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clin assess cv > Bates > Flashcards

Bates Flashcards

1
Q

What makes up the physiologic splitting of S2?

A 
A2 = aortic valve closure
P2 = pulmonic valve closure
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2
Q

Which sound do you hear first in splitting of S2?

A

A2

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3
Q

When are you more likely to hear a split S2?

A

During inspiration when the right heart filling time is increased

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4
Q

During the splitting of S2, which sound is louder?

A

A2

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5
Q

Where should you listen to hear splitting of S2?

A

2nd and 3rd left left interspace close to the sternum

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6
Q

What causes S3?

A

A pathologic change in ventricular compliance; An abrupt deceleration of inflow across the mitral valve (dilated heart from too much volume)

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7
Q

What causes S4?

A

Increased left ventricular and diastolic stiffness that decreases compliance

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8
Q

What causes the “opening snap” of mitral valve stenosis?

A

The mitral valve leaflet motion is restricted, so when it opens you can hear it

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9
Q

S4 marks ____ contraction and comes right before S1

A

Atrial

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10
Q

Where would you hear a mitral regurgitation murmur?

A

At the apex

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11
Q

Where does a mitral regurgitation murmur radiant toe?

A

The left axilla

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12
Q

Does a mitral regurgitation murmur become louder with inspiration?

A

No!

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13
Q

Where do you listen to hear a tricuspid regurgitation murmur?

A

Lower left sternal border

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14
Q

Where does a tricuspid regurgitation murmur radiate to?

A

Right of the sternum, to the xiphoid area, and to the midclavicular line, but NOT into the axilla

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15
Q

Does the intensity of tricuspid regurgitation increase with inspiration?

A

Yes

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16
Q

Where will you hear a ventricular septal defect?

A

3rd, 4th, and 5th left ICS

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17
Q

Where will you hear an innocent/physiologic murmur?

A

2nd to 4th ICS between the left sternal border and the apex

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18
Q

Will an innocent/physiologic murmur radiate?

A

A little

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19
Q

What will cause an innocent murmur to disappear or decrease?

A

Sitting

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20
Q

Where would you hear aortic stenosis

A

Right 2nd ICS

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21
Q

Where does aortic stenosis radiate to?

A

Often to BOTH carotids, down the left sternal border and to the apex

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22
Q

What will help you to hear an aortic stenosis murmur better?

A

Have the patient sit and lean forward!

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23
Q

Where will you hear a pathologic murmur of hypertrophic cardiomyopathy?

A

3rd and 4th ICS

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24
Q

Where does a hypertrophic cardiomyopathy murmur radiate?

A

Down the left sternal border to the apex, possibly to the base, but NOT to the neck

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25
Q

What causes the pathologic murmur of hypertrophic cardiomyopathy to decrease?

A

Squatting!!***

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26
Q

What causes the pathologic murmur of hypertrophic cardiomyopathy to increase?

A

Straining down from Valsalva and standing

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27
Q

Where will you hear a pulmonic stenosis murmur?

A

2nd and 3rd left interspaces

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28
Q

Where will a pulmonic stenosis murmur radiate?

A

Toward the left shoulder and neck (if loud)

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29
Q

So if you haven’t noticed pulmonic stenosis and aortic stenosis sound VERY similar, so how do you tell the difference?

A

The areas where you listen
Pulmonic = Left 2nd and 3rd ICS
Aortic = Right 2nd ICS

The radiation
Pulmonic = left shoulder and neck
Aortic = Carotids and down left sternal border

Splitting of S2
Pulmonic will have a decreased P2 sound if split
Aortic will have a decreased A2 sound if split

And you are going to hear an aortic stenosis murmur better when the patient is SITTING FORWARD!

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30
Q

Where are you going to hear an aortic regurgitation murmur?

A

2nd and 4th ICS

31
Q

Where is an aortic regurgitation murmur going to radiate?

A

To the apex and maybe right sternal border

32
Q

What is the pitch of an aortic regurgitation murmur?

A

High … USE THE DIAPHRAGM

33
Q

Blowing decrescendo; may be mistaken for breath sounds

A

Aortic regurgitation

34
Q

How should the patient be positioned if you are listening for an aortic regurgitation murmur? What do you listen with?

A

Sitting and leaning forward with a breath held after exhalation

Listen with the diaphragm!

35
Q

Where is the location of mitral stenosis usually limited to?

A

The apex

36
Q

How should the patient be positioned to listen to a mitral stenosis murmur? What should you listen with?

A

Lateral decubitus - heard better w/ exhalation

Listen with the BELL!

37
Q

If your patient reports having chest pain, what could be going on?

