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Physical Diagnosis > Cardiac Exam > Flashcards

Cardiac Exam Flashcards

1
Q

What Does Central Venous Pressure Measure

A

Jugular Venous pressure

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2
Q

How To Check for Central Venous PRessure

A
  1. Position the patient supine with the head of the table elevated 30 degrees.
  2. Use side lighting to observe for venous pulsations in the neck
  3. Sternal angle is used as a reference point
  4. RA is approximately 5-7 cm lateral and inferior to this point
  5. Estimate the height of the external jugular venous column in reference to the sternal angle
  6. Normal venous column should be no more than 2-3 cm above the sternal angle
  7. If the measurement is 4 cm or greater, central venous pressure is elevated
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3
Q

Type of pulse in Cardiogenic Shock

A

Small, thready, weak

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4
Q

Type of pulse in Aortic insufficiency

A

Bounding, because The condition causes widening (dilation) of the left lower chamber of the heart. Larger amounts of blood leave the heart with each squeeze or contraction. This leads to a strong and forceful pulse (bounding pulse

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5
Q

What Does Carotid Bruit indicate?

A

Carotid artery narrowing/stenosis. Increase risk of stroke

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6
Q

Where is the PMI normally located?

A

4th or 5th ICS, just medial to the midline. Les than the size of a quarter

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7
Q

• Describe a maneuver you would use to accentuate the murmur of aortic regurgitation (aortic insufficiency)

A

o Aortic insufficiency can be assessed by having the pt lean forward while sitting down, holding their breath in exhalation, and listening with the diaphragm

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8
Q

• Describe a maneuver you would use to accentuate the murmur of mitral stenosis

A

o Mitral valve stenosis can be accentuated by having the pt lay on their left side, and listen to the apex of the heart with the bell

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9
Q

• Identify the mitral valve variant that is associated with a mid systolic click

A

o Mitral Valve Prolapse

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10
Q

Grade I Murmur

A

Barely Audible

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11
Q

Grade II murmur

A

Soft, but easily heard

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12
Q

Grade III murmur

A

Loud without a thrill

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13
Q

Grade IV Murmur

A

Loud with a thrill

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14
Q

Grade V Murmur

A

Loud with minimal contact between stethoscope and chest

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15
Q

Grade VI Murmur

A

Loud with no contact between stethoscope and chest

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16
Q

Bronchivesicular Lung Sounds

A

intermediate in intensity and pitch between vesicular and bronchial. Usually heard over the 1st and 2nd interspaces and between the scapula posterior

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17
Q

Vesicular Lung Sounds

A

Soft and low pitched, heard over the majority of the lung fields

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18
Q

Bronchial Lung sounds

A

Loud and higher pitched, heard over the manubrium

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19
Q

Percussion Exam: Hyper-resonance

A

More air, emphysema, asthma, pneumothorax

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20
Q

Percussion Exam: Tympany

A

Large pneumothorax

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21
Q

Percussion Exam: Dullness

A

less air, lobar pneumonia, hemothorax, atelctasis, tumor

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22
Q

Percussion Exam: Flatness

A

Large pleural effusion

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23
Q

• Describe the findings one would note when performing tactile fremitus in a patient who had a pneumonia (lung consolidation) or tumor

A

o Pneumonia causes increased vibrations in the hands (consolidation)

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24
Q

• Describe the physical findings you would expect in a patient who presented in moderate to severe respiratory distress

A

o Tripod position, nasal flaring, pursed-lip breathing, use of accessory breathing, paradoxical breathing, use of respiratory equipment, orthopnea, cynosis

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25
Q

What produces heart murmurs?

A

Blood flow turbulence

26
Q

S1

A
  1. LUB
  2. Mitral and tricuspid valves close.
  3. Start of systole.
  4. Corresponds with carotid pulse.
27
Q

S2

A
  1. DUB
  2. Aortic and pulmonic valves close
  3. Start of diastole.
28
Q

What are normal Heart sounds?

A

S1, S2, Split S2

29
Q

What are Clicks? WHen do they occur, what do they sound like, and what causes clicks?

