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Physical Exam Midterm & Final > Cardiac & Vascular > Flashcards

Cardiac & Vascular Flashcards

1
Q

What is the PMI? Where is it?

A

Point of maximum impulse; should be located at about the 7th intercostal space

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2
Q

What is happening during diastole?

A

Ventricular filling/relaxation
Tricuspid/Mitral valves open
Atrial contraction

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3
Q

What is happening during systole?

A

Ventricular contraction
Pulmonary/Aortic valves open
Atrial filling/relaxation

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4
Q

The volume of blood ejected in one heartbeat/contraction (70mL is average)

A

Stroke volume

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5
Q

Functional measurement of stroke volume

A

Ejection Fraction

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6
Q

The volume of blood ejected from each ventricle in a one minute interval

A

Cardiac Output

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7
Q

If the EF is below 60% the most likely cause is…

A

CHF

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8
Q

Factors that effect the stroke volume are…

A

PRELOAD
MYOCARDIAL CONTRACTILITY
AFTERLOAD

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9
Q

Volume or load that stretches the cardiac muscle prior to contraction

A

Preload

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10
Q

Increased preload may be associated with…

A

Increased venous return, reduced HR, ventricular/systolic failure, pathologic valves (aortic or pulmonic)

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11
Q

Decreased preload may be associate with…

A

Decreased venous return, impaired atrial function, diastolic failure, pathological valves (mitral or tricuspid)

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12
Q

Not all the blood gets pumped out, more blood sitting in the chamber, increased stretching of the chamber when filled

A

Ventricular/Systolic Failure

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13
Q

The ability of the heart muscle to contract in response to preload

A

Ionotropy

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14
Q

Increased ionotropy may…

A

Increase the contractility of the cardiac muscle

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15
Q

How are ionotropy and EF related?

A

Increased ionotropy = increased EF

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16
Q

The load that the heart must pump against

A

Afterload

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17
Q

What factors effect the afterload?

A

Resistance in the arteries/peripheral vascular system & Aortic/Pulmonic valve stenosis

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18
Q

Aortic “zone” of the heart

A

2nd intercostal space; right sternal border

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19
Q

Pulmonic “zone” of the heart

A

2nd intercostal space; left sternal border

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20
Q

Erb’s point “zone” of the heart

A

3rd intercostal space; left sternal border

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21
Q

Tricuspid “zone” of the heart

A

4-5th intercostal space; left sternal border

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22
Q

Mitral “zone” of the heart

A

5th intercostal space; left mid-clavicular line

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23
Q

S1 represents…

A

Closure of AV valves (particularly mitral) at the end of diastole/beginning of systole

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24
Q

S2 represents…

A

Closure of semilunar valves (particularly aortic) at the end of systole which occurs as ventricular pressure falls below that of aortic pressure

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25
Q

Where is S1 loudest?

A

At apex (over mitral area)

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26
Q

Intensity of S1 is due to…

A

The speed that the mitral valve closes

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27
Q

Loud S1 is indicitive of…

A

Mitral stenosis; Elevated atrial contraction forces the valve open; Early indicator of disease

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28
Q

Soft S1 is indicitive of…

A

CHF, severely calcified mitral valve

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29
Q

Variable S1 is indicitive of…

A

Heart block or atrial fibrillation

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30
Q

Where is S2 best heard?

A

Over the upper sternal border in the Aortic & Pulmonary locations

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31
Q

Closure of the valves that is not simultaneous is called…

A

Splitting

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32
Q

Splitting can be either…

A

Physiological (normal) or Pathological

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33
Q

When should physiological splitting be heard? What does it represent?

A

Should only be present during S2, due to change in pressure in the thoracic cavity during inspiration that causes the right side of the heart a fraction of a second longer to contract than the left side

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34
Q

Wide splitting may be caused by…

A

Delayed RV contraction
Premature LV contraction
Increased RV afterload
Decreased LV afterload

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35
Q

Fixed splitting may be caused by…

A

ASD, RV failure

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36
Q

Paradoxical Splitting may be caused by…

A

Delay in closure of the Aortic valve (LBBB, Aortic, valve disease, LV outflow obstruction)

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37
Q

S3 and S4 are also called…

A

Gallops

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38
Q

S3 typically occurs…

A

Early in diastole, low pitched

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39
Q

S3 is best heard at ______ in the _______ position

A

The apex in left lateral decubitus

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40
Q

S3 is a sign of…

A

Rapid ventricular filling

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41
Q

S3 may be normal in…

A

Children and young adults

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42
Q

S3 is typically associated with what condition?

A

Congestive heart failure

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43
Q

S4 occurs immediately before…

A

S1 in late diastole

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44
Q

S4 is often considered to be…

A

“pre-systolic”

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45
Q

S4 marks….

A

Atrial contraction into a stiff, non-compliant ventricle

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46
Q

S4 is associated with what condition?

