cardiology

Question 1

Diastolic murmurs

Answer 1

aortic regurgitation
pulmonic regurgitation
mitral stenosis
tricuspid stenosis

Question 2

S1

Answer 2

closure of mitral & tricuspid valves

Question 3

S2

Answer 3

closure of aortic & pulmonic valves

Question 4

S3

Answer 4

volume overload, CHF,heard best w/bell in left lateral decubitus ; mitral stenosis

Question 5

S4

Answer 5

Pressure overload, HTN, LVH,Ischemia; heard best w/bells in left lateral decubitus
NEVER NORMAL

Question 6

ejection click

Answer 6

aortic stenosis

Question 7

opening snap

Answer 7

mitral stenosis

Question 8

mid systolic click

Answer 8

mitral valve prolapse

Question 9

split S2

Answer 9

Normal w/ inspiration

Question 10

Fixed split

Answer 10

atrial septal defect

Question 11

wide split

Answer 11

right bundle branch block

Question 12

paradoxical split

Answer 12

Left bundle branch block, splits w/expiration

Question 13

LOUD S1

Answer 13

short PR interval, tachycardia, mitral stenosis

Question 14

Quiet S1

Answer 14

AV blocks, mitrial regurgitation

Question 15

heart sound radiates to carotids

Answer 15

aortic stenosis

Question 16

heart sounds radiates to back/axillae

Answer 16

mitral regurgitation

Question 17

inspiration increases right side murmurs & gallops

Answer 17

mitral and aortic

Question 18

abrupt standing or valsalva increases heart sound: increases preload

Answer 18

hypertrophic cardiomyopathy

mitral valve prolapse

Question 19

squatting, leg raise increases most murmurs except

Answer 19

hypertrophic cardiomyopathy and mitral valve prolapse

Question 20

hand grip increases

Answer 20

mitral regurgitation

Question 21

systole - ventricular contractions

Answer 21

A/P valves open; stenosis

M/T valves close; regurgitation S1

Question 22

diastole - ventricular relaxation/atrial contraction

Answer 22

A/P valves close; insufficiency S2

M/T valves open; stenosis

Question 23

Aortic stenosis: Crescendo-Decrescendo systolic ejection murmur radiates to clavicle and carotid, heard best at RUSB

Answer 23

most common valve disorder; calcified valves, congenital bicuspid valves.
Sx: exertional angina, syncope, dyspnea
PE: CHF, narrow pulse pressure, pulsus parvous, S4,

Question 24

Aortic stenosis

Answer 24

ECG: LVH->LBBB->LAE->AFib
CXR: LVH->LAE-> failure
Echo: reduced area, increased gradiant, LVH

Question 25

Aortic stenosis treatment

Answer 25

asymptomatic: avoid exertion, serial echos symptomatic: surgery Avoid nitrates, ACE, vasodilators

Question 26

Aortic Insufficiency: early decrescendo, diastolic murmur heard best at Erb's point to LLSB w/ pt sitting, leaning forward, exhaling. absent S2

Answer 26

acute: failed valve, dissection chronic: atherosclerosis, endocarditis, marfans Sx: dyspnea, orthopnea, PND, syncope, angina PE: Wide Pulse pressure, displaced PMI, S3, dynamic pulses, apical heave

