Exam 3 Terminology - PAP 580

  1. anastomotic veins
    connect two saphenous veins
  2. ankle-brachial index
    the ratio of ankle systolic pressure to the arm systolic pressure, used in assessing the status of lower extremity arteries. It is calculated by dividing the higher of the left and right ankle pressures by the higher of the two brachial artery pressures
  3. arterioles
    minute artery, one that at its distal end leads to a capillary
  4. atheroma
    fatty degeneration or thickening of the walls of larger arteries
  5. atherosclerosis
    thickening, hardening, and loss of elasticity of the walls of arteries (gradual process)
  6. capillaries
    minute blood vessels that connect the ends of the smallest arteries (arterioles) with the beginnings of the smallest veins (venules)
  7. compartment syndrome
    elevation of tissue pressure with in a closed fascial compartment, causing decreased arteriovenous pressure and decreased muscular perfusion
  8. competent valves
    help propel blood toward heart, preventing pooling, venous stasis, and backward flow
  9. deep veins of the leg
    Carry venous return from lower extremities and are well-supported by surrounding tissues (femoral vein)
  10. inferior vena cava
    Veins from the legs and lower trunk drain upward into the inferior vena cava
  11. perforating veins
    connect superficial (saphenous) system with deep system
  12. superficial veins of the leg
    Subcutaneous with poor tissue support
  13. superior vena cava
    Veins from the arms, upper trunk, head, and neck drain into the superior vena cava, which empties into the right atrium
  14. thrombus formation
  15. thrombus
    a stationary blood clot along the wall of a blood vessel, frequently causing vascular obstruction
  16. axillary nodes
    Lymph nodes found in the armpit that drain the lymph channels from the breast
  17. dorsalis pedis artery
    dorsal artery of the foot
  18. epitrochlear nodes
    Found on the inside of the upper arm, just above the elbow
  19. great saphenous vein
    vein that drains blood from the superficial foot, leg, and thigh and joins the femoral vein
  20. inguinal nodes
    any of the approximately 18 nodes in the group of lymph glands in the upper femoral triangle of the thigh. These nodes are divided into the superficial inguinal nodes and the subinguinal nodes
  21. small saphenous vein
    vein that drains blood from the lateral border of the superficial leg and foot and joins the popliteal vein
  22. superficial inguinal nodes
    a node in one of the two groups of inguinal lymph glands in the upper femoral triangle of the thigh. The nodes form a chain distal to the inguinal ligament and receive afferent vessels from the skin of the penis, scrotum, perineum, buttocks, and abdominal wall below the level of the umbilicus
  23. arterial insufficiency
    inadequate blood flow in arteries. It may be caused by occlusive atherosclerotic plaques or emboli; damaged, diseased, or intrinsically weak vessels; arteriovenous fistulas; aneurysms; hypercoagulability states; or heavy use of tobacco. Signs of arterial insufficiency include pale, cyanotic, or mottled skin over the affected area, absent or decreased sensations, tingling, diminished sense of temperature, muscle pains, reduced or absent peripheral pulses, and, in advanced disease, arterial ulcers and atrophy of muscles in the involved extremity
  24. chronic venous insufficiency
    condition characterized by poor flow of venous blood, especially in the leg veins; symptoms include leg swelling, pain, cramps; risk of DVT. Skin is hyperpigmented with the bluish-red color of dependent edema, sometimes with swelling and cyanosis, progressing to pain and ulceration.
  25. deep vein thrombosis
    DVT - Occlusion of a deep vein (acute process) clot formation and inflammation of a deep vein
  26. intermittent claudication
    pain or cramping in the legs with exertion that is relieved by rest (with in 10 minutes)
  27. lymphangitis
    inflammation of the lymphatic vessels draining a body part that is inflammed or infected, lymph nodes are inlarged and tender - Acute bacterial infection (usually streptococcal)
  28. lymphedema
    edema caused by obstruction of lymphatic drainage of the tissues
  29. myxedema
    a dry, waxy type of swelling (nonpitting edema) with abnormal deposits of mucin in the skin (mucinosis) and other tissues, associated with hypothyroidism; the facial changes are distinctive, with swollen lips and thickened nose
  30. neuropathic ulcer
    an open area occurring as a result of peripheral neuropathy. These occur at high frequency in patients with diabetes.
  31. orthostatis edema
    edema caused by sitting or standing too long
  32. Raynaud'’s disease/phenomenon
    primary vasospastic disease of small arteries and arterioles with unknown cause, exaggerated response of vasomotor controls to cold or emotion. Raynaud’s disease(syndrome): Episodic spasm of the small arteries and arterioles; no vascular occlusion. Raynaud’s phenomenon: Syndrome secondary to other conditions such as collagen vascular disease, arterial occlusion, trauma, drugs
  33. thromboangiitis obliterans
    Buerger'’s disease - Occlusion and inflammation of small arteries and veins in smokers (acute and recurrent)
  34. thrombophlebitis
    Occlusion of a superficial vein (acute process) –due to clot formation and inflammation
  35. phlebitis
    inflammation of a vein
  36. varicose veins
    Varicose veins are dilated, tortuous, elongated superficial veins that are usually seen in the legs. Failure of venous valves (gradual process) – chronic back pressure (venous hypertension) in the veins leading to venous engorgement
  37. tortuous
    Having many turns; winding or twisting
  38. venous insufficiency
    Venous insufficiency is described as abnormal blood flow through veins that can cause local damage, damage to affected legs, or death.
