NURS 642 Exam 2 questions with correct answers
Cullens sign Correct Answer-periumbilical ecchymosis
(hemoperitoneum d/t pancreatitis, ectopic) r/t bleeding
Grey turners sign Correct Answer-flank ecchymosis (hematoperitoneum
d/t pancreatitis).
Murphy's sign Correct Answer-palpate with inspiration @liver margain -
pt stops breathing. gallbladder
Iliopsoas Correct Answer-Psoas muscle- right hand pushes down right
thigh as pt raises leg, causes RLQ pain. Appendicitis
Rebound tenderness (McBurney's) Correct Answer-press down between
iliac crest and umbilicus and release. pain on release is positive.
appendicitis
Rovsings (peritoneal irritation) Correct Answer-press deep on LLQ, pain
in RLQ = appendicitis. Press RLQ, pain in LLQ = diverticulitis
Markle's Correct Answer-jarring heel, press on heel elicits abd pain.
74% sensitive for appendicitis
Obturator (obturator muscle) Correct Answer-peritoneal irritation, flex
right leg at hip and knee, rotate at kneeinternally/externally. pain in
hypogastric area
,CVA tenderness Correct Answer-fist percussion on back over kidneys.
pyelonephritis.
CMT- cervical motion tenderness Correct Answer-PID or ectopic
pregnancy
Cardiomyopathy Correct Answer-Heart muscle structurally/functionally
abnormal without CAD, HTN, or congenital heart disease.
Restrictive Cardiomyopathy Correct Answer-Muscle unable to dilate.
Impaired filling.
Decreased CO from diastole = Diastolic HF. Presentation: exertional
intolerance and fluid restriction
CXR - pulm congestion, normal heart size.
*Echo - moderate EF (25-50%). normal to Thick ventricle walls.
Valvular: Endocardial involvement involvement
Biopsy to find cause. Most common is Amyloidosis. Arrthymias:
Ventricular tachy are uncommon except in sacrodosis blocks. Mainly
Atrial fib
Amyloidosis Correct Answer-Protein deposited into heart muscle.
PE: : thickened tongue, peri-orbital purpura, hepatomegaly
,Dilated Cardiomyopathy Correct Answer-Muscle is over dilated (LV or
LV&RV). Impaired contraction. Presenting symptoms: exertional
intolerance
Decreased CO from systole = Systolic HF.
Pansystolic (MR) murmur @ apex.
Labs - elevated BNP.
EKG - will be abnormal, nonspecific.
CXR - Cardiomegaly.
*Echo - Thin (dilated) ventricle walls (>60mm). Decreased EF < 30%.
Valvular: Annular dilatation-Mitral regurgitation is seen first then
tricuspid
Cause: idiopathic, genetic, pregnancy, myocarditis. Arrhythmias:
ventricular tachy or connection blocks
Hypertrophic Cardiomyopathy Correct Answer-Muscle cell protein
*genetic abnormality.
Impaired filling (small ventricles due to hypertrophy).
Muscle does not contract properly.
Decreased CO from diastole = Diastolic HF.
S/SX: asymptomatic; syncope, palpitations, DOE, sudden death!
SYSTOLIC EJECTION MURMUR / S4.
CXR - normal. EKG - normal.
*Echo - Thick ventricle walls & septum is thickest! EF Normal >60%
Valvular: related to valve septum.
Genetic testing or Biopsy for confirmation.
, TX: temporary = BB, CCB, diuretics. Later, EP interventions - ablation,
PPM, AICD.
Avoid: sudden position changes, bearing down, lifting weights, sudden
activity.
Tako-Tsubo Cardiomyopathy or "broken heart syndrome" Correct
Answer-Stressful event, postmenopausal
Presents similar to ACS: ST elevation & troponin elevated.
Echo - LV ballooning at apex.
TX: BB, ASA, and ACE-I until LV function normalizes (weeks to
months).
Arrhythmogenic RV Cardiomyopathy (ARVC) Correct Answer-Muscle
replaced by fibrous fatty tissue. RV=1st.
Genetic.
S/SX: syncope, presyncope, sustained palpitations, sudden cardiac death
(youth, athletes).
EKG: LBBB, arrhythmias.
Echo w/ unique RV findings.
AHA Indications for Cardiac Monitoring Correct Answer-AHA Class 1:
Cardiac monitoring indicated due to risk for life threatening arrhythmia.
§ EX: Cardiac arrest, unstable ACS, acute HF, Long QT, Complicated
PCI.