A

LVH due to systemic HTN & aortic stenosis

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47
Q

What sounds may be present with a summation gallop?

A

S3 & S4

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48
Q

These sounds are high frequency, best heard with the diaphragm, usually indicate valvular stenosis, are difficult to distinguish from S3/S4 sounds, and are brief and crisp

A

Ejection Clicks and Opening Snaps

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49
Q

Sound that occurs early systole, is heard everywhere, and not affected by standing

A

Aortic ejection click

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50
Q

Sound that occurs mid systole, is heard best at apex, and will occur earlier with standing

A

Mitral valve prolapse

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51
Q

Sound that occurs in early diastole, is low pitched, and is due to opening of abnormal valves (AV- usually mitral stenosis)

A

Opening snap

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52
Q

Murmurs are the result of…

A

Turbulent blood flow through vessels

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53
Q

The most common type of murmurs are?

A

Systolic murmurs, Comprise ~95% of all murmurs

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54
Q

The most common cause of murmurs is?

A

Mitral valve prolapse

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55
Q

Midsystolic murmur is due to…

A

Aortic/Pulmonic Stenosis

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56
Q

Pansystolic murmur is due to…

A

Mitral/Tricuspid Regurgitation

57
Q

Late systolic murmur is due to…

A

Mitral Valve Prolapse

58
Q

Early Diastolic murmur is due to…

A

Aortic Regurgitation

59
Q

Mid-diastolic murmur is due to…

A

Mitral/Tricuspid Stenosis

60
Q

Late Diastolic murmur is due to…

A

Mitral/Tricuspid Stenosis

61
Q

Murmurs that start loud and get quieter are…

A

Decrescendo

62
Q

Murmurs that get louder then softer are…

A

Crescendo – Decrescendo

63
Q

Murmurs that start quiet and get louder are…

A

Crescendo

64
Q

Murmurs that remain constant throughout are…

A

Plateau or uniform

65
Q

Decrescendo murmurs typically occur in…

A

Diastole

66
Q

Crescendo-decrescendo murmurs typically occur in…

A

Systole

67
Q

Plateau murmurs typically occur as…

A

Holosystolic murmurs

68
Q

Crescendo murmurs may be seen with….

A

Mitral stenosis

69
Q

Decrescendo murmurs may be seen with….

A

Aortic regurgitation

70
Q

Crescendo-Decrescendo murmurs may be seen with….

A

Aortic stenosis, Pulmonic stenosis

71
Q

Plateau murmurs may be seen with….

A

Mitral regurgitation

72
Q

Murmu from Aortic Stenosis may radiate to…

A

The carotids

73
Q

Mitral regurgitation may radiate to…

A

The left axillae

74
Q

Murmurs are graded on a scale of…

A

1-6

75
Q

Most murmurs are grade _______

A

Grade 2

76
Q

Murmurs accompanied by thrills are graded as…

A

Grade 4-6

77
Q

Murmurs that can be heard without assistance are grade _____

A

Grade 6

78
Q

A murmur that is blowing may be a sign of…

A

Aortic/pulmonic regurgitation, mitral regurgitation

79
Q

A murmur that is harsh may be a sign of…

A

Aortic/pulmonic stenosis

80
Q

A murmur that is rumbling may be a sign of…

A

Mitral/tricuspid stenosis

81
Q

A murmur that is musical may be a sign of…

A

Occasionally aortic stenosis, Still’s murmur

82
Q

A murmur that is machine-like may be a sign of…

A

PDA

83
Q

The handgrip maneuver may be usefull to…

A

Differentiate between mitral regurgitation (increased intensity) and aortic stenosis (decreased intensity)

84
Q

Leaning forward enhances the murmur associated with…

A

Aortic regurgitation (lean forward and hold breath in full expiration)

85
Q

Mitral murmurs are best heard in what position?

A

Left lateral decubitus position

86
Q

Mid to late diastolic rumble associated with AR (can mimic MS)

A

Austin Flint Murmur

87
Q

PR murmur specifically associated with pulmonary htn; high pitched, blowing

A

Graham Steell murmur

88
Q

Mid diastolic murmur heard at the apex during rheumatic fever

A

Carey Coombs murmur

89
Q

What pulse has an upward slope that peaks at systole

A

A normal pulse

90
Q

In a pulse waveform, the ____________ marks closing of the AV valves and then falls away and diastole begins

A

Dicrotic notch

91
Q

What pulse has a much flatter volume and less pronounced dicrotic notch

A

An anacrotic pulse

92
Q

An anacrotic pulse is often associated with what conditions?

A

Aortic stenosis or narrowing over the aortic valve

93
Q

Aortic stenosis may also cause what type of pulse?

A

A pulsus parvus et tardus or weak and slow

94
Q

This pulse is a double-peaked pulse

A

Bisferiens pulse

95
Q

With what conditions might you see a Bisferiens pulse?