  39. Peripheral Arterial Disease
    • (PAD) Stenotic, occlusive, and aneurysmal disease of the aorta, its visceral arterial branches, and the arteries of the lower extremities (exclusive of the coronary arteries)
    • No symptoms or non-specific symptoms despite the fact that it is present in approximately 30% of the adult population
  40. PAD Warning signs
    • Fatigue, aching, numbness or pain that limits walking or exertion
    • Poorly healing or nonhealing wounds of the legs or feet
    • Pain present at rest in the lower leg or foot that changes when standing or supine
    • Abdominal pain after meals associated with “food fear” and weight loss (intestinal ischemia)
  41. cellulitis
    Bacterial infection of the skin
  42. Radiculopathy
    Nerve root irritation, numbness fits a dermatomal pattern
  43. Neuropathy
    Peripheral nerve dysfunction
  44. arterial arches
    • formed by anastomosis, connects radial and ulnar arteries in the hand (also occurs in the foot)
    • Allen test will determine patency of supplying arteries.
  45. ulnar artery
    large artery that branches from the brachial artery to supply the muscles of the forearm and wrist and hand
  46. acute arterial occlusion
    • Embolism or thrombosis, possibly superimposed on arteriosclerosis obliterans
    • Occurs when blood flow in a leg artery stops suddenly.
    • If completely blocked, tissue begins to die (gangrene)
    • Medical care is needed right away to restore blood flow and save the leg
  47. brachial artery
    the main artery of the upper arm; a continuation of the axillary artery; bifurcates into the radial and ulnar arteries at the elbow
  48. popliteal artery
    a continuation of the femoral artery that branches to supply the legs and feet, palpable just behind the knee
  49. posterior tibial artery
    carries blood to the posterior compartment of the leg and plantar surface of the foot, from the popliteal artery
  50. radial artery
    arises from the bifurcation of the brachial artery in the cubital fossa, runs distally on the anterior part of the forearm
  51. femoral artery
    divided into three parts: The common femoral artery which divides into the deep femoral artery (a.k.a. Profunda), which provides blood to the thigh, and the superficial femoral artery, which provides blood to the arteries that circulate the knee and foot
  52. femoral vein
    blood vessel that accompanies the femoral artery in the femoral sheath. It begins at the adductor canal (also known as Hunter's canal) and is a continuation of the popliteal vein. It ends at the inferior margin of the inguinal ligament, where it becomes the external iliac vein
  53. Apical impulse
    • 5th intercostal space at mid-clavicular line
    • any motion of the anterior wall of the thorax localized in the area over the heart. Variations of precordial movements include apical impulse, left ventricular thrust, and right ventricular thrust
  54. Base of the heart
    the portion of the heart opposite the apex. It is superior and medially located. It forms the upper border of the heart, lies just below the second rib, and primarily involves the left atrium, part of the right atrium, and the proximal portions of the great vessels.
  55. Cardiac apex
    the pointed lower border of the heart. It is directed downward, forward, and to the left and is usually located at the level of the fifth intercostal space.
  56. cardiac tamponade
    compression of the heart caused by increased intrapericardial pressure due to collection of blood or fluid in the pericardium
  57. Diastole
    • The normal rhythmically occurring relaxation and dilatation of the heart chambers, especially the ventricles, during which they fill with blood
    • (S2 --> S1)
  58. Dyspnea
    Difficulty in breathing, often associated with lung or heart disease and resulting in shortness of breath. An uncomfortable awareness of breathing that is inappropriate to a given level of exertion. Some conditions increase the work of breathing (airway obstruction, changes in lung compliance, respiratory muscle weakness). Some conditions increase respiratory drive (hypoxia, acidosis)
  59. shortness of breath
    may be represented by dyspnea, orthopnea, or paroxysmal nocturnal dyspnea
  60. Edema
    condition of abnormally large fluid volume in the circulatory system or in tissues between the body's cells (interstitial spaces)
  61. pitting edema
    • pressure leaves a persistent depression in the tissues 
    • PRT - pitting recovery time, 1 point = 30 seconds.  Document 1+, 2+, 3+
  62. Insufficiency
    results from leakage and backflow of blood that is ejected
  63. Murmur
    distinguishable from heart sounds by their longer duration, attributed to turbulent blood flow and may be diagnostic of valvular heart disease, or "innocent" flow murmurs, especially in young adults, also in pregnancy, anemia, or hyperthyroidism (graded 1-6 depending on intensity)
  64. Grades of Murmurs
    • 1/6 - very faint, only heard with optimal conditions, no thrill
    • 2/6 - loud enough to be obvious, no thrill
