure is needed to expel air, and thus the difference between inspiration and expiration is greater. |
|
|
Term
| Why doesn't blood pooling in the lower extremities while standing create a greater change in BP? |
|
Definition
HR, stroke volume, and peripheral vascular resistance all increase to compensate |
|
|
Term
| During a physical exam a 14-yr old girl is given an orthostatics test. After laying down and having her pulse rate and BP taken, the girl is asked to stand and the physician immediately takes her blood pressure. Why are the results most likely inconclusive? |
|
Definition
The patient must remain standing for a minute so that the body has a chance to adapt and exhibit the positive test results. |
|
|
Term
| Orthostatic hypotension is defined as a decrease of at least how many mm Hg of systolic bp when standing? |
|
Definition
|
|
Term
| What must be coupled with orthostatic hypotension to have it be pathologically relevant? |
|
Definition
The patient must experience an inability to stand or an increase in pulse rate of 30 beats/min due to the decreased systolic bp. |
|
|
Term
| Indicate whether systemic venous return, RA/RV filling, pulmonary circulation capacitance, and LV stroke volume increase or decrease during inspiration |
|
Definition
Increases
systemic venous return
which leads to increased
RA/RV filling
which accommodates increased
Pulmonary circulation capacitance
which allows more blood to remain in the lungs and
Decreases
LV stroke volume |
|
|
Term
Which of the following calculated differences are approximately equal?
1. difference in systolic bp from expiration to inspiration
2. difference in intrathoracic pressure during expiration and inspiration
3. difference in LV stroke volume during expiration and inspiration
A. 1 & 2
B. 2 & 3
C. 1 & 3
D. 1, 2, & 3 |
|
Definition
D. 1, 2, & 3
Due to the heart's total containment in the thoracic cavity, stroke volume, systolic BP and the intrathoracic pressures should all be equivalent in relation to normal ventilation. |
|
|
Term
| When deciding which size bp cuff to use on a hypertrophic 22-yr old male football player, a 3rd year medical student held the cuff around the player's arm and there was a significant gap between the ends of the cuff. The second larger cuff overlapped just slightly when held around the upper arm. Which of the two cuffs would give a more accurate bp reading? |
|
Definition
The second.
(Always lean towards using a bigger cuff when it is in the middle ground. Cuffs should be at least 20% wider than the diameter of the arm and at least 80% of the arm circumference in length.) |
|
|
Term
| Where should the patient's arm be positioned for the greatest accuracy when a bp is being taken? |
|
Definition
|
|
Term
| Palpating the brachial pulse while you inflate the bp cuff helps provide what guidance for taking the reading? |
|
Definition
If you no longer feel the brachial pulse during inflation, it is probably somewhere close to the systolic bp and you should continue inflating another 20 mm Hg before starting your reading. |
|
|
Term
| A nurse reports that a hypertensive patient's bp is 178/108 on admission. As a 3rd year medical student you decide it is necessary to be thorough and correctly diagnose this patient and do your own bp reading. However you get a bp of about 128/108. Why is there such a great discrepancy in results? |
|
Definition
An auscultatory gap is present and because the med student did not inflate the cuff enough after the brachial pulse disappeared, the patient's hypertension was not identified. |
|
|
Term
At which speed should the pressure be released during the blood pressure exam?
A. 5 mm Hg/sec
B. 1 mm Hg/sec
C. 8 mm Hg/2 sec
D. 10 mm Hg/3 sec
E. 6 mm Hg/sec |
|
Definition
D. 10 mm Hg/3 sec
The needle should descend at a constant rate of about
3 mm Hg/second |
|
|
Term
| A nervous 1st year medical student took a patient's blood pressure that indicated a significantly lower diastolic bp. What user error could cause this result? |
|
Definition
When taking a bp, the pressure caused by the stethoscope can influence diastolic bp significantly if pressed too hard. |
|
|
Term
| What are the first and last phases that are heard when taking systolic and diastolic bp? |
|
Definition
Phase 1 and Phase 5
(phases 2-4 come between and sound like a swish, a crisp and loud noise, and a muffled noise respectively) |
|
|
Term
| By switching from a patient's right arm to his left arm, a left-handed patient's bp increased by almost 10 mm Hg. Is this a normal phenomenon or should the doctor worry about vascular occlusion of the vessel? |
|
Definition
Yes. It is normal due to the fact that the dominant arm usually has more musculature, resulting in a higher bp. |
|
|
Term
Which of the following is a valid bp?