Cullens sign Correct Answer-periumbilical ecchymosis
(hemoperitoneum d/t pancreatitis, ectopic) r/t bleeding
Grey turners sign Correct Answer-flank ecchymosis (hematoperitoneum
d/t pancreatitis).
Murphy's sign Correct Answer-palpate with inspiration @liver margain -
pt stops breathing. gallbladder
Iliopsoas Correct Answer-Psoas muscle- right hand pushes down right
thigh as pt raises leg, causes RLQ pain. Appendicitis
Rebound tenderness (McBurney's) Correct Answer-press down between
iliac crest and umbilicus and release. pain on release is positive.
appendicitis
Rovsings (peritoneal irritation) Correct Answer-press deep on LLQ, pain
in RLQ = appendicitis. Press RLQ, pain in LLQ = diverticulitis
Markle's Correct Answer-jarring heel, press on heel elicits abd pain.
74% sensitive for appendicitis
Obturator (obturator muscle) Correct Answer-peritoneal irritation, flex
right leg at hip and knee, rotate at kneeinternally/externally. pain in
hypogastric area
,CVA tenderness Correct Answer-fist percussion on back over kidneys.
pyelonephritis.
CMT- cervical motion tenderness Correct Answer-PID or ectopic
pregnancy
Cardiomyopathy Correct Answer-Heart muscle structurally/functionally
abnormal without CAD, HTN, or congenital heart disease.
Restrictive Cardiomyopathy Correct Answer-Muscle unable to dilate.
Impaired filling.
Decreased CO from diastole = Diastolic HF. Presentation: exertional
intolerance and fluid restriction
CXR - pulm congestion, normal heart size.
*Echo - moderate EF (25-50%). normal to Thick ventricle walls.
Valvular: Endocardial involvement involvement
Biopsy to find cause. Most common is Amyloidosis. Arrthymias:
Ventricular tachy are uncommon except in sacrodosis blocks. Mainly
Atrial fib
Amyloidosis Correct Answer-Protein deposited into heart muscle.
PE: : thickened tongue, peri-orbital purpura, hepatomegaly
,Dilated Cardiomyopathy Correct Answer-Muscle is over dilated (LV or
LV&RV). Impaired contraction. Presenting symptoms: exertional
intolerance
Decreased CO from systole = Systolic HF.
Pansystolic (MR) murmur @ apex.
Labs - elevated BNP.
EKG - will be abnormal, nonspecific.
CXR - Cardiomegaly.
*Echo - Thin (dilated) ventricle walls (>60mm). Decreased EF < 30%.
Valvular: Annular dilatation-Mitral regurgitation is seen first then
tricuspid
Cause: idiopathic, genetic, pregnancy, myocarditis. Arrhythmias:
ventricular tachy or connection blocks
Hypertrophic Cardiomyopathy Correct Answer-Muscle cell protein
*genetic abnormality.
Impaired filling (small ventricles due to hypertrophy).
Muscle does not contract properly.
Decreased CO from diastole = Diastolic HF.
S/SX: asymptomatic; syncope, palpitations, DOE, sudden death!
SYSTOLIC EJECTION MURMUR / S4.
CXR - normal. EKG - normal.
*Echo - Thick ventricle walls & septum is thickest! EF Normal >60%
Valvular: related to valve septum.
Genetic testing or Biopsy for confirmation.
, TX: temporary = BB, CCB, diuretics. Later, EP interventions - ablation,
PPM, AICD.
Avoid: sudden position changes, bearing down, lifting weights, sudden
activity.
Tako-Tsubo Cardiomyopathy or "broken heart syndrome" Correct
Answer-Stressful event, postmenopausal
Presents similar to ACS: ST elevation & troponin elevated.
Echo - LV ballooning at apex.
TX: BB, ASA, and ACE-I until LV function normalizes (weeks to
months).
Arrhythmogenic RV Cardiomyopathy (ARVC) Correct Answer-Muscle
replaced by fibrous fatty tissue. RV=1st.
Genetic.
S/SX: syncope, presyncope, sustained palpitations, sudden cardiac death
(youth, athletes).
EKG: LBBB, arrhythmias.
Echo w/ unique RV findings.
AHA Indications for Cardiac Monitoring Correct Answer-AHA Class 1:
Cardiac monitoring indicated due to risk for life threatening arrhythmia.
§ EX: Cardiac arrest, unstable ACS, acute HF, Long QT, Complicated
PCI.
