Cardiac

Question 1

Most anterior structure of the heart

Answer 1

Right ventricle

Question 2

Cardiac apex

Answer 2

Left ventricle most inferior tip

Question 3

Base of the heart

Answer 3

Top of heart. Near right and left second intercostal spaces adjacent to sternum

Question 4

PMI (point if maximal impulse)

Answer 4

Found at cardiac apex. Midclavicular 5th intercostal space

Question 5

PMI >2.5 cm

Answer 5

Left ventricular hypertrophy

Question 6

Great vessels

Answer 6

Pulmonary artery-bifurcates into left and right branches
Aorta, superior and inferior vena cava

Question 7

Atrioventricular valves

Answer 7

Tricuspid and mitral

Question 8

Semilunar valves

Answer 8

Aortic and pulmonic valves

Question 9

S3

Answer 9

Abrupt deceleration of inflow across mitral valve

Question 10

S4

Answer 10

Increased left ventricular end diastolic stiffness. Immediately proceeds s1.

Question 11

Systole

Answer 11

Period of ventricular contraction

Question 12

Diastole

Answer 12

Ventricular relaxation

Question 13

Late diastole

Answer 13

Ventricular pressure rises slightly during atrial contraction

Question 14

Systole

Answer 14

Aortic valve and pulmonic valve open
Mitral and tricuspid close

Question 15

Diastole

Answer 15

Tricuspid and mitral open
Pulmonic and aortic valve close

Question 16

S1 heard the loudest

Answer 16

Cardiac apex or PMI

Question 17

S2 heard the loudest

Answer 17

A2. The base of the heart

Question 18

Cardiac output

Answer 18

The volume of blood ejected from each ventricle in 1 minute. Product of HR and stroke volume

Question 19

Preload

Answer 19

The load that stretches the cardiac muscle before contraction

Question 20

After load

Answer 20

The degree of vascular resistance and ventricular contraction.

Question 21

Factors affecting blood pressure

Answer 21

Left ventricle stroke volume
Swelling due to pressure of the aorta and large arteries
Peripheral vascular resistance
Volume of blood in the arterial system

Question 22

Jugular venous pressure (JVP)

Answer 22

Reflects right atrial pressure equaling central venous pressure and right ventricular end diastolic pressure. Direct channel to right atrium

Question 23

Conduction system red flags

Answer 23

Palpitations, sensation of abnormal, irregular, or extra heart beats.

Question 24

Pulmonary edema

Answer 24

LV is not moving blood adequately

Question 25

Orthopnea

Answer 25

Shortness of breath with lying flat

Question 26

Peripheral edema

Answer 26

RV not moving blood adequately

Question 27

End result of heart disease

Answer 27

Pump malfunction

Question 28

Acute aortic dissection symptoms

Answer 28

Anterior chest pain: tearing or ripping and radiating to the back or neck

Question 29

Sudden dyspnea causes

Answer 29

Pulmonary embolism, spontaneous pneumothorax, anxiety

Question 30

Orthopnea and PND (paroxysmal nocturnal dyspnea) are from?

Answer 30

LV HF, obstructive lung disease, and mitral stenosis

Question 31

Edema

Answer 31

Interstitial tissue can absorb 5L of fluid and cause a 10% weight gain before pitting edema occurs.

Question 32

Periodical puffiness and tight rings

Answer 32

Nephrotic syndrome

Question 33

Enlarged waistline

Answer 33

Ascites from liver failure

Question 34

Questions to assess “is the forward pump function normal?”

Answer 34

Is the BP normal Are the extremities well perfused Are the pulses brisk and easily palpable Is the JVP normal Is there edema in the lower extremities

Question 35

Is the heart normal in size?

Answer 35

Is the PMI over the right ventricle?

Question 36

Any evidence of valvular heart disease?

Answer 36

Any diastolic or systolic heart murmurs?

Question 37

JVP and pediatrics

Answer 37

Difficult to see under 12 yo. Inspection not useful

Question 38

JVP increases

Answer 38

Right or left HF, pulmonary HTN, tricuspid stenosis, AV dissociation, increased venous vascular tone, and pericardial compression or tamponade

Question 39

JVP assessment

Answer 39

HOB at 60 degrees so the top of the internal jugular vein is visible

Question 40

Measuring JVP

Answer 40

Start at 30 degrees, turn head slightly away from you. If low may need flat HOB. When seen put a horizontal card at JVP and line it up with a ruler on the sternum

Question 41

JVP elevated on expiration

Answer 41

Obstructive lung disease

Question 42

Elevated JVP

Answer 42

Acute/chronic HF, tricuspid stenosis, chronic pulmonary HTN, superior vena cava obstruction, cardiac tamponade, constructive pericarditis

Question 43

Auscultating carotid arteries

Answer 43

Listen for bruit (atherosclerosis)

Question 44

Bruit

Answer 44

Murmur line sound. Have pt hold breath

Question 45

Palpate carotid pulse

Answer 45

Best at 30 HOB. Decreased pulsations could mean decreased stroke volume or local atherosclerotic narrowing

Question 46

Thrills

Answer 46

Vibrations

Question 47

Pulsus alternans

Answer 47

Best in radial and femoral arteries. Rhythm of pulse is normal but the force goes from strong to weak. Indicates LV dysfunction

Question 48

Pulsus paradoxus or paradoxical pulse

Answer 48

Greater than normal drop in systolic BP during inspiration. Found in pericardial tamponade, acute asthma and obstructive pulmonary disease. Constrictive pericarditis and acute pulmonary embolism.

Question 49

Heaves

Answer 49

Hold finger pads flat. Enlarged right or left ventricle that rhythmically lifts fingers.

Question 50

Thrills

Answer 50

Press ball of hand firmly to chest

Question 51

Diaphragm

Answer 51

For high pitched sounds s1 and s2, murmurs, and pericardial friction rubs

Question 52

Diaphragm

Answer 52

For high pitched sounds s1 and s2, murmurs, and pericardial friction rubs

Question 53

Bell

Answer 53

Low pitched sounds, s3 and s4 and the murmur of mitral stenosis

Question 54

Systolic murmurs

Answer 54

Midsystolic (blood flow across semilunar valves), pansystolic (regurgitation across AV valves), late systolic murmur (mitral regurgitation. May have click).

Question 55

Diastolic murmurs

Answer 55

Early diastolic murmurs (regurgitation across semilunar valves), middiastolic and pre systolic or late diastolic (both reflect turbulent flow across AV valves).