Cardiology: Cardiac Physical Exam

Question 1

where is JV located? what number is added to the height measured. define JVD, what 5 things does it suggest?

Answer 1

JVD>7 cm above the sternal angle (add 5 cm to the high measured), JV is located between the sternal and clavicular heads of the SCM: suggests right heart failure, pulmonary HTN, volume overload, tricuspid regurgitations, or pericardial disease

Question 2

define hepatojugular reflex: what 2 things does it suggest?

Answer 2

sustained pressure for 10 to 15 seconds over the upper abdomen while the patient is breathing quietly. In normal subjects, this maneuver transiently increases jugular pressure by only approximately 1 to 3. if sustained increased (while still pressing abdomen) then consider fluid overload, and impaired right ventricular compliance

Question 3

what is kussmaul’s sign? what 4 things does it suggest?

Answer 3

increased JVP with inspiration (normal inspiration should decrease JVP)
consider right ventricular infarction, postoperative cardiac tamponade, tricuspid regurg, constrictive pericarditis

Question 4

describe sound of aortic stenosis

Answer 4

harsh systolic ejection murmur that radiates to carotids

Question 5

a college male passed out while playing baskeball and had no prodromal symptoms or signs of seizure. his cardiac examination is unremarkable, and an ECG shows a slurred upstroke of the QRS. what are the nxt best steps?

Answer 5

this is wolf-parkinson white syndrome. advise against vigorous physical activity. treat arrhythmias with procainamide, and refer for an electrophysiology study

Question 6

what does mitral regurgitation sound like? draw it

Answer 6

holosystolic murrmur that radiates to axilla (anterior leaflet) or to rarely and weakly to carotids (posterior leaflet) see pic on pg 20

Question 7

what does mitral valve prolapse sound like? draw it

Answer 7

see pic on pg 20 midsystolic or lat systolic murmur with preceding click

Question 8

what does flow murmur sound like. draw it

Answer 8

soft sounding. vry common does not imply dz. see pic on pg 20

Question 9

what does aortic regurgitation sounds like? draw it

Answer 9

an early decrescendo murmur. see pic on pg 20

Question 10

what does mitral stenosis sound like? draw it

Answer 10

a mid- to late, low pitched murmur. see pic on pg 20

Question 11

draw PDA vs VSD

Answer 11

see pic on pg 20

Question 12

what does S3 gallop indicate? (2 things) name 2 types of pts in which it’s normal?

Answer 12

dilated cardiomyopathy (floppy ventricle) and mitral valve disease.
normal in younger pts and in hihg output state (pregnancy)

Question 13

what does S4 gallop indicate (3 things). normal in which two groups

Answer 13

hypertension, diastolic dysfunction (stiff ventricle), aortic stenosis. often normal in younger pts and in althetes

Question 14

define pulmonary edema

Answer 14

left heart failure (fluid backs up into the lungs)

Question 15

define peripheral edema (what 11 things could cause it)

Answer 15

Heart: right heart failure and biventricular failure, peripheral venous disease, constrictive pericarditis, tricuspid regurgitation, 
Liver: hepatic disease, hypoalbuminemia
 Tumor: lymphedema, 
Kidneys: nephrotic syndrome 
Drugs

Question 16

can 3 things can cause an increased peripheral pulse

Answer 16

compensated aortic regurgiation, coarctation (arms>legs), PDA

Question 17

what 2 things can cause decreased peripheral pulses?

Answer 17

peripheral arterial ds, late-stage herat failure

Question 18

what is pulus paradoxus? what 5 things cause it?

Answer 18

define=decrease systolic BP (>20mHg) with inspiration.
Heart: pericardial tamponade
Lungs: asthma and COPD, tension pneumonthorax, foreign body in airway

Question 19

define pulsus alternans. what 2 things can cause it? prognosis?

Answer 19

alternating weak and strong pulses. cardiac tamponade, impairer left ventricular systolic function. poor prognosis

Question 20

pulsus parvus et tardus, define it, what causes it?

Answer 20

weak and delayed pulse. aortic stenosis