A
  1. Occur only during systole

2. Distinguished from S1 and S2 by their higher pitch and briefer duration

30
Q

S3

A
  1. Occurs during passive diastolic ventricular filling
  2. Indicates serious ventricular dysfunction in adults, usually Left ventricle
  3. May be normal in children\
31
Q

S4

A
  1. Caused by atrial contraction, near the end of diastole
  2. S4 is heard much more often than S3 and indicates a lesser degree of ventricular dysfunction, usually diastolic
  3. S4 is absent in atrial fibrillation but is almost always present in active myocardial ischemia or soon after MI
  4. S4 without S3 is usual in diastolic LV dysfunction
32
Q

Opening Snap

A
  1. Occurs in early distole in mitral stenosis or tricuspid stenosis
  2. Mitral opening snap is very high pitched, brief, and heard best with the diaphragm
33
Q

Regurgitate Systolic murmurs

A
  1. Represent retrograde or abnormal flow into chambers that are at lower resistance
  2. Mitral or tricuspid regurgitation, ventral septal defects
34
Q

Causes of Diastolic Murmurs

A
  1. mitral stenosis

2. Aortic regurgitation

35
Q

Crescendo murmur

A

Mitral stenosis

36
Q

Decrescendo murmur

A

Aortic regurgitation

37
Q

Crescendo-decrescendo murmur

A

Aortic stenosis

38
Q

Plateau murmur

A

Mitral regurgitation

39
Q

Innocent murmur Characteristics

A
  1. Located over 2-4 LT Intercostal space between LT sternal border and apex
  2. Little radiation, variable quality, soft to medium pitch, intensity soft
  3. Crescendo-decrescendo shape
  4. Most common type of murmur
40
Q

Wheezing

A

Wheezes are musical respiratory sounds that may be audible to the patient and to others

41
Q

Cough

A

Cough is typically a reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi; it may sometimes be cardiovascular in origin (heart failure)

42
Q

The Five A’s of tobacco cessation

A

Ask about smoking at each visit
Advise patients regularly to stop smoking using a clear, personalized message
Assess patient readiness to quit
Assist patients to set stop dates and provide educational materials for self-help
Arrange for follow-up visits to monitor and support patient progress. Be their cheerleader

43
Q

What SpO2 level is asst. with cyanosis?

A

85%

44
Q

Cheyne-Stokes Breathing

A

periods of deep breathing alternating with periods of apnea

45
Q

Hypernea (kussmal’s breathing)

A

increased depth and rate of breathing

46
Q

Barrel Chest definition

A

AP diameter = lateral diameter

47
Q

Pectus Excavatum (funnel Chest) definition

A

a depression of the sternum; associated with mitral valve disease

48
Q

Pectus Carniatum (pigeon Chest)

A

an anterior protrusion of the sternum

49
Q

What causes asymmetrical Chest expansion?

A

with pleural effusion, lobar pneumonia, pulmonary fibrosis, bronchial obstruction, pleuritic pain with splinting, pneumothorax

50
Q

What causes increased vibration in tactile fremitus test?

A

Pneumonia

51
Q

What causes decreased unilateral vibration in tactile fremitus test?

A

atelectasis, bronchial obstruction, pleural effusion, pneumonthorax

52
Q

What causes decreased bilateral vibration in tactile fremitus test?

A

chest wall thickening (muscle, fat), COPD, bilateral pleural effusion

53
Q

Describe diaphragmatic excursion

A
  1. Measuring of diaphragm movement from full inspiration to full expiration
  2. Patient takes deep breath in and holds
  3. Provider percusses level of diaphragm, when it goes from resonant to dull, make mental note.
  4. Patient exhales completely and holds
  5. Provider percusses level of diaphragm, when it goes from resonant to dull, make mental note.
  6. Normal diaphragmatic excursion is 4-5 cm
54
Q

Crackles

A
  1. Intermittent, non-musical, and brief

2. Discontinuous sound

55
Q

Fine Crackles

A
  1. Soft, high-pitched and very brief
  2. Heard with CHF
    3 .Discontinuous sound
56
Q

Coarse crackles

A
  1. louder, lower pitched, longer in duration

2. Discontinuous sound

57
Q

Wheezes

A
  1. Muscial, high-pitched
  2. Continuous
  3. Asthma
58
Q

Rhonchi

A
  1. Lower pitched, snoring
  2. Secretion in large airways, COPD, pneumonia
  3. Continuous sound
59
Q

Results of Bronchophony

A
  1. Normal/Negative: the sound transmitted through the chest wall are muffled and indistinct.
  2. Abnormal/Positive: the sound transmitted are louder and clearer.
    This can indicated an airless lung – lobar pneumonia
60
Q

results of Egophony

A
  1. Normal/Negative: you will normally hear a muffled long E sound.
  2. Abnormal/Positive: you will hear the “ee” as “ay” known as an E-to-A change.
    This can indicated an airless lung – lobar pneumonia
61
Q

Results of Whispered Pectoriloquy

A
  1. Normal/Negative: whispered voice is normally heard faintly and indistinctly, if at all
  2. Abnormal/Positive: the whispered voice is louder and clearer.
    This can indicated an airless lung – lobar pneumonia

Physical Diagnosis (9 decks)

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