A

Occurs with severe aortic regurgitation or floppy aortic valve

96
Q

When do the two peaks of Bisferiens pulse occur?

A

During systole or contraction

97
Q

What are the two peaks of Bisferiens referred to?

A 
First = percussion wave
Second = tidal wave
98
Q

Pulse that occurs when the systemic arterial pressure falls less than 10 mmHg and is not detectable in the peripheral pulses

A

Pulsus Paradoxus

99
Q

Pulse where there is cariability of the pulse amplitude from beat-to-beat; thought to be related to changes in the action potential duration during contraction

A

Pulsus alternans

100
Q

What condition is Pulsus alternans seen with?

A

Severe left ventricular systolic failure

101
Q

What are the 6 P’s of peripheral pulse deficits?

A

Pain, Pallor, Pulselessness, Poikilothermia, Paresthesias, Paralysis

102
Q

With the capilly refill test (nail beds), how fast should the color return?

A

Within 2 seconds

103
Q

What is a “normal” ratio value for the ankle-brachial index?

A

Normal = 1.0 - 1.4

104
Q

Up to ___ % of strokes are caused by carotid artery disease

A

50%

105
Q

If you hear bruits while auscultating the carotid arteries (with the bell) then there is a ____ % chance there is an occlusion

A

60% chance

106
Q

What are early signs of chronic venous insufficiency?

A

Varicose veins
Tan/reddish skin changes
Weepy/excoriated skin
Pedal edema

107
Q

Venous insufficiency that occurs in the superficial veins; becomes red, inflamed, warm, and may be painful; treat with warm compress & NSAIDS

A

Phlebitis/Thromboplebitis

108
Q

Upon PE you find calf tenderness, lower leg swelling, palpable cord, and Homan’s sign. What is the pt presenting with?

A

DVT

109
Q

Splinter hemorrhages are seen with what condition?

A

Bacterial endocarditis

110
Q

Softening of the nail bed that is associated with hypoxic conditions and subacute bacterial endocarditis

A

Clubbing

111
Q

Yellow plaques around the eyelids associated with elevated lipid levels

A

Xanthelasma

112
Q

Lipid deposits in the anterior sclera; Very uncommon

A

Corneal arcus

113
Q

Angular Stomatitis and Conjunctival pallor are associated with what condition?

A

Anemia

114
Q

What are the 4 areas/zones/regions of the heart for auscultation?

A

Aortic, pulmonic, tricuspid, mitral

115
Q

Strong heart beat, can see the heart beating through the chest; similar to a lift

A

Heave

116
Q

S1 best heard at the…

A

Apex of the heart

117
Q

S2 best heard at the…

A

Base of the heart

118
Q

S2 splitting is best heard at the…

A

Base with inspiration

119
Q

S3 best heard at the…

A

Apex of the heart

120
Q

Sounds like “KEN-TUC-KY”

A

S3

121
Q

Sounds like “TEN-ES-SEE”

A

S4

122
Q

What does MS. ARD stand for

A

Mitral stenosis & Aortic regurgitation = Diastolic murmurs

123
Q

What does MR. PASS stand for

A

Mitral regurgitation, Physiologic, & Aortic stenosis = Systolic murmurs

124
Q

Mitral regurgitation may radiate to the…

A

Left axial area

125
Q

Aortic stenosis may radiate up to the…

A

Carotid area

126
Q

Veins in the scrotum become varicosed, leads to accumulation of blood in the testes, completely reversible with operation, may lead to infertility in ~50% of men

A

Varicoscele

127
Q

You palpate the skin of the leg and it is cold. This is a sign of….

A

Arterial disease

128
Q

Edema that does not pit cannot be…

A

Lymphedema

129
Q

The most common grade of pitting edema is…

A

2+ pitting

130
Q

Generalized edema is called…

A

Anecarca

131
Q

Parasitic infiltration of lymphatic system due to a tropical disease, causes severe lymphedema

A

Elephantiasis

132
Q

Redness/flushing

A

Rubor

133
Q

What is a normal JVD test result

A

5cm or less

134
Q

What is a normal pulse graded as?

A

Normal = 2+

135
Q

Erectile dysfunction is often the first warning sign of…

A

PVD & atherosclerotic disease

136
Q

Vascular disease described as painful, punched out, smaller, pulses are diminished, distal coldness, and nail changes

A

Chronic arterial ulcer

137
Q

Vascular disease that is punched out over malleoli and plantar feet, painless, and more common on plantar or side of foot

A

Diabetic foot ulcer

138
Q

Pt comes in with suspected DVT however, after exam you don’t think that’s the case. What do you need to rule out the DVT?

A

2 ultrasounds must be negative

139
Q

With AAAs when should you increase screening? at what point should intervention occur?

A

Increased screening once > 3cm

Intervene once > 5cm (5.5 ideal)

Physical Exam Midterm & Final (11 decks)

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