cardiac

Question 1

where is the aortic valve

Answer 1

2nd right ICS, RSB

Question 2

where is the pulmonic valve

Answer 2

2nd left ICS, LSB

Question 3

where is erbs point

Answer 3

3rd left ICS, LSB
can only be heard in left lateral recumbent position

Question 4

where is the tricuspid valve

Answer 4

4th left ICS, LSB

Question 5

s2 indicates

Answer 5

closing of aortic and pulmonic valves
beginning of diastole

Question 6

s1 indicates

Answer 6

closing of tricuspid and mitral valves
s1>s2 at apex, s2 >s1 at base
beginning of systole

Question 6

s2 indicates

Answer 6

closing of aortic and pulmonic valves
expiration - s2 is single
inspiration - s2 is made of 2 component sounds (A2 louder than P2)

split s2 in expiration - may be pathologic

Question 7

s3 indicates

Answer 7

ventricular gallop
“kentucky”
normal in young, healthy adults & pregnant women
abnormal in >40 yo - means LV failure/systolic dysfunction
heard best at apex in L lateral postion

Question 8

s4 indicates

Answer 8

atrial gallop
due to resistance to ventricular filling or diastolic dysfunction
(stiffness)
not heard in rhythm with AV dysfunction
heard best at apex w patient in L lateral position
use the bell

Question 9

systolic murmur

Answer 9

between s1 - s2

Question 10

diastolic murmur

Answer 10

between s2 - s1

Question 11

technique for hearing murmurs

Answer 11

have pt sit up, lean forward, and exhale

Question 12

where is the base and apex and PMI

Answer 12

base - top
apex - bottom
PMI (point of maximal impulse) - at apex

Question 13

PMI

Answer 13

point of maximal impulse
at apex
5th ICS, LML
helpful when delinating the L lateral border
helpful in evaluating HTN and CHF

Question 14

when are benign murmurs common?

Answer 14

pregnancy, anemia, fever

typically dissappear during adulthood

Question 15

murmur characteristics

Answer 15

timing
duration
pitch
intensity
pattern
quality
location
radiation
respiratory phase variants

Question 16

murmur intensity

Answer 16

grade I - barely audible in quiet room
grade ii - quiet but clearly audible
grade III - moderately loud
grade IV - loud, associated with thrill
grade V - very loud, thrill easily palpable
grade VI - very loud, audible with stethoscope off chest, thrill palpable and visible

Question 17

aortic stenosis

Answer 17

diamond shaped
systoic
radiation to neck
medium pitch
harsh
can have narrow pulse pressure

Question 18

mitral regurgitation

Answer 18

holosystolic
harsh
medium-high
radiates to left axilla or base
best heart with diaphragm
displaced PMI

Question 19

mitral stenosis

Answer 19

rumbling and low pitch
heard best at apex in left lateral position

Question 20

aortic regurgitation

Answer 20

decrescendo
diastolic
loud and high pitch
heard best with diaphragm
lateral displaced PMI
wide pulse pressure

Question 21

geriatric considerations

Answer 21

• increased SBP
• more prominent superficial veins
• thicker endocardium
• sclerotic valves, aortic stenosis
• increased collagen formation, increased heart stiffness, decreased stroke volume, decreased cardiac output
• slower vascular response
• increased vagal tone causes decreased resting HR
• increased risk for aortic aneurysm
• s4 common due to increased ventricular rigidity (collagen)

Question 22

pregnancy considerations

Answer 22

• CV changes
• increased blood volume by 1600 to 2000ml, returns to normal 3-4 weeks postpartum
• HR increases week 7, 20% elevation
• CO increases at week 10 and peaks at 50% at 25-32 weeks
• PMI may be displaced
• aortocaval syndrome (hypotensive when supine)

Question 23

arterial insufficiency

Answer 23

often caused by intermittent claudication

caused by exercise, relieved by rest

tropic changes - thick skin & nails, dryness, decreased hair growth

“punched-out” appearance of ulcers

cool extremities

Question 24

important peds assessment consideration

Answer 24

auscultate in 2 locations
palpate liver span in cardiac assessment

Question 25

characteristics of benign murmurs

Answer 25

low grade
goes away with position change
systolic
fever, anemia, distress

Question 26

still’s murmur

Answer 26

very common in preschool/school age children

musical, vibratory murmur

early to mid systole

left lower sternal border

goes away w carotid pressure & position change

often accentuated by increased CO (fever)

Question 27

venous hum

Answer 27

common in preschool/school age

soft, hollow, continuous murmur “breath sounds/whoosh”

louder during diastole

best heard under clavicle

goes away with manuevers that affect venous return (lying supine, JV compression)

Question 28

pulmonary flow murmur

Answer 28

low-grade soft ejection murmur

left upper sternal borders

Question 29

peds cardiac red flags

Answer 29

diastolic murmur
extra heart sounds (s3/s4) but S3 can be normal
murmurs in children with syndromes
infants with cyanosis, poor growth, poor feeding, dyspnea at rest
unequal pulses
older children with dyspnea, chest pain w exercise, dizziness, SOB

Question 30

venous insufficiency

Answer 30

heavy, boggy pressure

relieved by walking or elevation

pain is best in am, increases w dependence of extremities

wounds are shallow, superficial, irregular in shape

Question 31

homan’s sign

Answer 31

sharply dorsiflex the foot. calf pain may indicate thrombophlebitis

Question 32

ankle-brachial index

Answer 32

ankle blood pressure/arm blood pressure

(use highest of both arms, ankles)

helps assess for peripheral arterial disease

Question 33

ankle-brachial index

Answer 33

ankle blood pressure/arm blood pressure

(use highest of both arms, ankles)

helps assess for peripheral arterial disease