Advanced Health Assessment Exam 2

What mPAP value indicates pulmonary hypertension?

>25 mmHg

What can you give to temporarily treat Wolf Parkinson's White Syndrome?

Amiodarone and Procainamide

Why do we get a CBC in heart failure patients?

Anemia in heart failure patients results in a 2x increase in post-op mortality

What does AHI mean?

Apnea-hypopnea index

What is Wolf Parkinson White disease?

Arrythmia where atria and ventricles bypass the AV node

Which disease processes typically are obstructive diseases?

Asthma, chronic bronchitis, emphysema

Which abnormal breath sound has short, popping, crackling sounds that are not continuous?

Atelectatic crackles

Where do ribs 8-10 attach to?

Attach to costal cartilage above

What is the CFTR gene mutation? What does it cause in CF?

CFTR gene is found on epithelial cells of most exocrine glands Causes thickened secretions and luminal obstruction

What causes increased tactile fremitus?

Consolidation —> Pneumonia

What do murmurs mean for a newborn?

Could be a poor transition from fetal to pulmonic circulation that occurs immediately after birth

What do murmurs mean for a child?

Could mean heart disease, but other signs must be considered (clubbing fingers, poor weight gain, developmental delay, tachypnea/tachycardia)

What are abnormal breath sounds?

Crackles (rales), wheeze (rhonchi), stridor, pleural friction rub

What can a Left BBB lead to?

Heart failure

What blood pressure must we avoid during anesthesia?

Hypotension

How much tidal volume increases during pregnancy?

Increase by 40%

What age are infants obligatory nose breathers?

Infants are nose breathers until about 3 months

Why would we not aggressively treat hypertension pre-operatively?

Leads to perioperative hypotension —> "bad outcomes"

Left BBB occurs from which side of heart?

Left

How many METs (maximal exercise test score) if you can go up a flight of stairs or walk around the block?

MET of 4

What is another name for the sternal angle?

Manubriosternal angel or "Angle of Louis"

What are the 3 stages of diagnosed AHI?

Mild OSA: 5-15 abnormal breaths/hour Moderate OSA: 15-30 abnormal breaths/hour Severe OSA: >30 abnormal breaths/hour

What causes the release of Natriuretic Peptide?

Myocardial wall stretching

Does an absence of murmurs in a newborn mean that the heart is healthy?

No

What type of MI most often occurs postoperatively?

Non-ST-elevated MI (NONSTEMI)

What type of lung disorder is CF classified as?

Obstructive Lung disorder

What would obstructive lung diseases PFT be? What would their flow-loop look like?

PFT has: decreased FEV1, normal or decreased FVC, and decreased FEV1/FVC Flow loop: smaller with dent in loop "bite out of ice cream"

What would restrictive lung diseases PFT be? What would their flow-loop look like?

PFT: decreased TLC, FEV1, & FVC. Normal FEV1/FVC and a low DLCO

What causes decreased tactile fremitus?

Pleural effusion, pneumothorax, or obstruction

What position should the patient be in to assess JVD?

Position patient in supine position at a 30-45 degree angle

What patients would we test AHI on?

Sleep apnea patients

Which abnormal breath sound has inspiratory crowing sounds that are loudest in the neck?

Stridor

Which ribs are true ribs and why?

Ribs 1-7, they are true because they attach directly to the sternum by costal cartilage

What are the "floating ribs"?

Ribs 11-12

Right BBB occurs from which side of heart?

Right

Which BBB is more common? Right or Left

Right

Which type of BBB results from chronic conditions?

Right BBB

What is the standard diagnosis for pulmonary hypertension?

Right heart cath

What type of MI benefits from emergency intervention?

ST-elvated MI (STEMI)

What are the EKG leads and which part of the heart do they look at?

V1,V2: right ventricle V3, V4: septum V5, V6: left side of heart Lead I: left side of heart Lead II: inferior territory Lead III: inferiior territory aVF: inferior territory aVL: left side of heart aVR: right side of heart

In a 6 minute walking test, what distance would identify severity of Pulmonary HTN?

Walking less than 600 meters

Why do we auscultate the carotid artery?

We are assessing for the presence of a carotid bruit

When is the s3 heart sound heard? What part of cardiac cycle does it occur?

When: AV valves open Cycle: protodiastole

When is the s1 heart sound heard? What part of cardiac cycle does it occur?

When: closure of AV valves Cycle: beginning of systole

When is the s2 heart sound heard? What part of cardiac cycle does it occur?

When: closure of semilunar valves Cycle: end of systole

Where is the sternal angel located? What rib is it continuous with?

Where the manubrium and sternum meet. Continious with the 2nd rib

Are wheezes a continuous abnormal breath sound?

Yes

Is stridor a continuous abnormal breath sound?

Yes

Should we keep a patient, who has pulmonary HTN, on all their cardiac medications?

Yes

What do we measure in a AHI test? What are the criteria to measure?

-Measures number of abnormal respiratory events in an hour over night -Criteria: (1) must last for 10 seconds, (2) Patient has decrease in saturation by 3-4%

What is the normal anterior to posterior ratio?

0.7-0.75

What are 2 COPD testing that can be done pre-operatively?

1. ABG 2. Chest X-Ray

What are 4 types of pre-op screening tools for obstructive sleep apnea? (BASP)

1. Berlin 2. ASA Checklist 3. STOP-Bang 4. P-STAP

What are the 3 normal breath sounds? Where will you hear them?

1. Bronchial: trachea/neck region 2. Bronchovesicular: sternum/spine region/upper chest 3. Vesicular: lung fields/bases

When is COPD testing necessary?

1. Changes from baseline 2. Co-morbid cardiac/respiratory problems 3. Major surgery 4. If bullae are present (large air pockets in lungs)

What are the lung capacities and normal volumes?

1. ERV: expiratory reserve volume (1200) 2. TLC: total lung capacity (6000 mL) 3. VC: vital capacity (4800 mL) 4. IC: inspiratory capacity (3600 mL) 5. FVC: forced vital capacity

What are the goals of pulmonary function testing?

1. Look for evidence of respiratory disease 2. Assess progression of disease 3. Monitor for potentially toxic side effects of certain drugs (amiodarone)

When would a EKG pre-op be reasonable to obtain? (7 of them)

1. Risk factor or history of CAD 2. Abnormal heart rate 3. Arrythmias or known conduction defects 4. CVA 5. Structural heart disease 6. PAD 7. Males over 40 years old/Females over 50 years old

What is the Wolf Parkinson White triad?

1. Short P-R interval 2. Delta wave 3. Wide QRS

At what BP would you cancel a case?

180/110

How long should the wait time be for elective surgery after angioplasty without stent?

2 weeks of dual antiplatelet therapy

How long should the wait time be for elective surgery after angioplasty with drug-eluding stent?

6 months

What is the treatment choice for Wolf Parkinson's White Syndrome?

Ablation

What is the airway and cardiac importance of the sternal angel?

Airway: It is the site where tracheal bifurcation occurs Cardiac: upper border of the atria

What medications do you avoid with Wolf Parkinson White?

Beta blockers and Ca channel blockers

How is asthma diagnosed and what does a frequent cough mean?

Diagnosis: spirometry A frequent, chronic cough means that a child probably has asthma