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PCM 1 Midterm > Cardiac cycle and sounds > Flashcards

Cardiac cycle and sounds Flashcards

1
Q

landmarks to look for upon inspection of CV system

A
  1. sternal notch
  2. sternal angle
  3. sternal border
  4. mid-clavicular line.
  5. anterior axillary line
  6. xiphoid process
  7. nipples
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2
Q

what to look at when inspecting

A
  1. general appearance
  2. shape of chest
  3. landmarks
  4. neck veins
  5. scars
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3
Q

what to look for during palpation

A

PMI (point of maximal impulse) is used to estimate the location of the apex/L border of the heart.

Palpated near the 4th/5thintercostal space in the mid-clavicular line; pt may have to lift breast. It may not be felt in a healthy pt and should be small, brisk and less than 2.5 cm.

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4
Q

PMI should be what

A

small, brisk and less than 2.5 cm

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5
Q

percuss of the CV system

A

done to estimate the cardiac size when PMI cannot be found.

Start at the far left where more resenonant –> medially to find cardiac dullness.

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6
Q

Auscultate

A

Identify the 2 heart sounds

Ask yourself two questions

  • Is the rhythm normal or abnormal?
  • Are there any abnormal sounds?
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7
Q

Murmur

A

sound made when flow of blood through a valve is turbulent or disrupted.

Valve is non-compliant, incompetent, stiff or damaged

. Doesn’t always mean a problem. Should be evaluated with ECG.

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8
Q

AV valves

A
  1. R side of heart–> tricuspid valve
  2. L side of heart–> bicuspid/mitral valve
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9
Q

Semilunar valves

A

R side of heart (pulmonic valve)

L side of heart (aortic valve)

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10
Q

Ventricular systole (ventricular contraction and ejection)- pressure force that opens the semilunar valves (aortic/pulmonic) and closes the AV valves.

A

Opens semilunar valves

closes the AV valves

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11
Q

atrial systole

A

—occurs late in ventricular diastole—

AV valves open while semilunar are closed

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12
Q

S1

A

AV valves close: blood hits the closed valve as it tries to get into the ventricle

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13
Q

S2 (dub)

A

Semilunar valves close

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14
Q

cardiac listening post

A
  1. Aortic valve: second intercostal space, R sternal border
  2. Pulmonic valve: second intercostal space, L sternal border
  3. Erbs point: third intercostal space, L sternal border *
  4. Tricuspid valve: fourth or fifth intercostal space, L sternal border
  5. Mitral area or apex: fifth intercostal space, L midclavicular line
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15
Q

use diaphragm for what

A

high pitched sounds (s1, S2. AR, MR, friction rubs_

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16
Q

Use bell for

A

low pitch sounds (S3, S4, MS and carotid bruits)

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17
Q

always listen on

A

BARE SKIN

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18
Q

S3 (Ken-tuckee)

A

dull, low pitch sound heart best with bell during rapid ventricular filling. Normal sound in children but can indicate heart path in adult.

AV valves are now open.

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19
Q

S4 (Tenness-ee)

A

)àDull, low pitch, best heard with bell. Atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle.

Can be normal in trained athletes. (Ten-Nes-See). Occurs before S1

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20
Q

assessment of CV sustem includes (5 finger rule)

A
  1. Hx
  2. Physical
  3. ECG
  4. Imaging via exhocardiogram
  5. lab
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21
Q

what to ask in hx

A

fatigue, chest pain, palpations, syncope,

family hx

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22
Q

familial clustering is common in

A

hypertrophic cardiomyopathy

marfans

CAD

prolonged QT sundome

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23
Q

physical on CV exam

A
  • Inspection,
  • palpation,
  • percussion,
  • auscultate
  • heart sounds,
  • grade murmurs,
  • JVP
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24
Q

how to conduct PMI?

A

PMI should be felt for thrill.