A. 100/59
B. 119/79
C. 140/90
D. 118/81
E. 89/60 |
|
Definition
C. 140/90
Blood pressure is rounded to the nearest 2 mm Hg. |
|
|
Term
| When should a lower extremity blood pressure measurement be routinely done? |
|
Definition
On hypertensive patients that are less than 30 years of age. |
|
|
Term
| A thigh blood pressure measurement is done the same way as an upper arm bp measurement except that the cuff is inflated to what value relative to the systolic bp measured in the arm? |
|
Definition
at least 40 mm Hg higher than the systolic bp of the brachial artery
The leg usually has more soft tissue and muscle that occlude the femoral artery, thus increasing systolic bp values. |
|
|
Term
| What is indicated by a higher systolic pressure in the brachial artery than the femoral artery (arm vs leg)? |
|
Definition
A vascular obstruction to blood flow in the lower extremity may be present (coarctation of the aorta). |
|
|
Term
| When measuring for the paradoxical pulse, systolic bp will be higher during inspiration or expiration? |
|
Definition
|
|
Term
| Indicate what happens to bp during a palpatory blood pressure determination, an improper cuff administration, when bp is taken over clothing, and when the arm is positioned too high or too low. |
|
Definition
Palpatory bp-->measures 10 mm Hg less than auscultation
improper cuff-->higher bp than normal
taken over clothing-->lower than normal
arm position too high-->lower bp than normal
arm position too low-->higher bp than normal |
|
|
Term
| What are the three most common reasons to find an ascultatory gap? |
|
Definition
- elderly patient
- obese patient
- bp cuff is inflated a 2nd time immediately after first determination (attempt) |
|
|
Term
|
Definition
| It is positive when you can continue to feel the radial pulse distal to the bp cuff after the cuff has been inflated above systolic pressure. |
|
|
Term
| Why does arteriosclerosis make getting an accurate bp reading difficult? |
|
Definition
The vessels are stiff and thus require more pressure to be occluded than the actual systolic bp. |
|
|
Term
Which of the following pulse rates are normal (relative)?
A. 55 bpm in an 18-yr old male soccer player
B. 97 bpm in a hypotensive patient with influenza
C. 60 bpm in a 41-yr old teacher
D. 51 bpm in a 31-yr old pro cyclist
E. All of the above |
|
Definition
E. All of the above
Although normal rates are usually 50-95, a hypotensive patient will have a consistently higher pulse rate due to compensatory efforts of the cardiocirculatory system. Also, a pro cyclist will have a lower resting heart rate due to the (healthy) hypertrophy and strength of the LV. |
|
|
Term
| During tachycardia why could a radial pulse be inaccurate compared to an apical heart rate? |
|
Definition
| Some heart beats could lack the stroke volume and contractile strength to reach the radial artery. |
|
|
Term
| After taking a radial pulse (71) a 4th year med student decided to also take an apical heart rate with her stethoscope and discovered it was different (77). What is the pulse deficit? |
|
Definition
Six
apical HR - radial pulse = pulse deficit |
|
|
Term
| A difference in systolic pressure of about 15 to 20 mm Hg is called a pulsus alternans. This is indicative of what condition? |
|
Definition
Congestive heart failure (LV systolic dysfunction) |
|
|
Term
| Name the alternative pulse points: |
|
Definition
| Radial, femoral, popliteal, dorsalis pedis, posterior tibial |
|
|
Term
| Pulsus bisferiens produces two palpable beats during systole. What diseases are associated with this pulse contour? |
|
Definition
-hypertrophic subaortic stenosis
- severe aortic regurgitation |
|
|
Term
| A water-hammer pulse, which is a pulse that is hyperkinetic and has an increased pulse pressure, is associated with what disorder? |
|
Definition
Chronic aortic regurgitation |
|
|
Term
| Chronic mitral regurgitation is associated with what pulse contour? |
|
Definition
|
|
Term
| A patient with valvular aortic stenosis exhibits a small volume, slow-upstroke and delayed systolic peak. This pulse contour is called what? |
|
Definition
plateau pulse
anacrotic pulse
pulsus tardus et parvus |
|
|
Term
| When is body temperature at its lowest in relation to diurnal variation? |
|
Definition
In the early morning (2-8 AM) |
|
|
Term
| What temperature reading could indicate that a woman is ovulating? |
|
Definition
An increase of about 1 degree Fahrenheit from what would normally be recorded at that time of day |
|
|
Term
| Rank the different methods of measuring temperature by temperature reading from lowest to highest: |
|
Definition
Lowest reading-->Highest reading
Axillary-->Oral-->Tympanic-->Rectal |
|
|
Term
| Which temperature reading is the closest approximation to core temperature? |
|
Definition
|
|
Term
| If the ear canal is occluded with cerumen, how would the expected temperature reading change? |
|
Definition
|
|
Term
| A falsely elevated tympanic membrane temperature reading is most likely caused by what? |
|
Definition
Otitis media (inflammation of the tympanic membrane)
Otitis externa (inflammation of the ear canal) |
|
|
Term
| Is an oral PM temperature of 99.6 considered a fever? |
|
Definition
No.
