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