  1. pt lays supine at 45 degrees of lateral decubitis position
    - if upright, will be felt at the 5th ICS, medial to MCL
25
Q

Jugular vein tells us the activity of the _____ side of te heart

A

RIGHt

26
Q

Measuring our JVP can give us an indication of

A

· CVP (central venous pressure) and RAP (right atrial pressure)

27
Q

· Internal jugular (IJ) is a better estimate than _____________

A

external jugular (EJ)

28
Q

how to measure JVP

A

o Pt is supine to allow veins to engorge

o Pt is raised 30-45 degrees

29
Q

Normal JVP is

A

0-9

30
Q

Most common cause of elevated JVP is d/t

A

elevated RV diastolic pressure

31
Q

· Causes of increased JVD include

A

o 1. SVC obstruction

o 2. Severe heart failure

o 3. Constrictive pericarditis, cardiac tamponade

o 4. RV infarction

o 5. Restrictive cardiomyopathy

32
Q

a wave

A

o atrium is contracting and the triscupid valve is opening. Occurs during diastole.

33
Q

x descent

A

àatrium is relaxing and filling: triscuspid valve is closed.

Occurs during ventricular systole

34
Q

V wave

A

o atrium is tense, full; tricuspid valve is closed. Marks the beginning of diastole

35
Q

y descent

A

atrium is emptying and the tricuspid valve is open.

36
Q

S1 is heard when

A

beginning of systole and is loudest at the apexof the heart.

o MV closure–> 1stcomponent

o TV closure–> 2ndcomponent

37
Q

S2 occurs at the

A

end of systole (beginning of diastole) and is loudest at the base of the heart.

o AV closure–> 1stcomponent

o PV closure–> 2ndcomponent

38
Q

gradiing murmurs

A

· Graded on a scale from 1-6

o Grade 1àvery faint

o Grade 2àquiet, but heard easily with a stethoscope

o Grade 3àmoderately loud, no thrill

o Grade 4àloud, with a palpable thrill

o Grade 5àvery loud with stethoscope partially off of the chest

o Grade 6àheard with stethoscope entirely off of the chest

39
Q

· Systolic murmurs occur in between_______

· Diastolic murmurs fall in between ______

A

· Systolic murmurs occur in between S1 and S2

· Diastolic murmurs fall in between S2 and S1

40
Q

problem focused visit with CC

need a h&p and HPI?

A

needs hpi but not n&p

41
Q

wellness visit

A

need a H&P AND HPI

need immunizations, health care maintenance, and prevention

42
Q

sick vs not sick, vs really is absed on

A

general appearance and vital signs

43
Q

cystitis is a bladder localized UTI

pyelonephritis is what

A

kidney localized UTI— tested by Lloyds punch- costovertebral angle tenderness- flank pain

44
Q

gi origin

A

appendicitis

colitis

divertisculitis

45
Q

. Female reproductive processes

A

Menarche

dysmenorrhea

ovarian cyst

ovarian cyst rupture

46
Q

Assessment should be listed from most likely–> least

A
47
Q

Identify _________ on Review of Symptoms (ROS) as a sign of possible urinary tract cancer (kidney, ureter, bladder, urethra, prostate)

A

hematuria (blood in urine)

-can be seen with naked eye

if not, perform a UA (dipstick) an a urine microscope

48
Q

Transitional cells line from

A

renal pelvis –> proximal 2/3 of the urethra, so almost any area can be pre-disposed to cancer by smoking, toxin exposure, etc

49
Q

Impression (assessment is based on

A

H& p

50
Q

what lab work is cost effective for

A

UA, dipstick, reagent stick

51
Q

other tests performed when heamturia

A

TSH

Lipid panal

CBC

CMP

52
Q

when to run a urine culture

A

not indicated if drip and micro are NEGATIVE

53
Q

CT

A

more expensive and contrast can cause renal toxicity

54
Q

After US demonstrates mass in UT, _____ is important to determine extent of primary tumor and possible metastasis- also helps more clearly define anatomy for likely surgery which is the treatment choice for renal cell carcinoma and can be curative

A

CT

55
Q

PET scan

A

assess mets- most expensize

56
Q

bone scane

A

determine bony metasisis, the most common site in RCC

57
Q

MRI

A

xpensive and NOT beneficial

58
Q
  1. Determine significant Family History that may predispose to hematuria or other urinary tract disorders and develop a unified approach to patient problems and differential diagnosis.
A

Smoking, infection, glomerulonephritis, kidney stones (renal lithiasis), autoimmune diseases, respiratory complaints, upper or lower respiratory sx along with hematuria,

PCM 1 Midterm (11 decks)

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