A

Angina
Myocardial infarction
Aortic dissection
Pulmonary embolus

38
Q

An “irregularly irregular” heart palpitation could be?

A

Afib

39
Q

If your patient says their heart beat “skips and flops” it could be?

A

Premature contractions

40
Q

If your patient says their heart beat is regular and then speeds up and then slows down again, it could be?

A

PSVT

41
Q

If your patients heart rate is regular and rapid, it could be?

A

Sinus tachycardia

42
Q

When does “sudden” dyspnea occur?

A

Pulmonary embolus
Spontaneous pneumothorax
Anxiety

43
Q

When does exertional dyspnea occur?

A

Heart failure and other cardiac and pulmonary problems

44
Q

What disorders might your patient have if they are complaining of orthopnea, or dyspnea that occurs when they are lying down and gets better when they sit up?

A

LVH

Mitral stenosis

45
Q

What is the type of dyspnea that will wake a patient up from sleeping 1-2 hours after going to bed, and what is it associated with?

A

Paroxysmal nocturnal dyspnea

LVH
Mitral stenosis

46
Q

What is dependent edema, edema in the lowest body parts, typically caused by?

A

Heart failure

47
Q

Ascites is usually caused by?

A

Liver failure

48
Q

Pain or cramping in the legs during exertion that is relieved by rest within 10 minutes is called? what is it associated with?

A

Intermittent claudication

Atherosclerotic peripheral artery disease

49
Q

What could cause abdominal, flank, or back pain?

A

An expanding hematoma from an abdominal aortic aneurysm

50
Q

Coldness, numbness, or pallor in the legs with loss of hair over the anterior tibial surfaces could be?

A

Decreased ARTERIAL perfusion

Could get dry or brown-black ulcers from gangrene

51
Q

What could be two causes of swelling in the calves, legs, or feet?

A

Pitting edema

Chronic venous insufficiency

52
Q

How do you tell the difference between pitting edema and chronic venous insufficiency?

A

Chronic venous insufficiency will have “brawny changes” and skin thickening, especially near the ankle

Ulceration is common with chronic venous insufficiency; will have a brownish pigmentation

53
Q

When the rhythm of the pulse remains regular, but the force of the arterial pulse alternates because of strong and weak ventricular contractions; alternately loud and soft Korotkoff sounds

A

Pulsus alterans

54
Q

What does pulsus alterans usually indicate?

A

Severe left sided heart failure

55
Q

An abnormally large drop in systolic pressure during inspiration. Should normally be 3-4mmHg, but when it is greater than a 10mmHg drop it is??

A

Paradoxical pulse

56
Q

Paradoxical pulse should make you consider??

A

Pericardial tamponade

Constrictive pericarditis

57
Q

Humming vibrations when you palpate the carotid artery

A

Thrills

58
Q

A murmur like sound arising from turbulent arterial blood flow

A

Bruits

59
Q

If your patient has a thrill on palpation or a bruit on auscultation, what does this mean?

A

They could likely have atherosclerotic narrowing of the carotid artery, but could also be from external carotid artery disease or aortic stenosis

60
Q

Where will you hear a venous hum?

A

Above the medial third of the clavicles especially on the right

61
Q

Where will a venous hum radiate to?

A

1st and 2nd ICS

62
Q

What will help you hear a venous hum?

A

Auscultating with the BELL

63
Q

Where is a pericardial friction rub best heard?

A

3rd ICS to the left of the sternum

64
Q

What may increase the intensity of a pericardial friction rub?

A

When the patient leans forward, exhales, and holds their breath

65
Q

What does a pericardial friction rub sound like? is it high or low pitched?

A

Scratchy, scraping sound that is high pitched

66
Q

Pericardial friction rub is associated with??

A

Pericarditis!

67
Q

Where will you hear patent ductus arteriosus best?

A

2nd left ICS

68
Q

Produced from a congenital abnormality in which an open channel persists between the aorta and pulmonary artery

A

Patent ductus arteriosus

69
Q

Benign sound produced by turbulence of blood in the jugular veins, common in children

A

Venous hum

70
Q

What is the starting point for assessing JVP?

A

Head of bed at 30 degrees

71
Q

What is an above normal JVP?

A

Greater than 3-4cm above the sternal angle OR 8-9cm above the right atrium

72
Q

An above normal JVP is 98% specific for??

A

Increased left ventricular end diastolic pressure and low left ventricular ejection fraction

73
Q

An above normal JVP increases a persons risk for?

A

Death from heart failure

74
Q

What else is an elevated JVP associated with?

A 
Acute and chronic right and left sided heart failure
Tricuspid stenosis
Chronic pulmonary HTN
Cardiac tamponade
Pericarditis

clin assess cv (3 decks)

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