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Physical Assessment 1 > Cardio > Flashcards

Cardio Flashcards

1
Q

clenched fist over sternum indicates ?

A

Angina pectoris

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2
Q

finger pointing to the tender spot on chest=?

A

MSK pain

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3
Q

Hand moving from neck to epigastrum =?

A

heartburn

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4
Q

what causes pain in myocardium

A

angina pectoris
MI
myocarditis

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5
Q

what causes pain in pericardium

A

pericarditis

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6
Q

what causes pain in the aorta

A

aortic dissection

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7
Q

what causes pain in chest wall

A

costochondritis

herpes zoster

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8
Q

+clubbing indication of?

A

chronic hypoxia
-R–>L shunting
or
disesease state

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9
Q

splinter hemorrhages?

A

bac endocarditis

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10
Q

painful red papules on ends of fingers

A

oslar nodes

*bac endoacrditis

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11
Q

painless red macules on palms

A

janeway lesions

*bac ednocarditis

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12
Q

De Musset’s sign
define
indicates?

A

rhythmic nodding of head (in rhyhtm with HB)

aortic regurgitation

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13
Q

Maylor flush indicative of?

A

flushing on face

mitral stenosis

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14
Q

corneal arcus?
define
indicative of?

A

hyperlipidemia

gray-white discoloration of cornea

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15
Q

PMI is palpated where

A

5th intercostal space at or just medial to left midclavicular line

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16
Q

parasternal heave indicates?

A

right ventricular enlargement

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17
Q

S1 =?

A

tricuspid and mitral valves closing

*start of systole

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18
Q

S2=?

A

aortic and pulmonic valves closing

*end of systole/beginning of diastole

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19
Q

where do hear aortic valve?

A

2nd ICS on the right sternal edge

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20
Q

where do hear pulmonic valve?

A

2nd ICS on the left sternal edge

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21
Q

Tricuspid vavle where to hear?

A

4th or 5th ICS on left sternal edge

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22
Q

where to hear mitral valve?

A

5th ICS on Midclavicular line

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23
Q

diaphgram best for___ sounds

Bell best for ____sounds

A

dia= high frequney sounds like s1 and s2

bell=low freq sounds like s3 and s4

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24
Q

when you are listening over aortic area–what heart sound are you hearing?

A

S2

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25
Q

when you are listening over pulmonic area–what heart sound are you hearing?

A

S2

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26
Q

when you are listening over tricuspid area–what heart sound are you hearing?

A

S1

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27
Q

when you are listening over mitral area–what heart sound are you hearing?

A

S1

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28
Q

use what part of scope to ausculate carotid arteries?

A

bell

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29
Q

define murmur

A

turbulent and abnormal blood flow across a valve

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30
Q

define gallops

A

more than 2 heart sounds in a row

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31
Q

what causes murmurs

A

stenosis–valve narrowing

regurgitation–backflow of blood across valve

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32
Q

systolic murmurs can be ____ in younger ppl

A

benign

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33
Q

MC murmurs are involving which valve(s)

A

mitral and aortic

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34
Q

explain aortic stenosis

A

harsh sounding
SYSTOLIC
Crescendo-Decrescendo

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35
Q

harsh sounding
SYSTOLIC
Crescendo-Decrescendo

A

aortic stenosis

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36
Q

which murmur radiates to carotid arteries?

A

aortic stenosis

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37
Q

where does aortic stenosis murmur radiate to?

A

carotid arteries

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38
Q

explain aortic regurg

A

slow blowing
early DIASTOLIC
Decrescendo

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39
Q

slow blowing
early DIASTOLIC
Decrescendo

A

aortic regurg

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40
Q

explain mitral regurg

A

blowing

pansystolic or holosystolic

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41
Q

which murmur radiate towards axilla?

A

mitral regurg

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42
Q

where does mitral regurg murmur radiate to?

A

axilla

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43
Q

explain mitral stenosis

A

low frequency
rumbling
mid-diastolic

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44
Q

low frequency
rumbling
mid-diastolic

A

mitral stenosis

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45
Q

continuous machine like murmur

A

PDA

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46
Q

S3 gallop

A

low pitch
early diastole

cause: blood entering ventricle

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47
Q

s4 gallop

A

heard in late diastole

caused by ventricular filling of a stiff ventricle

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48
Q

s3 is indicative of?

A

advanced HF
OR
normal in young PT

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49
Q

S4 is heard in presence of ?

A

HF

or

LVH

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50
Q

S2 split heard during insp

-means?

A

INSPIRATION
*NORMAL!!
its called physioloic split

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51
Q

what is the physiologic split?

A

splitting of S2 during inspiration

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52
Q

S2 split during expiration?
means?
caused?