    • 3/6 - louder than grade 2, no thrill
    • 4/6 - louder than grade 3, has a thrill
    • 5/6 - heard with stethoscope partially off chest, has a thrill
    • 6/6 - heard with stethoscope completely off chest, has a thrill
  65. Criteria for classifying murmurs
    • timing and duration
    • shape
    • quality
    • pitch
    • radiation
    • intensity (loudness)
    • point of maximum intensity
  66. Valvular heart disease
    refers to several disorders and diseases of the heart valves, which are the tissue flaps that regulate the flow of blood through the chambers of the heart. These include: mitral valve prolapse (displacement), mitral valve insufficiency (regurgitation), mitral valve stenosis (narrowing), aortic valve insufficiency, aortic valve stenosis, tricuspid valve insufficiency, tricuspid valve stenosis, pulmonic stenosis, pulmonic insufficiency
  67. Orthopnea
    Discomfort in breathing that is relieved by sitting or standing in an erect position
  68. Paroxysmal nocturnal dyspnea
    Acute dyspnea caused by the lung congestion and edema that results from partial heart failure and occurring suddenly at night, usually an hour or two after the individual has fallen asleep
  69. Point of maximal impulse
    the point on the chest where the impulse of the left ventricle is felt most strongly, normally in the fifth costal interspace inside the mammillary line
  70. Regurgitation
    the backward flow of blood through a defective heart valve, named for the affected valve, as in aortic regurgitation; also, mitral, pulmonic, tricuspid, valvular
  71. Split heart sounds
    Right sided events occur slightly later than those on the left, delayed closure of pulmonic valve during inspiration results in 2 audible components, best heard in 2nd & 3rd left interspace close to sternum. Splitting of S1 (mitral & tricuspid valve closures) is best heard at lower left sternal border, does not vary with respirations
  72. Stenosis
    an abnormal narrowing or contraction of a duct or canal
  73. occlusive/occlusion
    closing off/acute problem - embolism or thrombosis
  74. stenotic valve
    abnormally narrowed valvular orifice that obstructs blood flow
  75. Systole
    The rhythmic contraction of the heart, especially of the ventricles, by which blood is driven through the aorta and pulmonary artery after each dilation or diastole (S1 --> S2)
  76. Venous hum
    A common innocent murmur heard during childhood. A continuous blowing, singing, or humming murmur heard on auscultation over the right jugular vein in the sitting or erect position; it is an innocent sign that is obliterated on assumption of the recumbent position or on exerting pressure over the vein.
  77. Ventricular hypertrophy
    abnormal enlargement of the heart caused by enlargement of the myocardium. It is often caused by hypertension, a valvular disease, or heart failure. PMI will be shifted to left.
  78. Aorta
    The large artery that is the main trunk of the systemic arterial system, arising from the base of the left ventricle, ending at the left side of the body of the fourth lumbar vertebra, dividing to form the right and left common iliac arteries, and whose parts are the ascending aorta, the aortic arch, and the descending aorta
  79. Aortic valve
    guarding the entrance to the aorta from the left ventricle (semilunar valve)
  80. Inferior vena cava
    A large vein formed by the union of the two common iliac veins that receives blood from the lower limbs and the pelvic and abdominal viscera and empties into the right atrium of the heart
  81. Left ventricle
    The chamber on the left side of the heart that receives the arterial blood from the left atrium and contracts to force it into the aorta
  82. Mitral valve
    between the left atrium and left ventricle, usually having two cusps (anterior and posterior), also known as one of the atrioventricular valves
  83. Pulmonary artery
    a vessel arising from the conus arteriosus of the right ventricle and bifurcating into the right and left pulmonary arteries.
  84. Pulmonary veins
    vein that carries oxygenated blood from the lungs to the left atrium of the heart
  85. Pulmonic valve
    fold in the pulmonary artery that directs blood to the lungs (semilunar valve)
  86. Right atrium
    the right upper chamber of the heart that receives blood from the venae cavae and coronary sinus
  87. Right ventricle
    the chamber on the right side of the heart that receives venous blood from the right atrium and pumps it into the pulmonary trunk (artery)
  88. Superior vena cava
    receives blood from the head and arms and chest and empties into the right atrium of the heart; formed from the azygos and both brachiocephalic veins
  89. Tricuspid valve
    The three-segmented valve of the heart that keeps blood in the right ventricle from flowing back into the right atrium, also known as one of the atrioventricular valves
  90. chordae tendineae
    (heart strings) are cord-like tendons that connect the papillary muscles to the tricuspid valve and the mitral valve in the heart.
