Cardiology

Question 1

Hepatomegaly could be a result of _________

Answer 1

Right ventricular dysfunction.

Question 2

ECG and CXR are most important screening tools for PC prior to referral.

Question 3

A thrill is a palpable murmur.

Question 4

Palpable thrill felt in suprasternal notch = aortic stenosis

Question 5

Your pediatric patient has a murmur. What other PE things can you check for?

Answer 5

Auscultation - APE to Man, listen posteriorly, listen with diaphragm AND bell, listen laying down, LLD, sitting up, leaning forward, squatting, after 30sec of jumping jacks
Inspection - chest wall symmetry, heaves.
Palpate - suprasternal notch, 4th or 5th intercostal space midclavicular line for l ventricular, feel for thrills, impulses. Radial pulse vs femoral pulse.
4 extremity BPs.

Question 6

Physiologic splitting of S2 is related to :

Answer 6

Respiration. During inhalation, chest pressure decreases, more blood enters RA and more blood pumped out of RV. You hear the split during inspiration, disappears during expiration

Question 7

T/F: 3rd heart sound is normal/common in kids and young adults, but S4 is always abnormal.

Answer 7

True.

Question 8

Grade IV murmur is distinguishable by the presence of a ___

Answer 8

THRILL

Question 9

Systolic ejection murmurs are (Pistol shot murmurs) - heard in the setting of stenotic/narrowed valves
Systolic Regurgitant (off on). - heard in the setting of regurgitant/leaky valves.

Question 10

Diastolic murmurs are ______ normal.

Answer 10

Never

Question 11

Diastolic murmurs are aortic/pulmonary insufficiency.

Question 12

70% of children have innocent “Normal Flow Murmur” AKA “stills murmur”
characteristics of innocent murmurs?

Answer 12

Grade 1-3 WITHOUT thrill
Systolic ejection in character
Lower left sternal border
2-5yrs
May persist
Accentuated with fever, anemia, exercise, anxiety. Normal ECG/CXR.

Question 13

Walk through their last event in detail and then ask “is that normally how all your episodes feel?” That way you know if you need to get history on previous episodes or not.

Question 14

Your patient has chest pain every month or two. Should you order a holter monitor test?

Answer 14

No. Zio patch maybe. If chest pain happens once every month or two, the chance you’ll catch it in 48hours is slim and it’s an inconvenience.

Question 15

S1 heart sound is the closure of ______ valves during ______

Answer 15

Mitral and tricuspid valves during systole

Question 16

S2 is the sound of ______ valves closing during ______. Sometimes has a ______ with inspiration because of ______

Answer 16

Aortic/pulmonic
Diastole
Physiologic split
decreased chest cavity pressure during inspiration.

Question 17

S3 can be normal or abnormal. What helps to distinguish?

Answer 17

Low frequency S3 in early diastole can be normal - represents rapid filling of ventricle and heard over LLSB
Abnormally loud “Kentucky” S3 gallop - could indicate heart failure, large VSD.

Question 18

S4 characteristics and reasons

Answer 18

Low frequency Tennessee
Decreased ventricular compliance
A-fib decreased atrial filling.