A

paradoxical split

  • *prolonged left ventricular phase such as:
  • LBBB
  • hypertrophic cardiomyopathy
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53
Q

define fixed split

-heard in ?

A

split of s2 throughout entire resp cycle aka heard on insp and epiration

heard in:
-atrial septal defect

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54
Q

do you always palpate the PMI?

A

not always palpable–even in healthy

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55
Q

describe location of LV

A

behind RV, to the left,

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56
Q

cardiac apex?

A

the tappered inferior tip–of LV

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57
Q

what is PMI

A

point of maximal impulse—produced MAX impulse

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58
Q

what happens if PMI is located on right side of chest?

A

situs inversus or dextrocardia

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59
Q

what is the normal size for PMI

A

1-2.5 cm

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60
Q

PMI > 2.5 cm?

A

LVH from HTN or aortic stenosis

61
Q

what does it mean if PMI is lateral to midclavicular line OR >10 cm lateral to midsternal line

A

LVH and ventric dilation from MI or HF

62
Q

name the AV valves

A

tricuspid and mitral

63
Q

name the Semilunar valves

A

pulmonic and aortic *half moon shape

64
Q

which side has greater pressure

A

left

65
Q

which side has louder heart sounds and why

A

left heart sounds are louder bc pressure is greater on L vs R

66
Q

systole=?

A

ventricular contraction

67
Q

diastole=?

A

ventric relaxation

68
Q

what is early systolic ejection sound?

A

extra sound accompanying opening of Aortic valve

69
Q

opening snap

  • define
  • assoc with?
A

sound of mitral valve opening (normally silent)

MITRAL STENOSIS

70
Q

S3

benign or pathologic?

A

benign in:

<40 and peds

71
Q

what causes S3

A

rapid deceleration of blood against ventricular wall

*after MV opens–>rapid ventricular filling occurs

72
Q

S3 gallop

A

pathologic change in ventricular compliance

**seen in adults

73
Q

S4

  • precedes___?
  • can mean___?
A

precedes: immediately after S1

can be pathologic chance in ventricular compliance

74
Q

splitting of S2?

  • define
  • benign or pathologic?
A

Aortic valve closure is heard just before pulmonic valve closure—->A2 + P2
*can be physiologically normal OR pathologic

NORMAL: when its occuring during inspiration

75
Q

explain the process of the normal physiologic process of why S2 splits during inspiration

A

inspire–>incr R heart filling time–>incr ventric SV–>incr duringation of R ventricular ejection–>delaying closure of P2

76
Q

which component of a split S2 is usually louder—A2 or P2..WHY?

A

aortic sound

since left sounds usually louder

77
Q

Murmurs are distinguished by??

A

pitch

longer duration

78
Q

what causes murmur

what is MC diagnostic of?

A

turbulent blood flow

diagnostic of valve disease

79
Q

define stenosis

A

valve orifice narrow–obstructs blood flow

*difficulty in opening

80
Q

define regurgitatioin

A

valve fails to fully close–blood leaks backward/RETROgrade

81
Q

“PASS”

A

pulmonic & aortic stenosis=SYSTOLIC

82
Q

“PARD”

A

pulmonic & aortic regurg=DIASTOLIC

83
Q

list the systolic murmurs

A

aortic and pulmonic stenosis

tri and mitral regurg

84
Q

list the diastolic murmurs

A

aortic and pulmonic regurg

tricuspid and mitral stenosis

85
Q

At or near the lower left sternal border

A

tricuspid valve

86
Q

right 2nd ICS to the apex

A

Aortic valve

87
Q

Left 2nd and 3rd Interspaces close to sternum—also at higher or lower levels

A

pulmonic valve

88
Q

at and around the cardiac apex

A

mitral valve

89
Q

primary pacemaker??

-makes ___ contract

A

SA node

*makes atria contract

90
Q

lcoation of SA node

A

RA

91
Q

SA node discharges impulses at a rate….

A

60-90 BPM

92
Q

location of AV node

-makes ___ contract

A

lower RA

*makes ventriles contract

93
Q

preload?

A

load that stretches cardiac muscle before contraction

  • volume of blood in RV at end of diastole
  • **VOLUME
94
Q

load that stretches cardiac muscle before contraction

-volume of blood in RV at end of diastole

A

Preload

95
Q

myocardial contractility?

A

ability of cardiac muscle to shorten when given a load–ventricles contract during systole

96
Q

ability of cardiac muscle to shorten when given a load–ventricles contract during systole

A

myocardial contractility

97
Q

afterload?

A

degree of vascular resistance to ventricular contraction

**PRESSURE

98
Q

degree of vascular resistance to ventricular contraction

A

afterload

99
Q

cardiac out=?

A

SV X HR

100
Q

BP=?

