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Physical Diagnosis & Assessment > Abnormalities On Auscultation > Flashcards

Abnormalities On Auscultation Flashcards

1
Q

True or false: The sound of valves is relative to where they are located in the precordium

A

False. Auscultation of heart sounds is where the sound travels

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2
Q

If you want to auscultate for aortic stenosis, what is the best location to hear this?

A

R 2nd ICS

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3
Q

What part of the heart correlates to the 2nd left ICS?

A

Pulmonic area

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4
Q

To evaluate for mitral value stenosis, you should auscultate at the __________

A

Left 5th ICS midclavicular line

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5
Q

Auscultation of the left 4th ICS is the sound of the _______ valve

A

Tricuspid

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6
Q

S1 is best heard at ______

A

Left 4th & 5th ICS

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7
Q

What sound does S1 indicate?

A

Closing of mitral & tricuspid Valves

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8
Q

S2 is the sound of the _______ valves closing

A

Aortic & pulmonic

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9
Q

The ____ valves do not close simultaneously when there is a __ (heart sound)

A

aortic & pulmonic

split S2

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10
Q

where is the split S2 heard best?

A

at the base of the heart -> 2nd L ICS

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11
Q

what can cause a split S2?

A

► Physiologic (related to inspiration)
► Right ventricle overload
► Delayed closure of pulmonary valve
► Delayed closure of aortic valve

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12
Q

if a split S2 is auscultated while performing the special auscultatory maneuver, this can indicate ____

A

aortic regurgitation

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13
Q

physiologic splitting of S2 occurs due to _____ and during ____ because there is increased venous return to the right side of the heart

A

decreased intrathoracic pressure

-during inspiration

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14
Q

a pathologic split S2 will occur during the ____ & with every ____

A

special auscultatory maneuver after sitting upright

-heart beat

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15
Q

if S2 splitting is physiological, you (will/will not) hear the split with every breath/.

what is this related to?

A

will not

  • inspiration/expiration
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16
Q

when does S3 occur during the cardiac cycle?

A

after S2

-occurs early in diastole -> rapid ventricular filling

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17
Q

if present, when is S4 heard & at what point of the cardiac cycle?

A

late diastole BEFORE S1

-abnormal last push to get blood from atrium -> ventricles

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18
Q

what mechanism in the heart causes the sound of S3? what does this sound like and where is it heard best?

A

rapid deceleration of blood as it strikes ventricle

  • Ken-tuc-ky ► Low pitched sound
  • Heard best at apex and along left sternal border.
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19
Q

what can pathologic causes are associated with the sound of S3?

A

► CHF (Systolic)
► Constrictive Pericarditis
► Hypertension (prolonged)

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20
Q

True or false: S3 is a normal physiologic finding in asymptomatic patients < 30 years old

A

True -> Related to rapid ventricular filling

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21
Q

what is the mechanism that produces the sound of S4?

A

Caused by atrial contraction which causes rapid flow of blood into non-compliant (stiff) ventricle
► Ventricle does not relax appropriately in diastole

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22
Q

when is S4 heard in the cardiac cycle and what does it sound like?

A

Heard in late diastole…just before S1

► Ten-nes-see

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23
Q

what are pathological causes of S4?

A

► patients with stiffened left ventricle
► caused by hypertension
► aortic stenosis
► Cardiomyopathy
► acute MI
► rupture of chordae tendinae in acute mitral regurgitation
► Associated with diastolic heart failure

24
Q

gallops are heart sounds heard during _ in the cardiac cycle

A

diastole

25
Q

what position is best to auscultate for mitral murmurs that indicate mitral valve abnormalities?

A

Left lateral decubitus

-using bell over 5th ICS MCL & left 5th ICS axillary (lateral)

26
Q

at what part of the cardiac cycle will a systolic ejection murmur be heard & what is it associated with?

A

Begin after the first heart sound

  • attains a peak during mid-systole
  • terminate before the second heart sound

Crescendo-decrescendo (slow, loud, slow)
-> aortic stenosis

27
Q

when are Pan-systolic or holo-systolic murmurs during the cardiac cycle?

A

during all of systole

28
Q

these murmurs are heard during all of diastole

A

Pan-diastolic or holo-diastolic murmus

29
Q

when is a pro-diastolic murmur heard during the cardiac cycle?

A

early diastole

30
Q

when is a pre-systolic murmur heard during the cardiac cycle?

