CARDIO

Question 1

PMI

Answer 1

-5th ICS
-9-7 cm lateral to midsternal line
-1-2.5 cm diameter

Question 2

S3 and S4

Answer 2

-S3- abrupt deceleration of blood across mitral valve
-S3 is normal in children and young adults
-in adults S3 is pathological gallop
-ventricular gallop

-S4- increase LV end diastolic stiffness -> decrease compliance
-S4 preceeds S1
-atrial gallop

-apex

Question 3

split S2

Answer 3

-separate closure of aortic and pulmonic valves
-d-dub
-during inspiration with longer RV filling time
-during expiration fuse together again
-RBBB
-bell

Question 4

location of valves

Answer 4

-aortic- right 2nd ICS
-pulmonic- left 2-3 ICS close to sternum
-tricuspid- LLSB

Question 5

pulse

Answer 5

-the pressure wave of the blood
-quicker than the blood itself
-pressure of LV delivery

Question 6

JVP

Answer 6

-right heart pressure and cardiac function
-atrial contraction reflection
-decrease with blood loss
-we have 5L more than 1L will decrease
-increase with HF, pulmonary HTN, tricuspid stenosis, AV dissociation, pericardial effusion and tamponade
-45 degree angle
-point where external jugular appears collapsed
-high - >3 above sternal angle
-high - > 7-8cm above RA

Question 7

chest pain

Answer 7

-MC sx of CAD
-acute coronary syndrome- exertional angina, upper back pain, neck or jaw pain, SOB, N/V, fatigue
-acute aortic dissection- anterior chest pain, tearing, radiating to back or neck

Question 8

paroxsymal nocturnal dyspnea

Answer 8

-sudden dyspnea and orthopnea that awakens from sleep
-1-2 hrs after going to bed
-pt sits up, window for air
-wheezing or coughing

Question 9

edema

Answer 9

-5L in interstitial space before pitting edema
-anascara- severe general edema extending to sacrum and abdomen
-press for 2s then assess
-monitor weight
-1+ - 2cm
-2+ - 4cm
-3+- 6cm
-4+ - 8cm

Question 10

syncope

Answer 10

-MC neurocardiogenic syncope
-20% of arrythmias

Question 11

palpation

Answer 11

-heaves- lift finger pads
-thrills- vibrations with ball of hand -> higher grade murmur
-RV- exhale and hold -> 3,4,5 ICS -> parasternal movement in pulmonary THN and pulmonic stenosis
-pulmonic area- pulmonary artery pulsations -> pulmonary HTN

Question 12

diaphragm vs bell

Answer 12

-diaphragm- higher pitched sounds of S1 and S2, aortic and mitral regurgitation, friction rubs
-bell- low pitched, S3 and S4, mitral stenosis

Question 13

systolic murmurs

Answer 13

-MIDSYSTOLIC
-aortic stenosis
-pulmonic stenosis
-HOCM
-atrial septal defect

-HOLOSYSTOLIC
-mitral regurgitation
-tricuspid regurgitation
-VSD

-LATE SYSTOLIC
-mitral prolapse

Question 14

diastolic murmur

Answer 14

-EARLY
-aortic regurgitation
-pulmonic regurgitation
-austin flint

-MID/LATE
-mitral stenosis
-tricuspid stenosis

-OTHER
-patent ductus arteriosus

Question 15

preload and afterload

Answer 15

-standing- decrease preload
-squatting- increase preload
-valsalva (bearing down / flex abdomen) - decrease preload
-isometric handgrip- increase afterload

-AS- increase with squatting (increase preload) and decrease with valsalva/standing (decrease preload)
-HOCM/MVP- decrease with squatting (increase preload) and increase with valsalva (decrease preload)
-hand griping only increase regurgitation

Question 16

murmur grades

Answer 16

-1- faint, not heard in all positions
-2- soft, heard in all positions
-3- loud, no thrill
-4- loud with thrill
-5- heard with stethoscope partially off chest, with thrill
-6- heard without stethoscope, thrill