A

CO X systemic vasc resistance

101
Q

three things that affect stroke volume

A

contractility
preload
afterload

102
Q

SV will increase with:

A

increase contractility
increase preload
decrease afterload

103
Q

what drug class do we use to lower preload? aka volume overload?

A

venous vasodilators–NITRO

104
Q

what drug class do we use to decr afterload? aka presure overload?

A

arterial vasodilators–EX hydralazine

105
Q

chronic HTN will cause?

A

LVH

106
Q

pulse pressure?

A

difference between SBP and DBP

107
Q

4 factors affecting BP

A
  1. LV stroke vol
  2. Distensibility of aorta and lrg arteries
  3. Peripheral vasc resistance
  4. vol of blood in arterial system
108
Q

what is the MC symptom of coronary heart disease CHD?

A

Chest pain

109
Q

transient skips and “flip Flops”—–?

A

PVC

110
Q

PAC?

PVC?

A

PAC–early beat of atrial origin

PVC—early ventric beat

111
Q

sinus arrythmia–speeds up with____?

A

inspiration

112
Q

SVT rate is over?

A

> 150 to be SVT

*below is Sinus tach

113
Q

ETOH withdrawl can precipitate___?

A

afib

114
Q

sudden dyspnea– want to think of?

A

PE
Spont Pnx
anxiety

115
Q

orthopnea

A

dyspnea when supine

bettter with sitting up

116
Q

PND?

A

episodes of sudden dyspnea and orthopnea that awaken PT from sleep
-prompting PT to sit/stand up

117
Q

PND can indicate?

A

LVHF
mitral stenosis
lung dx

118
Q

define edema

A

excessive fluid in extravascular interstitial space

119
Q

causes for edema?

A 
R and/or L ventricular failure 
pulm HTN 
COPD 
nutritional dx---hypalbuminemia 
positional
120
Q

pitting edema occurs when?

A

occurs after 10% wt. gain

121
Q

Dependent edema means?

A

edema is in the lowest part of the body—-flows with gravity

122
Q

periorbital puffiness can indicate?

A

nephrotic syndrome

123
Q

enlarged waistline can indicate?

A

ascities

liver failure

124
Q

MC cause of syncope?

A

vasovagal

125
Q

other causes of syncope

A

neurologic

cardiac—only in 20% of PTs

126
Q

jugular veins reflect____?

A

right artrial pressure

127
Q

JVP lowers with?

A

blood loss
dehydration
decrease vasc tone

128
Q

what position would you place a septic or hypovolemic PT to see veins?

A

supine

129
Q

Increase JVP with?

A

right or left HF–acute an chronic
pulm HTN
incr vasc tone

130
Q

how to place the head of a PT with volume overload?

A

raised!!

do not lay them down**

131
Q

delayed upstroke of carotid can indicate?

A

aortic stenosis

132
Q

bounding upstroke of carotid can indicate?

A

aortic insufficiency

133
Q

describe a normal cartoid upstroke

A

brisk
smooth
rapid
and follows S1 immediately

134
Q

pulsus alternans
deinfe
indicates?

A

reg rhythm but force alternates b/w beats—- strong and weak
can indicate severe LV dysfunction

135
Q

Paradoxical pulse
define
indicates?

A

greater than normal drop in SBP during inspiration

MC cause is acute asthma, also occurs in pericardial tampondae

136
Q

thrills?

A

vibrations felt in carotid pulse

137
Q

bruits?

A

murmur like sound heard in carotids

138
Q

+carotid brutis indicates?

A

aortic stenosis

139
Q

if the carotid pulse is small thready or weak—indicates?

A

cardiogenic shock

140
Q

what does it mean is PMI is tapping?

A

normal

141
Q

what does it mean if PMI is sustained

A

LVH from HTN or aortic stenosis

142
Q

what does it mean if PMI is diffuse

A

dilated ventricle from CHF or cardiomyopathy

143
Q

assessing PMI’s? (4)

A

location
amplitude
duration
diameter

144
Q

when assessing a pt for apical impulse (PMI) which is least imp to assess?

A

rhythm

we assess: location, amplitude, duration and diameter

145
Q

diaphragm of the stethescope detects?

A

high pitch sounds

S1 S2 and S4 and msot murmurs

146
Q

bell of the stethescpe detects?

A

low pitch sounds

S3 and rumble of mitral stenosis

147
Q

Harsh 2/6 medium-pitched holosystolic murmur best heard at the apex describes

A

mitral regurgitation

148
Q

Soft, blowing 3/6 decrescendo diastolic murmur best heard at the lower left sternal border describes

A

aortic regurg

149
Q

crescendo-decrescendo systolic murmur

A

aortic stenosis

Physical Assessment 1 (7 decks)

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