Cardiology-Intro

Question 1

Cardiomegaly enlarges and widens with CHF, where is PMI?

Answer 1

PMI in 5th ICS, left ant axillary line

b/c 5th is nl space but cardiomegaly has moved it to ANTERIOR axillary line

Question 2

Chest Pain/Angina
“substernal crushing pressure” - sometimes may not have CP, may just have “sob”
OPQRST

Answer 2

Onset/Provoking
Quality
Radiation of pain
Severity and site
Timing/Duration 
Associated sx: SOB, DOE, N/v diaphoresis

Question 3

Syncope

Answer 3

decreased cerebral flow
may be arrhythmia, low BP or low CO
Test: BP, EKG, holter, tilt table

Question 4

Edema = ? side heart failure

Answer 4

right side
Bed bound-sacral edema
Upright-pedal edema

Question 5

Dry cough - pulm or cards?

Answer 5

if dry cough do not forget heart failure, may also be taking an ACE I

Question 6

Arrhythmia that is thyroid in nature

Answer 6

A Fib

Question 7

Orthostatic BP changes

Answer 7

Lying to standing. Drops >20 mm systolic

Question 8

Irregular peripheral pulses

Answer 8

a fib

Question 9

Normal peripheral pulses

Answer 9

2+

Question 10

Bruit

Answer 10

Audible murmur over a blood vessel

Question 11

Bifed/bisferiens pulse

Answer 11

Double beat in systole

hypertrophic cardiomyopathy, aortic regurg

Question 12

Dicrotic pulse

Answer 12

exaggerated early diastolic wave seen in HF, 2 “humps”

Question 13

Pulses alternans

Answer 13

alternating strong/weak pulse seen in HF

Question 14

Paradoxical pulse

Answer 14

> 10 mm Hg drop during inspiration seen in Obstructive lung disease and tamponade

Question 15

Abdominal aorta - nl

Answer 15

65 with htn, smoking, renal dz and CAD

Question 16

Jugular Venous Pulsations

Answer 16

right heart fxn

+hepato jugular reflex (press on liver and watch neck) = +right HF

Question 17

+JVP
a wave -
V wave-

Answer 17

A-tricuspid synosis

V-tricuspid regurg

Question 18

To hear mitral stenosis

Answer 18

use the bell, roll to left lateral position, low frequency sounds

Question 19

to hear aortic regurg

Answer 19

sit up and lean forward, press firmly with diaphram (high frequency sounds)

Question 20

ASD -sound

Answer 20

fixed split S2

Question 21

normal split S2

Answer 21

with inspiration

Question 22

Split during expiration of S2

Answer 22

Lbbb, LVH, AS

Question 23

S3 gallop

Answer 23

Early rapid filling LV, normal in young
LV overload, CHF
Best heard at apex, LL decubitus, bell, low pitch
“kentucky”

Question 24

S4

Answer 24

vigorous atrial contraction into stiff LV
LVH, MI
LL decubitus with bell
Tennessee
Never hear in a fib

Question 25

Mitral valve prolapse sounds

Answer 25

Midsystolic click, LLSB, diaphragm

Question 26

Opening snap

diastolic rumble

Answer 26

Mitral Valve stenosis

Question 27

diastolic murmur

Answer 27

always disease present

Question 28

Grades

Answer 28

1-barely audible
2, 3 getting louder
4-with thrill
5-heard with edge of stethoscope
6-stethoscope off chest

Question 29

Innocent murmur

Answer 29

cresecendo/decresendo
normal hearts
2/6 decreases sitting up

Question 30

holosystolic or pansystolic

Answer 30

AV valve regurg
MR OR TR
VSD

Question 31

PDA murmur

Answer 31

machinery quality continuous

Question 32

Contraindication to exercise stress test

Answer 32

aortic stenosis

Question 33

Gold standard to treat CAD

Answer 33

Cardiac cath