Cardiac (lecture and objects- doesn't include tables)

Question 1

What is the ROS for cardiovascular system?

Answer 1

Chest pain
DOE
orthopnea
PND (paroxysmal nocturnal dyspnoea)
palpitations
edema

Question 2

What population do you really want to screen for major risk factors of CVD?

Answer 2

African Americans

Females

Question 3

When should you begin screening for diabetes?

Answer 3

45 years old and every 3 years after

Question 4

What are risk factors for DM?

Answer 4

BMI >25
CVD, insulin resistance, HTN, sedentary, ethnicity, hx GDM, dyslipidemia, PCOS (polycystic ovary syndrome), elevated fasting glucose or Hgb A1c, 1st degree relatives

Question 5

According to ATP III LDL guidelines, for a high risk individual what should their LDL be?

Answer 5

<100

Question 6

According to ATP III LDL guidelines, for a moderate high risk or moderate individual what should their LDL be?

Answer 6

<130

Question 7

According to ATP III LDL guidelines, for a low risk individual what should their LDL be?

Answer 7

<160

Question 8

What are the 5 guidelines for metabolic syndrome?

Answer 8

WC: males > 102 cm; females > 88 cm
fasting Glucose: > 100mg/dl or on Rx
HDL: males < 40 mg/dl; females < 50 mg/dl; on Rx
TG: > 150 mg/dl or on Rx
BP: > 130/> 85 or on Rx

Question 9

What artery is to the left of the sternum?

Answer 9

Pulmonary artery

Question 10

Where does the R ventricle sit?

Answer 10

Inferior border of R ventricle is below the junction of the sternum and the xiphoid process

Question 11

Where is the PMI normally found

Answer 11

the 5th intercosatal space 7 cm to 9 cm lateral to the midsternal line (not always palpable)

Question 12

What does a PMI greater than 2.5 cm indicate?

Answer 12

Left ventricular hypertrophy (seen in hypertension and aortic stensosis)

Question 13

What does displacement of the PMI lateral to midclavicular line or greater than 10 cm lateral to midsternal line suggest?

Answer 13

LVH (left ventricular hypertrophy)

Question 14

Where does the aorta arch back to the left then downward?

Answer 14

Sternal angle

Question 15

What does S1 indicate?

Answer 15

Beginning of systole

Closure of mitral valves, ejection of blood from LV

Question 16

What does S2 indiciate

Answer 16

Beginning of diastole

It may split with respiration

Question 17

What type wave deflection are the Q and S waves?

Answer 17

Negative

Question 18

What type reflection is the R wave?

Answer 18

Positive

Question 19

In normal physiologic splitting, what accentuates the split? When does it disappear?

Answer 19

Accentuated on inspiration

Disappears on expiration

Question 20

What does pathological splitting involve?

Answer 20

Splitting during expiration and suggests heart disease

Question 21

What type splitting could mean these things “delayed closure of pulmonic valve (pulmonic stenosis or R bundle branch block) Can also be caused by early closure of the aortic valve, as in mitral regurg “

Answer 21

Wide splitting

Question 22

What type splitting doesn’t vary with respiration and occurs in ASD and R ventricular failure?

Answer 22

Fixed splitting

Question 23

What is the name of the type of pathologic splitting that appears on expiration and disappears on inspiration. The closure of the aortic valve is abnormally delayed so A2 follows P2 in expiration. Common cause is L bundle branch block.

Answer 23

paradoxical or reversed splitting

Question 24

What will a thrill feel like?

Answer 24

Buzzing or vibratory sensation when you press the ball of your hand to the chest

Question 25

What sound should the PMI correspond with?

Answer 25

Early systole (S1)

Question 26

Where is the PMI located?

Answer 26

4th-5th LICS MCL

Question 27

What is the amplitude of the PMI?

Answer 27

Gentle, brisk tap

Question 28

What type sounds can the Bell hear?

Answer 28

Low pitched
S3 and S4
Stenosis murmur

Question 29

What type sounds can the diaphragm hear?

Answer 29

High pitched sounds
S1 and S2
aortic and mitral regurg
murmurs
rubs

Question 30

These sounds are accentuated in what position : S3, S4, mitral valve murmurs?

Answer 30

Left lateral decubitus (LLD)

Question 31

What position accentuates aortic valve murmurs?

Answer 31

Sit and lean forward

Question 32

What can you hear upon stand and strain phase of valsalva?

Answer 32

decreased venous return, decreased arterial BP

Question 33

What can you hear on the release phase of Valsalva?

Answer 33

increase LV volume

increased arterial Bp

Question 34

What grade must a thrill have?

Answer 34

4-6

Question 35

What murmurs radiate downward (think MRTAPS)

Answer 35

Mitral and tricuspid regurg

Question 36

What murmurs radiate up (think MRTAPS)

Answer 36

Pulmonic (L side of neck)

Aortic (Carotids)