Question 27

``` Aortic Insufficiency Pulses: waterhammer corrigans quinkes deMusset Traubes Duroziez ```

Answer 27

Waterhammer: bounding forceful Corrigans: alternating weak & strong pulse Quinke's: alternating filling & blanching of capilliary finger nail bed deMusset: rhythmic nodding of head in sync w/ femoral artery Traubes; pistol shot systolic sound heard over femoral artery Duroziez: audible diastolic murmur heard over femoral artery when compressed with bell stethoscope

Question 28

Aortic Insufficiency:

Answer 28

ECG: LVH-> LAE CXR: LVH->LAE->Cardiomegaly echo: increased regurgitant fraction Stress test: hypotension w/ exercise

Question 29

Aortic Insufficiency treatment:

Answer 29

asymptomatic: serial echos, afterload reduction symptomatic: avoid exertion, treat CHF: ace, vasodilators surgery: NYHA class III/IV: replacement

Question 30

Mitral Stenosis: mid diastolic rumble heard best at apex with bell in left lateral decubitus position. LOUD S1

Answer 30

Rheumatic heart dz; increased with pregnancy, AF, tachycardia Sx: DOE, orthopnea, fatigue, palpitations, peripheral edema. PE: AFIB, parasternal lift, crackles

Question 31

Mitral Stenosis:

Answer 31

ECG: normal LV, LAE, RVH, RAE, Afib CXR: LAE, CHF echo: reduced valve area, increased gradiant, LAE

Question 32

Mitral Stenosis Treatment:

Answer 32

avoid exertion, pregnancy counseling, agressive mgmt of volume, manage AFIB and CHF Beta blockers, digitalis surgery NYHA III/IV: balloon->repair-> replace

Question 33

Mitral Regurgitation: holosystolic murmur at the apex or axilla with apical thrill

Answer 33

Acute: MI, Ischemia Chronic: MVP, LV, Dilatation: CHF, DCM Sx: dyspnea, PND, Orthopnea, palpitation, peripheral edema. PE: displaced hyperdynamic PMI; parasternal lift, thrill, S3

Question 34

Mitral Regurgitation

Answer 34

ECG: LAE, LVH, CXR: LAE, LVH, Failure Echo: regurgitant fraction, LAE Right heart CATH: elevated Pulmonary Capillary Wedge Pressure

Question 35

Mitral Regurgitation Treatment:

Answer 35

``` asymptomatic: serial echos Acute Sxs: vasodilators -> surgery Chronic Sxs: decreased preload (diuretics) -> decrease afterload (ACE) Surgery: for symptomatic MR NYHA: III/IV Repair-> Replace ```

Question 36

Mitral Valve Prolapse: thickened leaflets, myxomatous degeneration, F>M.

Answer 36

Sx: stabbing chest pain, anxiety, depression, palpitations, fatigue, Heartsounds: Mid systolic click

Question 37

Mitral Valve Prolapse treatment

Answer 37

benign neglect | only if symptomatic:

Question 38

Hypertrophic Cardiomyopathy: grade II/III systolic ejection murmur at left sternal border that increases w/ sudden standing/valsalva. Diminishes w/ squatting/ leg raise.

Answer 38

Sxs: exertional dyspnea, near syncope PE: double/triple carotid & apical impulses at the neck S4

Question 39

Hypertrophic Cardiomyopathy:

Answer 39

ECG: LVH in young individuals, Q waves in V5, V6, I, aVL CXR: LVH Echo: asymptomatic hypertrophy of the septum

Question 40

Hypertrophic Cardiomyopathy Treatment:

Answer 40

Exercise restriction and beta blockers refractory: surgical myectomy, ETOH ablation, dual chamber pacemaker AICD & Amiodarone for SCD symptoms

Question 41

Tricuspid Stenosis: narrrowing of tricuspid valve opening, restricts blood flow from right atrium to right ventricle

Answer 41

giant A waves Sxs: palpitations, fluttering discomfort sensation, cold skin and fatigue.

Question 42

Tricuspid Regurgitation: backward leakage of blood at tricuspid valve-right side heart.

Answer 42

Sxs: vague fatigue, weakness, | may have pulsing in neck veins, abdominal swelling, lower extremity edema in legs, ankles, feet.

Question 43

Tricuspid Regurgitation Treatment:

Answer 43

only if symptomatic; diuretics for edema. | Surgical valve repair or replacement.

Question 44

Pulmonic Stenosis: narrowing of the pulmonary opening and restricts blood flow from the right ventricle to the pulmonary artery. Due to congenital birth defect. can develop from rheumatic heart dz or carcinoid syndrome.

Answer 44

Sxs: low exercise tolerance, fatigue, fainting, abdominal distention, poor weight gain, shortness of breath, chest pain, palpitations, cyanosis-lips, fingernails.

Question 45

Pulmonic Stenosis Treatment:

Answer 45

If mild - no treatment | if moderate to severe- referral to cardiology, valve repair, replacement.

Question 46

Innocent, Physiologic, functional murmurs: sounds made by blood circulating in the heart.

Answer 46

Stills murmur: musical, resonant, vibratory sound at the right lower left sternal border or right upper sternmal border. Venous hum: flow of blood at internal jugular vein that causes the vein walls to vibrate.

Question 47

Patent Ductus Arteriosis: unclosed hole in aorta, ductus arteriosis fails to close.

Answer 47

Sxs: rough continuous machinery murmur Small hold- asymptomatic Large hold- tachypnea, difficulty feeding, growing. Treatment: catheterization closure w/