  91. Angina pectoris
    discomfort in the chest and/or adjacent areas, usually due to myocardial ischemia
  92. Myocardial infarction
    (MI) prolonged severe anginal discomfort associated with myocardial necrosis
  93. myocardial ischemia
    condition of insufficient blood flow to the heart muscle via the coronary arteries, often resulting in chest pain (angina pectoris)
  94. ischemia
    deficiency of blood supply due to obstruction of the circulation
  95. Pleuritic chest pain
    sharp chest pain that increases with inspiration or cough
  96. Anasarca
    edema involving all aspects of the body – upper and lower extremities and the face
  97. Ascites
    collection of fluid in the peritoneal cavity
  98. opening snap
    (Abnormal Heart Sound) a sharp, high-pitched click in early diastole, associated with the opening of the mitral valve in cases of mitral stenosis. Hx of rheumatic fever
  99. ejection click
    (Abnormal Heart Sound) a high-pitched sound occurring shortly after S1. It is associated with a dilated pulmonary artery or septal defects
  100. pericardial friction rub
    (Abnormal Heart Sound) a to-and-fro sound that waxes and wanes with diastole and systole. It is present even when the patient holds his breath
  101. thrill
    (Abnormal Heart Sound) a vibration, high in frequency and sustained. If a vibration is felt but no murmur is heard, the vibration is not called a thrill
  102. pericardial knock
    (Abnormal Heart Sound) a high-pitched sound best heard during diastole. Pericardial knocks are caused by a thick pericardium limiting expansion of the ventricle during the filling phase (diastole)
  103. Valsalva maneuver
    performed by attempting to forcibly exhale while keeping the mouth and nose closed. It is used as a diagnostic tool to evaluate the condition of the heart and is sometimes done as a treatment to correct abnormal heart rhythms or relieve chest pain.
  104. angioedema
    a vascular reaction involving the deep dermis or subcutaneous or submucosal tissues, representing localized edema caused by dilatation and increased permeability of the capillaries, and characterized by the development of giant wheals
  105. S1
    Normal heart sound produced by closure of the mitral valve
  106. S2
    Normal heart sound produced by closure of the aortic valve
  107. S3
    • caused by vibration of the ventricular walls, resulting from the first rapid filling so it is heard just after S2, low in frequency and intensity, commonly heard in children and young adults. In older adults and the elderly with heart disease, an S3 often means heart failure
    • (Tennessee)
  108. S4
    • occurs during the second phase of ventricular filling, when the atriums contract just before S1, thought to be caused by the vibration of valves, supporting structures, and the ventricular walls, this abnormal sound is heard in people with conditions that increase resistance to ventricular filling, such as a weak left ventricle.
    • (Kentucky)
  109. preload
    the load that stretches the cardiac muscle before contraction. Volume of blood in the right ventricle at the end of diastole constitutes its preload for the next beat. Pathologic increase is called volume overload
  110. myocardial contractility
    ability of the cardiac muscle, when give a load, to shorten. Contractility increases when stimulated by action of the sympathetic nervous system and decreases when blood flow or oxygen delivery to the myocardium is impaired
  111. afterload
    the degree of vascular resistance to ventricular contraction. Sources of resistance to the left ventricular contraction include the tone in the walls of the aorta, the large arteries, and the peripheral vascular tree, as well as the the volume of blood already in the aorta. Pathologic increase is called pressure overload
  112. pulse pressure
    difference between systolic and diastolic pressures
  113. palpitations
    unpleasant awareness of the heartbeat. Described as skipping, racing, fluttering, pounding, or stopping of the heart. Can be caused by: arrhythmias, medications, smoking, caffeine, thyrotoxicosis, hypoglycemia, fever, anemia, anxiety
  114. aortic area
    right second interspace
  115. pulmonic area
    left second interspace
  116. right ventricular area
    left sternal border
  117. left ventricular area
    apex (~5th interspace area on midclavicular line)
  118. tricuspid area
    lower left sternal border
  119. Angle of Louis
    manubrio-sternal joint, sternal angle
  120. Percussion
    establish whether underlying tissues are air-filled, fluid-filled, or solid
  121. anaphylaxis
    a type of allergic reaction, in which the immune system responds to otherwise harmless substances from the environment. Unlike other allergic reactions, however, anaphylaxis can kill. Reaction may begin within minutes or even seconds of exposure, and rapidly progress to cause airway constriction, skin and intestinal irritation, and altered heart rhythms. In severe cases, it can result in complete airway obstruction, shock, and death.
  122. asthma
    reversible bronchial hyperresponsivemess involving release of inflammatory mediators, increased airway secretions, and bronchoconstriction. Symptoms are wheezing, coughing and tightness in chest.
  123. atelectasis
    when a plug in a mainstem bronchos (as from mucus or a foreign object) obstructs air flow, affected lung tissue collapses into an airless state (alveoli collapse). Trachea may shift toward involved side.
  124. atrial fibrillation
    Fibrillation in which the normal rhythmical contractions of the cardiac atria are replaced by rapid irregular twitchings of the muscular wall that cause the ventricles to respond irregularly.
  125. bronchitis
    Excessive mucus production in bronchi, followed by chronic obstruction of the airways. Symptoms include productive cough, recurrent respiratory infections, wheezing my develop. Mild to moderate burning pain mid upper chest, aggravated by coughing
  126. COPD
    Chronic Obstructive Pulmonary Disease - slowly progressive disorder in which the distal air spaces enlarge and lungs become hyperinflated. Chronic bronchitis is often associated. Wheezes with possible crackles.