AM temperatures of >98.9 and PM temperatures >99.9 temperatures indicate fever |
|
|
Term
| What are the common symptoms of fever? |
|
Definition
| clammy skin (due to cutaneous vasconstriction), increased muscle metabolism, sweating to mediate a temperature increase |
|
|
Term
| Hodgkin's lymphoma has symptomatic fever that comes a goes in weekly increments. This fever pattern is called what? |
|
Definition
|
|
Term
| A 22-yr old medical student returns from her African summer mission trip with a fever that occurs every 3rd day. This fever is symptomatic of what typically native African disease? |
|
Definition
Malaria (P. vivax or P. ovale) |
|
|
Term
72 hours after being admitted with a high fever, a 31-yr old man returning from the Caribbean experiences a normal temperature. He is subsequently discharged, but returns to the ER when the fever returns 72 hours later. What disease does he most likely suffer from?
|
|
Definition
|
|
Term
| Hectic fever is a type of remittent or intermittent fever. What makes it unique from those general types of fever? |
|
Definition
The magnitude of the daily variation of temperature (>2.5 F). |
|
|
Term
| Upper limit fever readings that are not caused by drugs or environmental factors are usually caused by what? |
|
Definition
Gram-negative bacteremia (106 F) |
|
|
Term
REVIEW
Celsius= 5/9 * [(Fahrenheit) - 32] |
|
Definition
Fahrenheit = [9/5 * (Celsius)] + 32 |
|
|
Term
| Hypothermia begins when the oral temperature is less than what temperature? |
|
Definition
95 degrees F
(Causes include hypothyroidism, hypoadrenalism, overwhelming infection, intoxications, and cold exposure) |
|
|
Term
| What is the range of breaths per minute within which we do not identify the respiratory rate as tachypnea or bradypnea? |
|
Definition
8-25 breaths/minute
Bradypnea <8
Tachypnea >25 |
|
|
Term
| An increased depth of breathing is called: |
|
Definition
|
|
Term
| During metabolic acidosis, how do the lungs and a person's breathing rate help to adapt to the decreased blood pH? |
|
Definition
| Kussmaul's breathing, a marked increased in inspiratory and expiratory volumes at a slightly fast but sometimes normal or slowed rate, helps excrete carbon dioxide and bring pH back to normal. |
|
|
Term
| An alternating over correction and under correction of carbon dioxide pressure causes what pattern of respiration? |
|
Definition
Cheyne-Stokes breathing
(alternating apnea and hyperpnea) |
|
|
Term
| Neurological diseases (bilateral cerebral cortical dysfunction, hemorrhage, tumor, infarction, and brain trauma) have the same respiratory symptom as a normal sleeping person. What is it? |
|
Definition
Cheyne-Stokes breathing
(over/under correction of CO2 pressure) |
|
|
Term
| Biot's breathing (breathing alternating with long periods of apnea) is usually observed in patients with what kind of dysfunction? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Anxiety can cause hyperventilation. What effect on PCO2 would you expect from this hyperpnea/tachypnea? |
|
Definition
|
|
Term
| A patient with pneumonia experiences relief from difficulty breathing when they sit up (orthopnea). This occurs in relation to being supine because: |
|
Definition
there is decreased vital capacity and lung compliance (gravity anterior --> posterior) and increased venous return (less gravity inferior-->superior) when the person is supine. |
|
|
Term
Orthopnea usually does NOT indicate which of the following disorders?
A. heart failure
B. chronic lung disease
C. upper limb vascular occlusion
D. Pneumonia
E. Pleural effusion |
|
Definition
C. upper limb vascular occlusion
The other 4 are all disorders that can have orthopnea as an accompanying symptom. |
|
|
Term
| A 55-yr old chronic smoker presents with a right upper lobe bronchial tumor (non-metastatic). Although rare, this tumor has a very identifying symptom related to breathing patterns. This symptom is? |
|
Definition
Trepopnea- a shortness of breath that is worse in one lateral decubitis position
(other causes of trepopnea include CHF and unilateral lung disease) |
|
|
Term
| A very specific symptom related to congestive heart failure occurs when a person experiences shortness of breath that begins several hours after falling asleep. It is called: |
|
Definition
| Paroxysmal nocturnal dyspnea (PND) |
|
|
Term
| BMI (body mass index) has a formula of: |
|
Definition
weight (kg) / height^2 (m^2)
OR
lbs/in^2 x 703 |
|
|
Term
| BMI indicates overweight, obese, and extreme obesity at what levels? |
|
Definition
25, 30, and 40 respectively |
|
|
Term
| In order to lose the same amount of weight, a person with a higher BMI will have to have a greater or lesser decrease in caloric intake than someone with a lower BMI? |
|
Definition
Higher
People with a higher BMI need to eat fewer calories than someone with a lower BMI in order to lose the same amount of weight. |
|
|
Term
| At what BMI level is someone considered underweight? |
|
Definition
|
|
Term
| A 49-yr old homeless man is admitted to the ER with ankle and sacrum edema, quadriceps and deltoid dystrophy, and a loss of subcutaneous fat (triceps, midaxillary line, hands). What do these visible symptoms most likely indicate? |
|
Definition
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