Block 2

Question 1

pericardium

Answer 1

tough, double walled fibrous sac. small amount of fluid for lubrication.

Question 2

ventricles

Answer 2

lower chambers. large. thick walled. right ventricle is anterior surface of heart.

Question 3

atria

Answer 3

upper chamber. also called auricles. small, thin walled reservoirs.

Question 4

aortic valve

Answer 4

semilunar. 3 cusps. between LV and aorta. open during systole. closed in diastole.

Question 5

pulmonic valve

Answer 5

semilunar. 3 cusps. RV and pulmonary artery. open in systole. closed in diastole.

Question 6

Superior vena cava

Answer 6

O2 poor blood from head neck and upper extremities to RA

Question 7

inferior vena cava

Answer 7

O2 poor blood from abdomen pelvis and lower extremities to RA

Question 8

pulmonary artery

Answer 8

carries O2 poor blood from RV to lungs

Question 9

Aorta

Answer 9

carries O2 rich blood from LV to body.

Question 10

Apex of the Heart

Answer 10

blunt corner. Lower left ventricle. Behind 5th intercostal at mid clavicular line.

Question 11

Base of heart

Answer 11

left atrium. opposite apex.

Question 12

precordium

Answer 12

anterior surface of body covering the heart

Question 13

tricuspid valve

Answer 13

right AV valve. 3 cusps. separates RA from RV. open in diastole. closed in systole.

Question 14

mitral valve

Answer 14

Left AV. 2 cusps. separates LA from LV. Open in diastole. Closed in systole.

Question 15

blood flow in cardiac cycle

Answer 15

vena cava –> RA–> tricuspid –>RV–> pulmonic valve –> Pulm. artery–> lungs –> pulm. vein –> LA –> mitral –> LV –> aortic valve –> aorta–> systemic circulation

Question 16

What is happening during atrial contraction?

Answer 16

Diastole. ventricles relax and fill. AV valves are open. Atria contract. Semilunar valves are closed.

Question 17

What happens during ventricular contraction?

Answer 17

systole. blood ejected from LV through aortic valve. Blood from RV through pulmonic valve to lungs. AV valves shut. semilunar valves open.

Question 18

Inspection in the cardiovascular exam

Answer 18

1. signs of acute cardiac distress: cyanotic or diaphoretic skin, pallor, cool temp, difficulty breathing, levine’s sign, anxiety.
2. S/Sx of chronic heart conditions: clubbing, xanthelasma, surgical scars, habitus.
3. Apical pulse: (4th-5th ICS)

Question 19

Auscultation in the cardiovascular exam

Answer 19

quiet environment w/ adequate exposure.

Aortic valve - R 2nd ICS
Pulmonic valve - L 2nd ICS
Second pulmonic area - L 3rd ICS
Tricuspid - L 4th ICS
Mitral / Apical - L 5th ICS, midclavicular

Question 20

Palpation in the cardiovascular exam

Answer 20

(1) PMI - estimate of heart size. location, diameter, amplitude
(2) Lift, heave, or thrill?
(3) assessment of cardiac rate and rhythm
apical impulse

Question 21

Auscultation of S1 and S2

Answer 21

S1 - listen while patient holds breath following inspiration

S2 - listen while patient inhales, split s2?

Question 22

palpation on cardiac exam

Answer 22

not usually preformed

Question 23

S1

Answer 23

"lub"
closure of AV valves.
Best heard at apex of heart, left 5th ICS @ left sternal border.
beginning of systole. 
diaphragm.

Question 24

S2

Answer 24

"dub"
closure of semilunar valves.  
end of systole.
diaphragm.
Left and Right 3rd ICD? Or Left?

Question 25

Equipment for CV exam

Answer 25

stethoscope - auscultation.
measuring tape - estimate heart size from midsternal line to PMI
pen light - to find PMI

Question 26

Split heart sounds

Answer 26

when AV valves or semi-lunar valves don’t close at the same time

S1 split is rare
S2 split is common

Question 27

Physiologic Splitting

Answer 27

During deep inspiration. decreased intrathoracic pressure. increase in venous return. right side of heart fills more than left, delays closure of pulmonic valve so it is heard after aortic valve closure

Question 28

pathologic fixed splitting

Answer 28

not affected by respiration. pulmonic valve closure is delayed b/c more blood in RV than LV. result of septal defects or RV failure.

Question 29

pathologic paradoxic splitting

Answer 29

closure of aortic valve is delayed. left bundle branch block. heard during expiration. disappears during inspiration.

Question 30

Chest pain

Answer 30

assess for the following:

• onset and duration: sudden, gradual, length of episode, exertional, eating?
• character: aching, sharp, dull, stabbing, burning
• location: radiating?
• severity: 0-10?
• occurs with other symptoms…

Question 31

Fatigue in CV disorders

Answer 31

suggests angina, myocardial ischemia

fever + fatigue = endocarditis?

Question 32

Dyspnea in CV disorders

Answer 32

difficult and labored breathing, SOB

occurs in conjunction w/ chest pain, angina, myocardial ischemia.

Question 33

Diaphoresis in CV disorders

Answer 33

excessive sweating.

suggests acute cardiac disease

Question 34

syncope in CV disorders

Answer 34

may suggest cor pulmonale or arrhythmia

Question 35

Cyanosis in CV disorders

Answer 35

insufficient O2 in blood. suggests acute heart disease.

Question 36

Cough in CV disorders

Answer 36

dry cough + sharp stabbing = pericarditis or cor pulmonale

Question 37

Orthopnea in CV disorders

Answer 37

SOB when lying down. Suggests CHF

Question 38

Claudication in CV disorders

Answer 38

limping due to pain in butt or calf w/ walking. Due to muscle ischemia.

Question 39

Paroxysmal Nocturnal Dyspnea in CV disorders

Answer 39

SOB wakes you in the night, sudden sharp spasm. Suggests mitral insufficiency or regurg.

Question 40

xanthelasma

Answer 40

yellow fat deposits under skin. implies high cholesterol and chronic heart disease.

Question 41

Respiration

Answer 41

gas exchange.
external - between lungs and air
internal - alveoli and tissues

Question 42

Ventilation

Answer 42

movement of air into and out of lungs

requires: brainstem, patent airway, and muscles of ventilation.