  127. coronary artery disease
    narrowing or blockage of the arteries and vessels that provide oxygen and nutrients to the heart. It is caused by atherosclerosis, an accumulation of fatty materials on the inner linings of arteries. The resulting blockage restricts blood flow to the heart. When the blood flow is completely cut off, the result is a heart attack
  128. congestive heart failure
    characterized by breathlessness and abnormal sodium and water retention, resulting in edema, with congestion of the lungs or peripheral circulation, or both
  129. mitral valve prolapse
    ballooning of the support structures of the mitral heart valve into the left upper collection chamber of the heart
  130. mitral valve stenosis
    condition in the heart in which one of the valve openings has become narrow and restricts the flow of blood from the upper left chamber (left atrium) to the lower left chamber (left ventricle)
  131. pleurisy
    inflammation of the membrane that surrounds and protects the lungs (the pleura). Inflammation occurs when an infection or damaging agent irritates the pleural surface. As a consequence, sharp chest pains are the primary symptom of pleurisy
  132. pneumonia
    inflammation of the lung parenchyma from the respiratory bronchioles to the alveoli. Symptoms include pleuritic pain, cough, sputum, fever and chills may be present, may follow acute URI
  133. pneumothorax
    leakage of air into pleural space through blebs on visceral pleura, with resulting partial or complete collapse of the lung. Symptoms include pleuritic pain, cough, sudden onset, associated dyspnea. PMI will be shifted from expected location and tracheal deviation toward side of pathology
  134. tension pneumothorax
    the presence of air in the pleural space when pleural pressure exceeds alveolar pressure, caused by a rupture through the chest wall or lung parenchyma associated with the valvular opening. Air passes through the valve during coughing but cannot escape on exhalation. Unrelieved pneumothorax can lead to respiratory arrest. Tracheal deviation away side of pathology
  135. pulmonary edema
    condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately
  136. pulmonary embolus
    Blockage of an artery of the lung by foreign matter such as fat, tumor, tissue, or a clot originating from a vein. Sudden onset; associated dyspnea & anxiety; pain, cough and hemoptysis if lung tissue infarcts
  137. tuberculosis
    potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. It is caused by a bacterial microorganism, the tubercle bacillus or Mycobacterium tuberculosis.
  138. accessory muscles
    any of the muscles of the neck, back, and abdomen that may assist the diaphragm and the internal and external intercostal muscles in respiration, especially in some breathing disorders or during exercise. Often elevated effort of breathing contributes to increased anterior-posterior diameter of the chest (barrel chest) over time
  139. adventitious sounds
    "added" - abnormal auscultatory sounds heard over the lung, such as crackles/rales, rhonchi, or abnormal resonance. Ask the patient to cough, and listen again, clearing of adventitious sounds suggests secretions - post-tussive
  140. agonal
    (Cheyne-Stokes respiration) breathing with rhythmic waxing and waning of depth of breaths and regularly recurring apneic periods (Etymology: Gk, agon, struggle)
  141. air hunger
    a form of respiratory distress characterized by gasping, labored breathing, or dyspnea.
  142. Allen Test
    A test for occlusion of the radial or ulnar artery, in which one of these arteries is compressed after blood has been forced out of the hand by clenching it into a fist; failure of the blood to diffuse into the hand when opened indicates that the artery not compressed is occluded
  143. alveoli
    Small air sacs or cavities in the lung that give the tissue a honeycomb appearance and expand its surface area for the exchange of oxygen and carbon dioxide
  144. antecubital fossa
    a depression at the bend of the elbow. Etymology: L, ante, before, cubitum, elbow, fossa, ditch
  145. apnea
    Temporary absence or cessation of breathing
  146. AV node
    Atrioventricular node - Highly specialized area of the heart muscle located low in the atrial septum which transmits electrical impulses from the SA node along to the bundle of HIS
  147. barrel chest
    A large chest with increased anteroposterior diameter and usually some degree of kyphosis, sometimes seen in cases of emphysema.
  148. bigeminy
    the occurrence of two beats of the pulse in rapid succession
  149. Biot's respirations
    Ataxic Breathing (Biot’s Breathing) Ataxic breathing is characterized by unpredictable irregularity. Breaths may be shallow or deep, and stop for short periods. Causes include respiratory depression and brain damage, typically at the medullary level.
  150. Transmitted voice sounds tests
    • Brochophony - voice sounds become louder
    • Egophony - "ee" sounds like "ay"
    • Whispered pectoriloquy - whispered sounds become louder and clearer
  151. bronchophony
    spoken words are louder upon auscultation - transmitted voice sounds test. Normally muffled and indistinct.
  152. bronchospasm
    bronchial spasm; spasmodic contraction of the smooth muscle of the bronchi, as in asthma
  153. bronchovesicular
    pertaining to the bronchi, bronchioles, and alveoli
  154. bundle branches
    a segment of the network of specialized conducting fibers that transmits electrical impulses within the ventricles of the heart. Bundle branches are a continuation of the atrioventricular (AV) bundle, which extends from the upper part of the intraventricular septum. The AV bundle divides into a left and a right branch, each going to its respective ventricle by passing down the septum and beneath the endocardium. Within the ventricles the bundle branches subdivide and terminate in the Purkinje fibers.
