11.28 B

Question 1

What are the three primary, overarching reasons for performing a CV exam?

Answer 1

• assessment of a complaint or symptom
• define physiologic state
• screen for disease

Question 2

What are the four aspects of a CV exam?

Answer 2

inspection, palpation, percussion, auscultation

Question 3

During a CV exam, how should the patient be positioned?

Answer 3

at 30 degrees from horizontal

Question 4

The carotid upstroke should be ____ and ____ with a normal velocity of ____.

Answer 4

rapid and synchronous with a normal velocity of 30-180 cm/s

Question 5

Ascultation of the carotid arteries is checking for what?

Answer 5

turbulent flow due to stenosis

Question 6

The jugular venous pressure is a good measure of what pressure?

Answer 6

the central venous pressure which is the right atrial pressure

Question 7

Clinicians underestimate jugular venous pressure by how much compared to cath measurements?

Answer 7

by approximately 3 cm H2O

Question 8

Describe the venous pulse?

Answer 8

there are two falls, the X and the Y, thus it often looks to flutter or wavey

Question 9

Where is the radial pulse?

Answer 9

on the wrists

Question 10

Where is the brachial pulse?

Answer 10

just above the elbows

Question 11

Where is the posterior tibial pulse?

Answer 11

on the medial side of the ankle

Question 12

Where is the dorsalis pedis pulse?

Answer 12

between the first and second tow

Question 13

Pitting edema is graded on a scale of what?

Answer 13

1+ to 4+

Question 14

Grade 2+ pitting edema is characterized by what?

Answer 14

pitting of 4-6 mm

Question 15

What three vertical lines in the chest help guide where to listen for heart sounds?

Answer 15

• sternum
• mid-clavicular line
• anterior axillary line

Question 16

Palpation of the chest is looking for what?

Answer 16

heaves and thrills

Question 17

What is the apical impulse?

Answer 17

the point of maximal impulse where you can best feel the heart beating

Question 18

The apical impulse can be found where?

Answer 18

mid-clavicular line at the 5th or 6th intercostal space

Question 19

If the apical impulse is found lateral to the mid-clavicular line, it predicts what?

Answer 19

low ejection fraction

Question 20

What are sustained precordial movements?

Answer 20

movements that sustain past S2

Question 21

What are sustained precordial movements indicative of?

Answer 21

aortic stenosis, volume overload, severe cardiomyopathy, or ventricular aneurysm

Question 22

An S3 sound is indicative of what?

Answer 22

heart failure

Question 23

An S4 sound is indicative of what?

Answer 23

a stiff heart secondary to long-term hypertension

Question 24

Which sound is the lub and which is the dub?

Answer 24

S1 = lub, S2 = dub

Question 25

An S3 sound is generated by what defect?

Answer 25

it is an abnormal early diastolic filling sound

Question 26

An S4 sound is generated by what defect?

Answer 26

an abnormal late diastolic filling sound

Question 27

What are some common ways to describe and characterize murmurs?

Answer 27

• timing
• location of maximal intensity
• grade/amplitude
• radiation
• pitch
• quality
• shape (crescendo or decrescendo)

Question 28

Are diastolic or systolic murmurs more common?

Answer 28

systolic

Question 29

Are diastolic or systolic murmurs more commonly disease?

Answer 29

diastolic murmurs are always disease

Question 30

What’s the main difference between a grade 3 and a grade 4 murmur?

Answer 30

a grade 4 is characterized by a palpable thrill

Question 31

What are the three basic murmurs?

Answer 31

• aortic stenosis
• mitral regurgitation
• mitral stenosis

Question 32

Describe an aortic stenosis murmur.

Answer 32

• crescendo-decrescendo
• radiates to carotids and accompanied by a slow and low
• chief complaint was often shortness of breath, angina, or syncope

Question 33

Describe a mitral regurgitation murmur.

Answer 33

• lower pressure so quieter and lower pitched
• holosystolic
• best heard at apex
• radiates to the axilla

Question 34

Describe a mitral stenosis murmur.

Answer 34

• mid-diastolic
• low pitched (heard with the bell)
• best heard at the apex

Question 35

What is the cause of a venous hum?

Answer 35

high blood flow for the anatomy

Question 36

Describe a venous hum.

Answer 36

• continuous
• best heard above the head of the clavicle
• associated with high flow states like pregnancy, anemia, and pediatric age
• benign

Question 37

An S3 is also known as a what?

Answer 37

ventricular gallop

Question 38

An S4 is also known as a what?

Answer 38

an atrial gallop

Question 39

Describe an S3 sound.

Answer 39

• Ken-Tuc-Ky
• early diastolic sound
• vest heard at the apex with the bell

Question 40

Describe an S4 sound.

Answer 40

• Ten-Ne-See
• late diastolic sound
• beast heard at the apex or LLSB with bell

Question 41

S2 splitting is the result of what?

Answer 41

a difference in closing time of the pulmonic and aortic valves

Question 42

In an S2 split, which sound is heard first?

Answer 42

the S2a (aortic valve first)

Question 43

Why would you want to decrease venous return?

Answer 43

to increase the sound of outflow tract murmurs like HOCM

Question 44

What are some ways to decrease venous return and increase the sound of an outflow tract murmur?

Answer 44

valsalva or have the patient move from squatting to standing

Question 45

What are some maneuvers for increasing venous return during a CV exam to change the amplitude of specific murmurs?

Answer 45

• prolonged abdominal palpation
• standing to squatting
• passive leg elevation

Question 46

Edema is indicative of a problem with either of what two organs?

Answer 46

heart or liver