A

late diastole

31
Q

what does regurgitation/insufficiency indicate in regards to the heard valves?

A

inadequate closure of valves

32
Q

a grade _ murmur is a loud murmur that also has a palpable thrill on exam

A

grade 4

33
Q

a grade _ murmur is the loudest murmur heard with the stethoscope touching the chest which also has a palpable thrill

A

grade 5

34
Q

True or False: a murmur in a pt that previously had this murmur has become softer. this is a good sign.

A

false

-problematic

35
Q

what pathologies can systolic murmurs indicate?

A 
AS MI TI PS
► Aortic Stenosis
► Mitral Insufficiency
► Tricuspid Insufficiency
► Pulmonic Stenosis
36
Q

if a pt has a known hx of mitral & tricuspid insufficiency, what type of murmur do you expect to auscultate on exam and where would this best be heard?

A

systolic murmur
-apex
> L 4th ICS
> L 5th ICS MCL

37
Q

what pathologies can diastolic murmurs indicate?

A

► Aortic Insufficiency
► Mitral Stenosis
► Tricuspid Stenosis
► Pulmonic Insufficiency

38
Q

what type of murmur do you expect to hear for aortic regurgitation and where would you auscultate on the chest for this?

A

diastolic murmur

-L 3rd ICS

39
Q

if a pt has a known hx of aortic stenosis, performing the valsalva maneuver will make the murmur _____

A

softer

  • d/t less blood (venous return) being ejected from aortic valve
  • less venous return to left ventricle
40
Q

along with a crescendo-decrescendo murmur, there will also be ______ & ____ palpated on exam in patients with aortic stenosis

A

delayed carotid upstroke

-thrill

41
Q

a blowing diastolic murmur is auscultated at the L 3rd ICS. what can this indicate?

A

aortic regurgitation

42
Q

a harsh, saw like systolic ejection murmur is auscultated at the R 2nd ICS. what can this indicate?

A

aortic stenosis

43
Q

a patient with a known hx of aortic regurgitation will have what physical exam findings?

A

bounding carotid pulse

-blowing diastolic murmur

44
Q

why does handgrip & squatting decrease the sound of the murmur in pt’s with aortic regurgitation?

A

increase in pressure of arteries -> increase in afterload

45
Q

with the patient leaning forward, the ___ is used to auscultate for a decrescendo murmur at the L 3rd ICS which can indicate _____

A

diaphragm

-aortic regurgitation

46
Q

Activity will cause the ___ murmur to be ____ as activity will increase the amount
of blood moving through heart in patients with mitral stenosis

A
  • diastolic

- increase

47
Q

if a pt has a known hx of mitral stenosis, the ____ position will make it best heard upon auscultation with the ___ of the stethescope

A

left lateral decubitus

-bell

48
Q

a mid diastolic decrescendo murmur has a _____ sound preceded by an ____ in mitral stenosis

A
  • low pitched rumbling

- opening snap

49
Q

during systole, a holosystolic/pansystolic murmur is heard with every beat. what type of heart sound is this and what can this indicate?

A

S3

-mitral regurgitation

50
Q

where is a holosystolic murmur best heard?

A

apex of the heart

-left 5th ICS

51
Q

on auscultation, there is a non-ejection (mid-systolic) click. what can this indicate and why does this happen?

A

mitral valve prolapse (MVP)

> Thought to be caused by mitral chordae snapping during systole

52
Q

what is the valsalva maneuver and what does it cause?

A

Forced expiration against a closed glottis

► Causes an increase in intrathoracic pressure

53
Q

what happens when there is an increase in intrathoracic pressure when performing the valsalva maneuver?

A

► Decreases venous return
► Decreased cardiac output (as there is decrease in pre-load)
► Increase in arterial pressure
► Effects heart rate (decreases immediately, then increases)

54
Q

where/what position is a pericardial friction rub heard best & what does it sound like?

A

Rough, scratchy, crunching sound heard best during inspiration -> pt sitting up/leaning fwd
-along left sternal border

55
Q

what can clicks auscultated on exam indicate other than MVP?

A

prosthetic valves

56
Q

if a click is classified as functional, what does this mean & in what patients does this happen in?

A

individuals with no anatomic

cardiac defect but with a physiologic abnormality such as anemia

57
Q

if a click is classified as organic, what does this mean?

A

occurring in individuals with a cardiac defect with or without a physiologic abnormality

Physical Diagnosis & Assessment (7 decks)

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