  155. bundle of HIS
    a band of atypical cardiac muscle fibers connecting the atria with the ventricles of the heart, occurring as a trunk and two bundle branches; it propagates the atrial contraction rhythm to the ventricles, and its interruption produces heart block. The term is sometimes used specifically to denote only the trunk of the bundle
  156. cachexia
    general ill health and malnutrition, marked by weakness and emaciation, usually associated with severe disease, such as tuberculosis or cancer
  157. click
    a brief, sharp sound, especially any of the short, dry clicking heart sounds during systole, indicative of various heart conditions (mitral valve prolaspe)
  158. clubbing
    Clinically a bulbous swelling of the soft tissue at the nail base, with loss of the normal angle between the nail and the proximal nail fold. The angle increases to 180° or more, and the nail bed feels spongy or floating. The mechanism is still unknown but involves vasodilatation with increased blood flow to the distal portion of the digits and changes in connective tissue, possibly from hypoxia, changes in innervation, genetics, or a platelet-derived growth factor from fragments of platelet clumps. Seen in congenital heart disease, interstitial lung disease and lung cancer, inflammatory bowel diseases, and malignancies.
  159. consolidation
    alveoli fill with fluid, red cells, and white cells as in pneumonia, pulmonary edema or pulmonary hemorrhage. Increased tactile fremitus over involved area with brochophony, egophony and whispered pectoriloquy
  160. crackles/rales
    May be described as fine or coarse, caused by abnormalities of the lungs (pneumonia, fibrosis, heart failure) or of the airways (bronchitis, bronchiectasis)
  161. crescendo
    shape of a murmur where the murmur grows louder
  162. decrescendo
    shape of a murmur where the murmur grows softer
  163. cyanosis
    bluish discoloration of the skin and mucous membranes, caused by a lack of oxygen in the blood, associated with cold temperatures, heart failure, lung diseases, and smothering
  164. decubitus
    An act of lying down; the position assumed in lying down. To bring the ventricular apex closer to the chest wall so you can assess the PMI, you should also ask the patient to turn to the left side, termed the left lateral decubitus position.
  165. differential diagnosis
    Determination of which one of two or more diseases with similar symptoms is the one from which the patient is suffering
  166. effusion
    escape of a fluid into a part; exudation or transudation.
  167. Pleural effusion - fluid in the pleural space with tracheal deviation away from side of pathology.
    Mild or severe, sharp or stabbing, pleuritic; pain may be localized to the chest wall or referred to the ipsilateral shoulder or upper abdomen because of diaphragmatic involvement, associated symptoms vary according to underlying pathology
  168. transudation
    the passage of a substance through a membrane as a result of a difference in hydrostatic pressure
  169. exudation
    the escape of fluid, cells, and cellular debris from blood vessels and their deposition in or on the tissues, usually as the result of inflammation
  170. egophony
    a change in the voice sound of a patient with pleural effusion or pneumonia as heard on auscultation. When the patient is asked to make “ee” sound, it is heard as “A,” an E-to-A change, particularly over an area of consolidated or compressed lung above the effusion. Transmitted voice sounds test
  171. ejection sound
    sharp sound heard on auscultation in early systole over the aortic or pulmonic area when the aorta or pulmonary artery is dilated
  172. emphysema
    chronic respiratory disease where there is over-inflation of the alveoli in the lungs, causing a decrease in lung function, and often, breathlessness
  173. empyema
    pus in the pleural cavity
  174. excursion
    Chest expansion test, sometimes termed lung excursion. Diaphragmatic excursion is determined by the distance between the level of dullness on full expiration and the level of dullness on full inspiration, normally about 3 to 5.5 cm.
  175. fasciotomy
    surgical procedure that cuts away the fascia to relieve tension or pressure to relieve compartment syndrome in lower extremities
  176. fat necrosis
    necrosis in which fat is broken down into fatty acids and glycerol, usually occurring in subcutaneous tissue as a result of trauma
  177. tactile fremitus
    • palpable vibration, as felt by the ulnar surface of hand placed on the chest during speaking. Increased over areas of consolidation, decreased over areas of pleural effusion or pneuomthorax
    • Sound travels better through fluid/solid than open space
    • Have patient say "boy oh boy", "scooby doo", or "blue balloon"
  178. vocal fremitus
    one caused by speaking, perceived on auscultation
  179. friction rub
    a dry, grating sound heard with a stethoscope during auscultation. A friction rub auscultated over the pericardial area is suggestive of pericarditis; a rub over the pleural area may be a sign of lung disease
  180. pleural rub
    friction sound heard during breathing in patients with peuritis, due to the rubbing of the visceral and parietal pleurae
  181. hemoptysis
    • Coughed up blood from the lungs. Most common due to acute & chronic bronchitis, pneumonia, TB, lung cancer
    • (This is not the same as vomiting blood - hematemesis)
  182. holosystolic
    Relating to or lasting throughout the systole of a heartbeat
  183. hyperlipidemia
    An excess of lipids in the blood
  184. hyperpigmentation
    increase in the natural color of the skin, found in Addison's Disease, chronic renal disease, hyperthyroidism, hemochromatosis
  185. hyperpnea
    Abnormally deep and rapid breathing
  186. hyperresonance
    Greater than normal resonance, often of a lower pitch, on percussion of the body
  187. hypertension
    high blood pressure - stage 1 hypertension is a systolic of 140-159, diastolic of 90-99, stage 2 hypertension is a systolic of ≥160, diastolic ≥100
  188. infraclavicular
    below the clavicles
  189. JVD
    Jugular-venous distention - clinical indicator of obstruction to the return of blood to the right atrium, e.g. because of congestive heart failure or space-occupying lesion in the anterior thorax
  190. Kussmaul's respirations
    Deep, rapid respiration characteristic of diabetic acidosis or other conditions causing acidosis
  191. Metabolic acidosis
    disruption of the body's acid/base balance (too much acid and not enough bicarbonate), can be a mild symptom brought on by a lack of insulin, a starvation diet, or a gastrointestinal disorder like vomiting and diarrhea. Metabolic acidosis can indicate a more serious problem with a major organ like the liver, heart, or kidneys. It can also be one of the first signs of drug overdose or poisoning
  192. myasthenia gravis
    autoimmune disease that causes muscle weakness, affects the neuromuscular junction, interrupting the communication between nerve and muscle, and thereby causing weakness. A person with MG may have difficulty moving their eyes, walking, speaking clearly, swallowing, and even breathing, depending on the severity and distribution of weakness. Increased weakness with exertion, and improvement with rest, is a characteristic feature of MG
  193. mycobacteria
    small rod shaped bacteria (tuberculosis)
  194. nasal flaring
    An ↑ in nostril size with breathing, a classic sign of severe asthma
  195. nocturia
    excessive urination at night
  196. pallor
    paleness, as of the skin.
  197. pathologic
    Characterized by disease or the structural and functional changes due to disease. Pathologic heart murmurs may indicate a heart defect.
  198. physiologic
    Characteristic of normal, healthy functioning
  199. plateau murmur
    murmur has the same intensity throughout
  200. PMI
    point of maximal impulse - the place where the apical pulse is palpated as strongest, often in the fifth intercostal space of the thorax, just medial to the left midclavicular line
  201. post-tussive
    When you hear crackles, wheezes or rhonchi, ask the patient to cough, and listen again, clearing of adventitious sounds suggests secretions
  202. productive cough
    cough that expels mucus or sputum from the respiratory tract
  203. Purkinje fibers
    modified cardiac muscle fibers composed of Purkinje cells, occurring as an interlaced network in the subendothelial tissue and constituting the terminal ramifications of the cardiac conducting system
  204. respiratory distress
    condition in which patients with lung disease are not able to get enough oxygen, signs include cyanosis, audible wheezing, deviation of the trachea, use of accessory muscles
  205. occupational exposure
    construction/industry workers (asbestos), farmers (dust/mineral particles), miners (coal dust), firefighters (dust/gases/fumes/combustion particles)
  206. rhonchi
    a continuous snorelike sound in the throat or bronchial tubes, due to a partial obstruction (secretions in large airways)
  207. wheezes
    a whistling type of continuous sound, suggests narrowed airways as in asthma, COPD, or bronchitis
  208. sinus node/sinoatrial node
    collection of atypical cardiac muscle fibers (Purkinje fibers) at the junction of the superior vena cava and right atrium, in which the cardiac rhythm normally originates and which is therefore called the cardiac pacemaker
  209. split S1
    S1 also has two components, an earlier mitral and a later tricuspid sound. The mitral sound, its principal component, is much louder, again reflecting the high pressures on the left side of the heart. It can be heard throughout the precordium and is loudest at the cardiac apex. The softer tricuspid component is heard best at the lower left sternal border; it is here that you may hear a split S1. The earlier, louder mitral component may mask the tricuspid sound, however, and splitting is not always detectable. Splitting of S1 does not vary with respiration.
  210. split S2
    • the second heart sound, S2, and its two components, A2 and P2, caused primarily by closure of the aortic and pulmonic valves, respectively. During inspiration, the right heart filling time is increased, which increases right ventricular stroke volume and the duration of right ventricular ejection compared with the neighboring left ventricle. This delays the closure of the pulmonic valve, P2, splitting S2 into its two audible components. During expiration, these two components fuse into a single sound, S2.
    • Best heard in 2nd & 3rd left interspace close to sternum
  211. sputum
    Matter coughed up and usually ejected from the mouth, including saliva, foreign material, and substances such as mucus or phlegm, from the respiratory tract
  212. cough
    • A reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi (mucus, pus, blood, dust, foreign bodies, cold or warm air, inflammation of the respiratory mucosa, pressure or tension in the air passages from tumor or enlarged lymph nodes, may be cardiac in origin)
    • Duration: acute < 3 weeks, subacute 3-8 weeks, chronic > 8 weeks
  213. stridor
    noisy breathing in general, also refers specifically to a high-pitched crowing sound associated with croup, respiratory infection, and airway obstruction.
  214. subcostal retractions
    sign of respiratory distress where retractions are seen below the rib cage
  215. tachypnea
    very rapid respiration
  216. thyrotoxicosis
    An excess of thyroid hormones in the blood, causing a variety of symptoms that include rapid heart beat, sweating, anxiety, and tremor, hyperthyroidism, Graves' Disease
  217. vital capacity
    the volume of gas that can be expelled from the lungs from a position of full inspiration, with no limit to duration of inspiration; equal to inspiratory capacity plus expiratory reserve volume
  218. whispered pectoriloquy
    Transmission of the voice sound through the pulmonary structures so that it is unusually audible on auscultation of the chest, indicating either consolidation of the lung parenchyma or the presence of a large cavity. Transmitted voice sounds test.
  219. active listening
    process of closely attending to what the patient is communicating, being aware of the patient's emotional state, using verbal and non-verbal skills to encourage the speaker to continue and expand upon important concerns
  220. echoing
    simple repetition of the patient's last words, encourages the patient to expand on factual details and feelings
  221. empathy
    the capacity of the clinician to identify with the patient and feel the patient's pain as the clinician's own.
  222. empowering the patient
    Sharing power with the patient over their medical care by: evoking patient's perspective, conveying interest in the person not just the problem, following the patient's lead, elicit and validate emotional content, share information with the patient (especially at transition points during visit), make clinical reasoning transparent to patient, reveal the limits of your knowledge
  223. focused questions
    questions aimed to elicit more focused responses
  224. guided questioning
    shows sustained interest in the patient's feelings and deepest disclosures - moving from open-ended to focused questions, using questions to elicit graded response, series of questions, multiple choices for answers, clarifying what the patient means, encouraging with continuers, using echoing
  225. neutral utterances
    "hmmm", "mm-hm", "go on", encourages the patinet to say more
  226. OLD CARTS
    Onset, Location, Duration, Character, Aggravating/Alleviating Factors, Radiation, Timing
  227. open-ended questions
    general questions, can elicit a number of responses, allow full freedom of response
  228. OPQRST
    Onset, Palliating/Provoking Factors, Quality, Radiation, Site, Timing
  229. paraphrase
    provider indicates understanding of patient's story and encourages the patient to express deeper feelings
  230. partnering
    when building relationships with your patients, be explicit about your commitment to an ongoing partnership - make the patient feel that regardless of what happens with their illness, you envision continuing their care
  231. patient centered
    encourages patient to express what is most important to them, personal concerns in addition to symptoms
  232. reassurance
    identifying and acknowledging the patient's feelings, later after examination/lab studies interpret for patient what you think is happening and deal openly with expressed concerns.  Reassurance comes from making the patient feel confident that problems have been fully understood and are being addressed.
  233. sacred seven
    • Location
    • Quality
    • Severity
    • Timing/Onset
    • Setting
    • Aggrevate
    • Alleviate
    • Associated symptoms
  234. self-disclosure
    self-disclosure-part of relationship building skills-and indirect inquiry- "I had a similar experience, it made me feel...."
  235. summarization
    giving a capsule summary of the patient's story during the course of the interview serves to show you have been listening carefully, identifies what you know and don't know, let's the patient add any other information or correct any misunderstandings
  236. transitions
    Patients may be apprehensive during a health care visit, to put them more at ease, tell them when you are changing directions during the interview.  Moving from one part of the history to the next, or moving to the physical examination. "Now I would like to examine you, I'll step out while you change into a gown."
  237. validation
    to affirm the patient by acknowledging the legitimacy of his/her emotional experience
  238. 3 tissue layers of arteries
    intima - endothelium; media - smooth muscle; adventitia - outer layer of connective tissue with nerve fibers and vasa vasorum (perfuse the media layer). Internal elastic membrane (lamina) separates the intima and media layers, external elastic membrane (lamina) separates the media and adventitia layers.
  239. arrhythmia
    any deviation from the normal cardiac rhythm
  240. diaphragm of stethoscope
    • best for listening to high pitched sounds
    • S1 and S2
    • aortic and mitral regurgitation murmurs
    • pericardial friction rubs
    • press firmly
  241. bell of stethoscope
    • best for listening to low pitched sounds
    • S3 and S4
    • mitral stenosis murmur
    • apply lightly
  242. blowing sound
    mitral or tricuspid regurgitation
  243. harsh sound
    aortic or pulmonic stenosis
  244. rumbling sound
    mitral stenosis
  245. muscial sound
    • usually caused by resonating structures such as valve leaflets
    • Still’s murmur - benign murmur of childhood
Card Set
Exam 3 Terminology - PAP 580
PVS, Cardiac, and Respiratory Terms Exam 3